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Who Is a Good Fit for Hospice?
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Many factors should be discussed when considering hospice care.
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Many factors should be discussed when considering hospice care.
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News By Profession
Nursing & Nursing Services
Many factors should be discussed when considering hospice care
By Lindsey Nolen
Provided by a coordinated team of medical personnel, hospice is designed to offer comprehensive care in the final stages of life. Although this program has statistically shown to reduce Medicare costs by preventing hospitalizations and reducing late-in-life medical interventions, it is not necessarily the ideal resolution in all circumstances.
According to the American Hospice Foundation,1 there are four key elements to consider when determining the necessity of hospice care. These factors include comprehensive coverage with minimum out-of-pocket expenses, the best choice for care, reduced family burden, and eligibility.
In terms of all-inclusive coverage, as Medicare beneficiaries, patients are entitled to the Medicare Hospice Benefit program without additional premiums. Additionally, if patients are enrolled in a managed care organization (MCO), they have access to this benefit, even if their MCO does not specifically cover hospice services. These amenities typically include: skilled nursing services, volunteer services, physician visits, skilled therapy, home health aide visits, medical social services, spiritual counseling, nutrition counseling and bereavement support for the family.
Additionally, the Medicare Hospice Benefit provides 95% coverage of the cost of drugs for pain and other symptoms, and for inpatient respite care to relieve the caregiving responsibilities of the family. Further assisting those in need of this service, most hospices do not collect the 5% co-payment and provide continuous nursing and short-term inpatient services in a medical crisis.
As with most healthcare services, personal choice factors into the decision about which provider to use. A benefit of being a Medicare beneficiary, these patients are entitled to choose any Medicare-certified hospice throughout the country. Similarly, users of the MCO can select their choice of provider, not being restricted to the organization's network.
Furthermore, should a patient or family determine health services are required that are unrelated to the terminal illness, they can still acquire them through the MCO. This is under the condition that the user does not cancel his enrollment plan. Yet, if a patient or a patient's family would prefer to seek care from their own doctor rather than from a selected hospice physician, methods of accommodation will vary. Although it is possible to have a doctor be reimbursed through Medicare, it is important to ask in advance if that is a valid option.
Having to take care of a loved one during his last days can become an overwhelming task, especially when trying to simultaneously maintain a sense of normalcy throughout work and daily life. For this reason, hospice care can assist greatly through its ability to provide financial relief in combination with volunteers to help complete household chores, provide the patient company and generally respond to a family's need for support.
"Hospice referrals are too often made when someone is already on their 'death bed.' Although needed, this late referral to hospice is failure to provide the best care possible for the entire final course of disease," explained Monica Williams-Murphy, MD, Huntsville Hospital emergency physician and medical director for advanced care planning and end-of-life education. "Early and appropriate hospice referrals ensure that the patient and their loved ones can enjoy maximum quality of life for as long as possible. Then, when death approaches, hospice ensures peace for all parties."
Financially, Medicare Hospice Benefit can reduce family burden by alleviating the extra expenses that can be associated with caring for a terminally ill relative. In every Medicare-certified hospice setting, after admission there is virtually no paperwork, bills, claims, or financial surprises. In an effort to further support these family members, bereavement services are available to the family for about a year after the death.
Ultimately, to qualify for the Medicare Hospice Benefit patients must have Medicare Part A. This is a hospital insurance plan covering nursing care, hospital stays, some home health services, skilled nursing care after a hospital stay and hospice care. Additionally, a doctor and hospice medical director must confirm that a patient has a life expectancy of less than six months, and patients must agree in writing not to pursue treatments for curing their illness.
"Hospice is really ideal for anyone that has come to terms with the fact that they are in the last few weeks or months of their life, and want to spend that time as comfortable as possible with family members and loved ones," explained Laura Troyani, founder and chief editor of PlanBeyond, an online site that helps people get better educated about the legal, healthcare, and financial aspects of end-of-life planning. "If you're still holding out hope for a cure or to win back more time, hospice care isn't the place for you."
Another admission criterion may also be that patients have a primary caregiver, although this is not required by all hospice services. Due to eligibility factors varying slightly between providers, again it is important to request all admissibility-related information prior to the absolute need for such services.
Overall, while inherent emotional struggles are part of experiencing a close death, having access to hospice and Medicare Hospice Benefit can help ease the expense and burden experienced by a family. This comprehensive care helps guide and best prepare patients to die in comfort knowing both they and their families will be getting the support they need.
Lindsey Nolen is a former staff writer at ADVANCE.
1. American Hospice Foundation. The Medicare Hospice Benefit: A Good Fit with Managed Care. http://americanhospice.org/learning-about-hospice/the-medicare-hospice-benefit-a-good-fit-with-managed-care/