Basic Issues about Hospice Care
Hospice is an alternative to the traditional medical care near the end of a patient’s life, as the goal changes from attempting a find a cure to keeping the patient comfortable. Hospice care is palliative care that focuses on keeping a dying person as pain-free as possible immediately prior to death.
Medicare Part A and most insurance plans cover hospice care. Physicians, hospital discharge planners and nursing homes are good starting points to locate hospice care in your area, as well as online searches at the National Hospice and Palliative Care Organization and the Hospice Association of America. To qualify, a physician and the hospice organization’s medical director must certify that the patient has a terminal illness and will probably have six months or less to live, and the patient must sign a statement choosing hospice care instead of standard health insurance benefits for health problems that are related to the terminal illness.
Hospice is not just care provided at home; it may also be given in a hospital, nursing home, or separate hospice facility. Because hospice care is focused on easing pain rather than radical medical intervention, it usually does not require sophisticated or cumbersome medical devices, and services often extend to his/her family members and friends, involving and training them in giving care, and providing breaks and counseling services. The specific type of hospice care provided may depend on what agency provides it, but hospice services are generally provided by a team of caregivers and may include medical care, where a hospice doctor generally oversees and coordinates the care, sometimes working in tandem with a patient’s primary care physician; nursing care provided either around-the-clock, if needed, or sporadically for check-ups or special services, such as administering injections; help with daily needs, such as bathing, cooking, or cleaning; visits from a religious counselor, if requested; counseling services, both for the patient and for family members; social services support, such as help with insurance and financial matters; respite care to provide breaks and rest time for caregivers, especially family members; medical supplies and equipment — such as hospital beds, bedside commodes, wheelchairs, and oxygen; medications to help control pain and symptoms; physical, speech, dietary, and occupational therapists; and bereavement care following a death.
Medicare pays a fixed amount for most hospice services, including nursing services; medical equipment, such as wheelchairs or walkers; medical supplies, such as bandages and catheters; drugs for symptom control and pain relief; short-term hospital care, including respite care to give caregivers a break from their duties; home health aide and housekeeping services; physical, occupational, and speech therapy; social worker services; nutritional counseling; and grief counseling for both the patient and the family. Patients may be personally responsible for paying for the difference between what Medicare will pay and what the hospice service charges; treatments designed to cure a terminal illness; treatment or services not related to comfort care; and room and board, except for temporary respite care.
A word of caution: If hospice care will be received at home, the patient’s family should find out the amount of services that will be provided before agreeing to give up standard medical benefits, as nursing and other services provided in the home environment are sometimes extremely limited.