When people hear the word hospice, they may become frightened and confused, that's because there are many myths and misconceptions about what hospice is and what it can do for persons who are nearing the end of their lives.
Since our population is aging and the need for hospice services is continuing to grow, it is important to clear up the mystery of hospice. This article is designed to introduce you to hospice and to show you how hospice may help you and your loved ones during life's final journey.
Hospice is a unique approach to caring for persons who are terminally ill. It involves a team of specially trained professionals who provide expert medical care, pain management, and emotional and spiritual support that is tailored to the individual patient's needs and wishes. Their focus is on caring not curing. In addition, recognizing the tremendous toll that illness takes on family members, the hospice team also provides compassionate comfort and support to the patient's loved ones, both during the illness and beyond.
Sevices are available 24 hours a day seven days a week.
Originally introduced in England in the 1960s, the hospice philosophy is based on the belief that death is a natural part of life. It does not prolong life, nor does it hasten death. Hospice simply allows. Since our population is aging and the nature to take its course. Hospice's sole focus is on assisting the terminally ill to live life to the fullest during their final days.
Hospice services are available to anyone regardless of illness, culture, age, gender, or financial status. The criteria for receiving hospice care are that the patient has a terminal illness, has been certified by a medical professional as having a prognosis of six months or less, and does not wish to pursue curative treatment.
Once a referral to hospice has been made by a medical professional, members of the hospice staff will come and conduct an assessment of the patient's overall needs as well as establish a care team. Along with the primary caregiver (usually a member of the family), the hospice team and the patient will outline an appropriate care plan.
From the moment a patient enters into hospice care, he or she may access a wide range of services, including:
You don't have to go anywhere — hospice comes to you! Whether you are in a nursing hone, hospice facility, hospital, or in your own home, hospice professionals will provide services wherever you live and are most comfortable. This flexibility in service is part of the hospice mission to help patients live their lives as they wish during this difficult time.
Hospice care is usually paid by Medicare and, in 43 states, Medicaid. In addition, many other types of health plans, including health maintenance organisations (HMOs) and preferred provider organizations (PPOs), cover the costs related to hospice care. For patients who do not have insurance and do not qualify for Medicare/Medicaid, many hospice programs will offer their services free of charge.
Hospice care is a method of caring for the terminally ill that helps them continue their lives with as little disruption as possible, while emphasizing supportive services rather than cure. Hospice care is intended to help ease the physical and emotional pain of terminally ill people and their families. It is provided in the home or a hospice facility, nursing home, or hospital. Medical, social, counseling, spiritual, and homemaker services can all be part of hospice care, depending on individual and family needs.
Medicare covers hospice care under the Part A, or Hospital Insurance, portion of the program. You are eligible for Medicare hospice benefits if you are:
Although a Medicare-approved hospice program includes physicians among the team of trained staff providing care, you may choose to continue under your regular doctor's care. The hospice team, including family members, trained volunteers, a social worker, nurse, and clergy or other counselors, will work together with the doctor to provide necessary care. Hospice services are available on an as-needed basis, any time of the day or week.
Medicare coverage of hospice care is limited by time periods. You may elect to receive hospice care for up to two periods of 90 days each, followed by an unlimited number of 60-day periods. A physician must certify that you are terminally ill at the beginning of each care period for you to continue receiving care. You can stop getting services whenever you choose - for instance, if your illness goes into remission.
Medicare can help beneficiaries cover the cost of hospice care when they need it.
Typical hospice services covered under Medicare include:
During the hospice benefit period, Medicare generally will not cover:
Medicare pays the hospice directly for your care.
To locate a Medicare-approved hospice program in your area, contact the Part A or home health intermediary in your state. The telephone number can be found in the back of the Medicare handbook and on Medicare's Web site. You can also call your state or local health department, your state hospice organization, or the National Hospice Organization Hospice Help Line at 1-800-658-8898.
Medicare's booklet, Medicare Hospice Benefits, explains the hospice program and its benefits, eligibility requirements, and how to find a hospice program. The publication includes telephone numbers for the hospice agency in every state. The Important Contact section lists the name and telephone number of the regional home health intermediary. The book is available in English and Spanish. You can view the book online at Medicare's Web site or order it by calling 1-800-MEDICARE (1-800-633-4227). http://www.medicare.gov/publications/pubs/pdf/hosplg.pdf
Your physician and other medical professionals may know of hospice programs in your community. Two other resources are the National Hospice and Palliative Care Organization www.nhpco.org (703-837-1500) and the Hospice Foundation of America www.hospicefoundatiom.org (800-854-3402). Both organizations have databases of hospice programs located throughout the United States to make your search easier.
While all hospice programs provide the same core services and subscribe to the same philosophy and mission of helping the terminally ill, each hospice program has its own characteristics and strengths that set it apart from other programs. It is important to find out as much as you can about any hospice program you are considering.
