Hospice care: services, benefits, cost

Hospice is a specialized form of health care that aims to provide comfort and an optimal quality of life for those facing a life-limiting illness or incurable diagnosis. The person in hospice receives personalized care that takes into account not only their physical needs, but also their emotional, social, and spiritual needs .

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While advances in life-prolonging therapies and technologies have made impressive strides, there are times when a person is unable or unwilling to make the effort to control their condition. In cases like this, people will often seek funds to make the most of the remaining time. This can include, for example, solving emotional problems or managing pain. This is when hospice can be very helpful.

If you are faced with such a decision, it is important to know exactly what hospice is and what services it can provide for you and your family.

Hospice is not necessarily a place or institution where you go. It is a philosophy of care that addresses the needs of patients and their loved ones when life-prolonging treatments are no longer beneficial or desirable.

Services and benefits

Palliative care is generally provided wherever the patient lives. This could be your home or nursing home , retirement center , inpatient hospice , or even a hospital.

Regardless of location, assistance will be provided by trained hospice volunteers and an interdisciplinary team of healthcare professionals (including healthcare providers, nurses, social workers, hospice aides, and others).

Hospice services offered in the United States are largely defined by the Fiscal Equality and Fiscal Responsibility Act of 1982. Services provided by Medicare Hospice Benefit may include:

  • Physician Involvement: The patient's regular healthcare provider will generally oversee care in coordination with the hospice medical director.
  • Nursing services: A hospice patient is generally assigned a case nurse who visits him one to three days a week. The duty nurse is also available to hospice patients up to 24 hours a day when needed.
  • Laboratory tests: Blood tests , X-rays, and other necessary diagnostic tests are provided as part of hospice services at a frequency consistent with standard medical practice.
  • Medical Equipment: Hospice provides the equipment necessary to create a safe, comfortable and caring environment. It can be a hospital bed, wheelchair, adult diapers, bandages, or disposable latex gloves.
  • Medications – Hospice generally covers all medications related to the patient's diagnosis, as well as those intended to control pain and other symptoms.
  • Therapy: If needed, the hospice can provide a physical , therapist , or speech therapist to assist in the care of the patient.
  • Social services. Hospice patients are assigned a certified social worker to help them and their families with their practical and emotional needs.
  • Home Help – A hospice home care aide can help patients with personal care (such as bathing or dressing) or help caregivers with household chores and other responsibilities. Services are generally provided two to three times a week, depending on need.
  • Counseling Services: Hospice patients and their families can receive dietary counseling, pastoral or spiritual support, and quick consultations upon request. Hospices must also offer grief counseling to family members and caregivers for at least one year after the death of your loved one.
  • Foster Care: Foster care is a short-term temporary assistance program designed to help caregivers avoid stress and burnout .

The hospice team will continually assess the patient's condition and, if necessary, review their plan of care.

Hospice care also provides practical support to family and loved ones during these difficult times. The team can help with planning for the funeral or memorial services .

Common misconceptions

Many people view hospice as a service available only to end-stage cancer patients. However, according to the National Hospice and Palliative Care Organization (NHPCO), the majority of people admitted to hospice in 2017 had a non-cancer diagnosis, such as heart disease, lung disease, stroke or coma .

Another widespread misconception is that those who enter hospice have lost hope or "want to die." In fact, the role of the palliative care professional is not to hasten death or “ help someone to die '', but to help those with an incurable disease obtain the best possible quality of life, always without a reasonable probability of being cured. . Or they choose not to seek further treatment.

The overall mission of the hospice provider is to keep life alive. By viewing death as part of a natural process, patients can spend the rest of their days in utmost comfort and completeness.

Hospice and palliative care

The terms palliative care and palliative care are often used interchangeably, but they are not the same. While both are aimed at reducing pain and improving overall quality of life, palliative care can be provided at any time and for as long as deemed necessary for a person with a chronic or life-threatening condition.

For example, a patient with stage 4 breast cancer may receive palliative care to treat the side effects of the same treatments (such as chemotherapy or radiation therapy) that are used to prolong life. The same can apply to a person with secondary progressive multiple sclerosis , progressive Alzheimer's disease, or stage 4 emphysema .

In contrast, hospice care is a more limited form of care, as it is for those who are known to be nearing the end of their lives. At some point the patient may transition from palliative care to palliative care.

