Hospice Frequently Asked Questions

Hospice Care Frequently Asked Questions

What Is the Difference Between “Curative” and “Palliative” Measures?

Curative measures are those intended to cure a patient of a disease or illness; palliative measures are those that offer pain and/or symptom control. When a patient enters the hospice program, he or she acknowledges curative measures are no longer appropriate, and palliative care is provided for comfort.

What Are the Requirements to Receive Hospice Care?

In order to receive hospice care, the focus of care has often shifted from cure to care for those with a life-limiting illness. To participate in hospice:

• You understand that you have a life-limiting or terminal illness
• You desire a shift in health care from curative care to comfort care, which focuses on aggressive pain and symptom control
• Two physicians agree that, in their best clinical judgment, if your illness runs its normal course you are most likely in the final six months of your life
• Patients with both cancer and non-cancer illnesses are eligible to receive hospice care
• You are willing to have someone help make health care decisions for you if you are unable to make them for yourself

Does the Life Expectancy Have to Be Six Months?

 The six-month life expectancy criteria is an established federal guideline for hospice programs related to reimbursement standards. More importantly, it is a realistic measure of the ideal length of time the hospice team needs with a patient and family to provide optimum assistance.

However, predicting life expectancy is not an exact science. We do have patients who live well beyond the six-month prognosis, and when patients live longer, we continue to serve them. We are required to assess patients on a regular basis and discharge the patients who no longer meet the admission criteria.

When Should a Decision About Entering a Hospice Program Be Made, and Who Should Make It?

At any time during a life-limiting illness it’s appropriate to discuss the patient’s care options, including hospice. By law, the decision belongs to the patient.

 Can a Hospice Patient Who Shows Signs of Recovery Be Returned to Regular Medical Treatment?

Certainly. If the patient’s condition improves and the disease seems to be in remission, patients can be discharged from hospice and return to aggressive therapy or go on about their daily life. If the discharged patient should later need to return to hospice care, Medicare and most private insurance companies will allow additional coverage for this purpose.

When Is the Best Time to Start Hospice Care?

 If you asked most hospice patients or their families this question, the majority would answer that they wish they had known about hospice earlier. Often, help is needed sooner. Research has shown that hospice can increase both the quality of life and how long a patient lives. Families whose loved ones received hospice only within the last few weeks of life have been shown to have a harder time adjusting during the bereavement period than those whose loved ones received hospice care for weeks and months before passing on.

If you think that you or your loved one could benefit from hospice, ask your physician if hospice might be a service to consider or contact one of our admissions counselors.

Must Someone Be With the Patient at All Times?

It’s usually not medically necessary for someone to be with the patient all the time. However, one of the most common patient fears is the fear of dying alone. Therefore, we generally recommend someone being with the patient at all times. While family and friends deliver most of the care, hospice care providers may have volunteers to assist with errands and relief for the caregivers.

How Is Hospice Care Provided in the Home?

Typically, a family member serves as the primary caregiver, and when appropriate, helps make decisions for the patient. Members of the hospice staff make regular visits to assess the patient and provide additional care or other services. Hospice staff is available 24 hours a day, seven days a week, to assist the caregiver and patient.

The hospice team develops a comprehensive care plan that meets each patient’s individual needs for pain management and symptom control. The team usually consists of the following individuals:

• The patient’s personal physician
• Hospice physician (or medical director)
• Nurses
• Home health aides
• Social workers
• Clergy or other counselors
• Trained volunteers
• Speech, physical, and occupational therapists (if directed by the hospice team)

How Does Hospice Serve Patients and Families?

Hospice care is a family-centered approach that includes a team of doctors, nurses, social workers, counselors, chaplains, and trained volunteers. The team works collaboratively, focusing on the patient’s needs, whether physical, psychological, or spiritual. The goal is to help keep the patient’s pain and symptoms in control while allowing their loved ones to stay with them through their final moments.

Below is a list of services available to hospice recipients:

• Physician services for the medical management of the patient’s care
• Routine home visits by registered nurses and licensed practical nurses
• Home health aides and homemakers for services such as dressing and bathing
• Social work and counseling
• Medical equipment, such as hospital beds, wheelchairs, and oxygen
• Medical supplies, such as bandages and catheters
• Medication for symptom control and pain relief
• Volunteer support to assist patients and loved ones
• Physical therapy, speech therapy, occupational therapy, and dietary counseling
• Other services as directed by the hospice team

How Is Hospice Paid For?

Hospice care is covered by most insurance plans, including Medicare, Medicaid, and most private insurers. The hospice receives payment from your insurance carrier on a per diem basis, which means that all care is provided for a fixed daily price, though it may vary slightly by geographical location and from insurer to insurer.

If you do not have health insurance, you still will be eligible for hospice care, often at little or no cost to you and your family. The first thing hospice care providers will do is assist families in finding out whether the patient is eligible for any coverage they may not be aware of. Barring this, some hospice care providers will provide for anyone who cannot pay using money raised from the community or from memorial or foundation gifts. Contact one of our admissions counselors to discuss your specific situation and needs.

What Does Hospice Care Cover?

The hospice benefit covers nursing care, social services, durable medical equipment, medications used for pain and symptom control, and consulting physicians’ fees relative to the terminal illness and planned by the Hospice Interdisciplinary Team (IDT).

What Is the Difference Between Regular Medicare and Medicare Hospice Benefit?

With hospice Medicare, hospice assumes full responsibility for treatment related to the terminal illness and on the IDT plan of care. The patient is not billed for these goods and services, and there is no deductible or co-payment.

What Does the Hospice Admission Process Involve?

One of the first things the hospice program will do is contact the patient’s physician to make sure he or she agrees that hospice care is appropriate for the patient at this time. Our medical director can assist with this step if the patient does not have a primary physician.

The patient or their caregiver will be asked to sign consent and insurance forms similar to the forms patients sign when they enter a hospital. The form Medicare patients sign also explains how selecting the Medicare hospice benefit affects other Medicare coverage.

Is an Advanced Directive or Do Not Resuscitate Order Needed to Be Admitted to Hospice?

Neither is necessary for admission. We do, however, encourage our families to have advanced directives. They are also asked not to call 911, but to allow the care of the patient to be guided by the Hospice Interdisciplinary Team. Heroic efforts to save lives through artificial means are generally not a part of the hospice care program. For more information on advance care directives and planning, please get in touch with us.

What Is Bereavement Support?

Sacred Journey Hospice has a strong bereavement program with a full-time bereavement counselor who facilitates follow-ups with all the hospice families. Our practice is to maintain contact with hospice families for a period of 13 months following the death of a patient. Regular phone contact, spiritual counseling, and support groups are available for anyone who chooses to participate.