When considering a hospice program you may wish to ask the following questions:
There are federal, state, and professional organizations that evaluate hospice programs. They conduct ongoing surveys and evaluations to ensure that hospice programs meet the standards developed by the National Hospice and Palliative Care Organization. In addition, hospice programs are licensed by the state and must he certified by Medicare to provide services.
Hospice is unique because it provides care to address all the needs of the dying patient, including physical, emotional, and spiritual concerns. In addition, it provides support to family members and friends both during the illness and beyond through bereavement counseling.
At any time during a life-limiting illness, it’s appropriate to discuss all of a patient’s care options, including hospice. By law the decision belongs to the patient. Understandably, most people are uncomfortable with the idea of stopping aggressive efforts to "beat" the disease. Hospice staff members are highly sensitive to these concerns and always available to discuss them with the patient and family.
The patient and family should feel free to discuss hospice care at any time with their physician, other health care professionals, clergy or friends.
Most physicians know about hospice. If your physician wants more information about hospice, it is available from the National Council of Hospice Professionals Physician Section, medical societies, state hospice organizations, or the National Hospice Helpline, 1-800-658-8898. In addition, physicians and all others can also obtain information on hospice from the American Cancer Society, the American Association of Retired Persons, and the Social Security Administration.
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 will allow additional coverage for this purpose.
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 this patient at this time. (Most hospices have medical staff available to help patients who have no physician.) The patient will be asked to sign consent and insurance forms. These are similar to the forms patients sign when they enter a hospital.
The so-called "hospice election form" says that the patient understands that the care is palliative (that is, aimed at pain relief and symptom control) rather than curative. It also outlines the services available.
The form Medicare patients sign also tells how electing the Medicare hospice benefit affects other Medicare coverage.
Your hospice provider will assess your needs, recommend any equipment, and help make arrangements to obtain any necessary equipment. Often the need for equipment is minimal at first and increases as the disease progresses.
In general, hospice will assist in any way it can to make home care as convenient, clean and safe as possible.
There’s no set number. One of the first things a hospice team will do is to prepare an individualized care plan that will, among other things, address the amount of caregiving needed by the patient. Hospice staff visit regularly and are always accessible to answer medical questions, provide support, and teach caregivers.
In the early weeks of care, it’s usually not necessary for someone to be with the patient all the time. Later, however, since one of the most common fears of patients is the fear of dying alone, hospice generally recommends someone be there continuously. While family and friends do deliver most of the care, hospices provide volunteers to assist with errands and to provide a break and time away for primary caregivers.
It’s never easy and sometimes can be quite hard. At the end of a long, progressive illness, nights especially can be very long, lonely and scary.
So, hospices have staff available around the clock to consult by phone with the family and make night visits if appropriate. To repeat: Hospice can also provide trained volunteers to provide "respite care",to give family members a break and/or provide companionship to the patient.
Hospice patients are cared for by a team of physicians, nurses, social workers, counselors, hospice certified nursing assistants, clergy, therapists, and volunteers - and each provides assistance based on his or her own area of expertise. In addition, hospices provide medications, supplies, equipment, and hospital services, related to the terminal illness. and additional helpers in the home, if and when needed.
Hospice neither hastens nor postpones dying. Just as doctors and midwives lend support and expertise during the time of child birth, hospice provides its presence and specialized knowledge during the dying process.
No. Although 90% of hospice patient time is spent in a personal residence, some patients live in nursing homes or hospice centers.
Hospice believes that emotional and spiritual pain are just as real and in need of attention as physical pain, so it can address each. Hospice nurses and doctors are up to date on the latest medications and devices for pain and symptom relief. In addition, physical and occupational therapists can assist patients to be as mobile and self sufficient as they wish, and they are often joined by specialists schooled in music therapy, art therapy, massage and diet counseling. Finally, various counselors, including clergy, are available to assist family members as well as patients.
Very high. Using some combination of medications, counseling and therapies, most patients can attain a level of comfort that is acceptable to them.
Usually not. It is the goal of hospice to have the patient as pain free and alert as possible. By constantly consulting with the patient, hospices have been very successful in reaching this goal.
No. While some churches and religious groups have started hospices (sometimes in connection with their hospitals), these hospices serve a broad community and do not require patients to adhere to any particular set of beliefs.
Hospice coverage is widely available. It is provided by Medicare nationwide, by Medicaid in 39 states, and by most private insurance providers. To be sure of coverage, families should, of course, check with their employer or health insurance provider.
Medicare normally covers all services and supplies for the hospice patient related to the terminal illness.
The first thing hospice will do is assist families in finding out whether the patient is eligible for any coverage they may not be aware of. Barring this, most hospices will provide for anyone who cannot pay using money raised from the community or from memorial or foundation gifts.
Hospice provides continuing contact and support for caregivers for at least a year following the death of a loved one. Most hospices also sponsor bereavement groups and support for anyone in the community who has experienced a death of a family member, a friend, or similar losses.
This article includes materials furnished by the AARP and other sources. You can go to the AARP's website at http://www.aarp.com. Or contact your local or State AARP office for more information.
