The Medicare Hospice Benefit

By: Sherry Netherland, Director of Special Projects for Assisted Healthcare Services

Hospice care is more than the care of the terminally ill. At Assisted, Hospice care is not about dying, but in fact, it is about helping the patient live a quality life for as long as possible. Our main focus is quality care so patients can enjoy their loved ones and continue their normal lives. When the end of life journey arrives, we allow the patient to die peacefully and with dignity.

When Is the Right Time to Consider Hospice?

When considering end-of-life care, explore the hospice benefit and your comfort care options. Ask questions. Options are available at any time at the end-of-life when the patient’s life expectancy is six months or less if the disease follows its normal course. However, benefits are best appreciated if there are months rather than days to establish relationships and support. In fact, the number one comment heard from families after the death of their loved one is, “I wish we had hospice services earlier.”

Hospice might be the right choice when:

What Does Hospice Eligibility Mean?

  1. A physician certifies that the patient’s life expectancy is six months or less if the disease follows its normal course.
  2. The patient is no longer seeking active treatment for their terminal disease. No more invasive or curative measures are planned.
  3. The patient has arrangements in place for a “willing and able” caregiver to provide on-going care and assistance for when the patient is no longer able.
  4. Patients using Medicare must be eligible for Medicare Part A benefits.

What Services Are Included in the Hospice Benefit?

When patients elect the Medicare Hospice Benefit, the hospice agency assumes financial responsibility for all authorized services provided to manage the terminal illness. All services are provided under the direction of the Interdisciplinary Team. The patient and his/her family must be willing to cooperate with the team when planning and providing care.
The Interdisciplinary Team is comprised of the following hospice professionals:

  1. Primary Care Physician – You may keep your primary care physician who is an important part of the Hospice Team.
  2. Hospice Trained Physician – The physician may act as a consultant to your primary care physician or be your primary care physician. Home visits may be provided.
  3. Skilled Nursing – Intermittent visits to teach and support the patient and family in their caregiver role. The number of visits necessary depends upon the patient’s condition.
  4. Hospice Aide – Intermittent bath visits and teaching the primary caregivers about basic hygiene and safety.
  5. Social Worker Services – Intermittent visits to assist patients and families with social, emotional and planning needs. The number of visits necessary depends upon the patient/family need and Interdisciplinary Team.
  6. Spiritual Counseling – Spiritual Counselors provide support that is consistent with patient and family beliefs and desires. The number of spiritual care visits necessary is determined by need and by the Interdisciplinary Team.
  7. Volunteer Visits – Volunteers may provide support based upon patient/family request and as determined by the Interdisciplinary Team.
    Hospice includes a formulary of prescription and non-prescription medications for symptom control of the terminal diagnosis and pain relief.

Hospice also provides the medical equipment and supplies that are necessary for comfort care relating to the terminal diagnosis, such as a hospital bed, wheelchair, oxygen, commode, incontinence supplies, etc.

Grief and loss counseling in the form of bereavement support groups and a series of inspirational mailings are provided for up to one year following the loss.
Because the Medicare Benefit Part A covers the costs of all authorized covered medical and support services related to the terminal condition, the patient receiving Hospice Medicare benefits may no longer use their traditional Medicare for medical or support services for the terminal illness.
Medicare WILL continue to pay for covered benefits that are not related to the terminal illness.

Can I Use My Medicare Hospice Benefit Even if I No Longer Live in My Own Home?

The Medicare Hospice Benefit can be elected wherever a patient resides. It can be a private home, residential care home, assisted living community, or a skilled nursing facility. Patients are provided the same services regardless of the setting. The Hospice Interdisciplinary Team will support and educate caregivers in all settings to provide goal-directed and individualized hospice care.

Can You Be Discharged from Hospice Care or Revoke the Hospice Benefit?

The Medicare Hospice Benefit can be revoked by the patient at any time should the patient choose to seek curative care of the patient’s condition improves. If the patient improves and stabilizes such that medical need for hospice care is called into question, the patient may be discharged from hospice. Medicare does allow for resumption of hospice if the patient should show later decline and wish to re-elect hospice.

©2013 Sherry Netherland is the Director of Special Projects for Assisted Healthcare Services, a Medicare certified, CHAP accredited home health agency with 7 branches in California and Arizona. She founded the Assisted Speakers Bureau and she speaks on a variety of healthcare related issues. To learn more about private duty nursing, home health care and hospice and how Assisted can help, www.assisted1.com.

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