A healthcare provider can help you understand which care is best for you or your loved one, hospice or hospice care, and the decision will depend on the condition and needs of the patient.

The right to care and coverage of expenses.

According to NHPCO, the cost of hospice care for most Americans is paid for through your Medicare Hospice Benefit .

To be eligible for benefits, you or a loved one must:

  1. Eligibility for Medicare Part A
  2. Have a diagnosis of a terminal illness with a prognosis of six months or less by a licensed physician .

Medicare defines four levels of hospice care :

  • Current care
  • General hospital care
  • Permanent care
  • Stationary breath

Prior to admission, the treating physician and hospice provider will select an appropriate level for the patient's needs. As these needs change, the level of care can be adjusted.

A healthcare provider can recertify a patient for the Medicare hospice benefit if the patient's condition continues to deteriorate but they have lived for more than six months.

Health insurance

In addition to Medicare, many private health insurance plans offer hospice benefits, like government Medicaid programs. Because benefits can vary from one insurer or policy to another, it is important to understand what your plan does and does not cover.

This is especially true for Medicaid. While many believe that Medicaid works the same way as Medicare (since they are regulated by the same federal agency, the Centers for Medicare & Medicaid Services), what is offered may vary from state to state .

The Medicaid hospice benefit is a supplemental state plan for people with low income or disabilities. While all states offer some type of hospice benefits, some have a limit on what you can get, while others require a copayment for services .

To be eligible, you must apply for the election without further treatment for an incurable disease. The only exception is for people under the age of 21, who can choose between hospice treatment and ongoing treatment. If you decide to refuse treatment, you can always change your mind later and get your Medicaid covered benefits back.

Medicaid coverage can also be used in conjunction with your existing Medicare coverage if you meet both criteria. Having one doesn't mean giving up the other, although Medicare usually pays first .

To better understand what is offered in your state, call your area Medicaid office and speak with a representative.

Private insurance or without insurance

If you have private insurance or got coverage through work or the health insurance market , check your plan to see how long your benefits last (some limit hospice care to 45 days) and if your desired providers are in or out of the net. she. network .

If you are uninsured and not eligible for Medicare or Medicaid, there are hospices that offer a variable payment program based on your financial situation. There are also non-profit hospices that cover many of the costs through charitable donations or grants for eligible individuals.

Regardless of your insurance status, feel free to inform the hospice agency of your circumstances and ask what services are available to you.

Make an informed decision

Usually, a person is ready for hospice care when they decide to continue treatment designed to provide comfort rather than to treat a life-limiting illness. That said, there are pros and cons to participating in a hospice program.

On the one hand, it has a comprehensive and interdisciplinary team of professionals, whose cost can be fully covered by insurance. On the other hand, not all palliative care programs are the same.

Because hospices pay a flat daily rate to provide all necessary care from insurers, services (and quality of services) can vary significantly from institution to institution .

Therefore, it is important to explore all possible options with as many hospice providers as possible. You should work closely with your doctor or seek the advice of an experienced hospice patient attorney .

Feel free to interview hospice staff carefully, asking as many questions as necessary to make an informed decision. Among the questions you should ask:

  • Do you accept my insurance?
  • What hospice services do you provide? They are covered?
  • How will the hospice team coordinate my care with my doctor?
  • Do you offer services outside of office hours?
  • Will I have the same hospice nurse during my treatment?
  • How many patients are assigned to each hospice nurse?
  • What other team members can I see? How often?
  • How long does the palliative care team see patients?
  • How will you deal with my pain and other symptoms?
  • Can I go to the hospital if my symptoms are uncontrollable?
  • Will you have a hospital bed available for me if needed?
  • How will you inform me and my family about my condition?
  • Will my family and I participate in care decisions?
  • How do you prepare me and my family for what lies ahead?

To find hospice providers near you, talk to your doctor or contact your health insurance company for a list of in-network providers. You can also search the Internet using the NHPCO -operated Provider Finder.

Get the word of drug information

Moving to hospice is not always an easy transition and it can take time before a decision is made. And that's okay. By starting a conversation with your primary care provider or hospice agency, you can begin to think about what is best for you and your family at a time that is convenient for you. However, the sooner a person with a life-limiting illness goes to hospice care, the more benefits they can gain, including peace of mind.

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