Hospice Care
The goal of hospice care is to help people who are dying to have peace, comfort, and dignity by giving them medical, psychological, and spiritual support. In some areas of the country, the focus of care extends beyond the terminally ill to include people who are chronically or seriously ill. Hospice care can take place at home, at a hospice center, in a hospital, or in a skilled nursing facility. If care is centered in the home, the patient can still be admitted to a hospital, extended-care facility, or an inpatient hospice center. Patients can return to their home and in-home care when they and their family are ready.
Hospices provide certain services. Pain and other symptom control is a significant part of hospice care while allowing the patient to remain as alert and comfortable as possible.
Hospice care extends its services to support both the patient and the patient's family. People differ in their spiritual needs and religious beliefs, so the focus varies but can include helping people look at death or say good-by. There are often programs to help people perform a desired religious ceremony or ritual.
Family meetings with hospice also give everyone a chance to share feelings, talk about what’s happening, and learn about death and the process of dying. Family members find that these meetings keep them informed about what to expect in the patient. Hospice personnel share information so that care is coordinated among inpatient and outpatient groups and the various caregivers within each group. There is often a respite care program as well, to give the patient and caregivers time away. Finally, there is bereavement care to allow those who were family and friends but are now suffering a loss to cope with their own feelings and issues.
Do you want hospice care for yourself? Not everyone does, especially without knowing about the programs. Medicare offers a one-time only hospice consultation. You can meet with a hospice medical director or hospice doctor to discuss your care options and treatment needs. You don’t have to choose hospice care if you use this consultation service. If insurance coverage is not available or does not cover all costs, the patient and family can hire hospice providers and pay for services out of pocket. Some hospices are able to provide services without charge if a patient has limited or no financial resources.
Hospice care is paid for by Medicare, Medicaid in most states, the Department of Veterans Affairs, most private insurance plans, HMOs, and other managed care organizations. Also, community contributions, memorial donations, and foundation gifts allow many hospices to give free services to patients who can’t afford payment. Some programs charge patients according to their ability to pay. To get payment from Medicare, an agency or facility must be approved by Medicare to provide hospice services. In this case, you pay nothing for hospice care, but you may have co-pays for prescription medicines. You also have to pay a percentage of the bill for inpatient respite care.
To qualify for the Medicare hospice benefit, a doctor and the hospice medical director (also a doctor) must see the patient and certify that the patient has less than 6 months to live if the disease runs its normal course. The hospice benefit begins with 2 time periods of 90 days each, and continues with an unlimited number of 60-day time periods. The doctor or nurse practitioner must re-certify the patient in a face-to-face visit before the third 60-day time period, then again before each benefit period after that.