When is the right time to ask about hospice?

Now is the best time to learn more about hospice and ask questions about what to expect from hospice services.  Although end-of-life care may be difficult to discuss, it is best for family members to share their wishes long before it becomes a concern.  This can greatly reduce stress when the time for hospice is needed.  By having these discussions in advance, patients are not forced into uncomfortable situations.  Instead, patients can make an educated decision that includes the advice and input of family members and loved ones.

How does hospice and palliative care begin?

Typically, hospice care starts as soon as a formal request or a ‘referral’ is made by the patient’s doctor.  Often a hospice program representative will make an effort to visit the patient within 48 hours of that referral, providing the visit meets the needs and schedule of the patient and family/primary caregiver.  Usually, hospice care is ready to begin within a day or two of the referral.  However, in urgent situations, hospice services may begin sooner.

Why does hospice care have volunteers?

Hospice volunteers are generally available to provide different types of support to patients and their loved ones including running errands, preparing light meals, staying with a patient to give family members a break, and lending emotional support and companionship to patients and family members.

Because many hospice volunteers spend time in the homes of patients, each hospice program generally has an application, interview, and background check process to assure the person is right for this type of volunteer work.  In addition, hospice programs have an organized training program for their patient care volunteers.  Areas covered by these training programs often include understanding hospice, confidentiality, working with families, listening skills, signs and symptoms of approaching death, and loss and grief and bereavement support.

Can I receive hospice or palliative care if I reside in a nursing facility or assisted living facility?

Hospice services can be provided to a terminally ill person wherever they live.  Palliative care services can be provided for chronic illnesses wherever the person may live, as well. This means a patient living in a nursing facility or long-term care facility can receive specialized visits from hospice nurses, home health aides, chaplains, social workers, and volunteers, in addition to other care and services provided by the nursing facility.  Dynamic and the nursing home will have a written agreement in place in order for the hospice to serve residents of the facility.

What are the financial benefits of hospice and palliative care?

Hospice is covered by most insurance plans, including Medicare and Medicaid, with very few if any out-of-pocket costs to the patient.

The Medicare hospice benefit covers costs related to the terminal illness, including the services of the hospice team, medication, medical equipment, and supplies. Medicare reimburses for different levels of hospice care recognizing sometimes patients require special attention.

• Medications: The Medicare hospice benefit covers medications needed to treat the patient’s terminal illness. Generally hospice providers will order medications for you, and you can get them from the pharmacy or arrange for delivery.
  Note: Medications for a condition not related to the terminal illness (allergy medication for example) are not covered by the hospice benefit.
• Medical supplies: The physician and nurse will work with the family to determine which medical supplies and equipment the patient needs. Again, generally most hospice providers will order the equipment and have it delivered to the home.

When is the best time to have “the conversation” about hospice?

Now is the best time to learn more about hospice and ask questions about what to expect from hospice services.  Although end-of-life care may be difficult to discuss, it is best for family members to share their wishes long before it becomes a concern.  This can greatly reduce stress when the time for hospice is needed.  By having these discussions in advance, no one is forced into uncomfortable situations.  Instead, people can make educated decisions that include the advice and input of family members and loved ones.

After a diagnosis of life-limiting illness, patients and their families should consider their choices for care. A patient does not have to be bed-bound or critically ill to be admitted to hospice. A hospice representative would be happy to talk with you or your family about the hospice option.

What are the different levels of hospice care?

Most hospice patients live at home or in a nursing home. Routine home hospice care covers the services, of the interdisciplinary hospice team, medications and equipment. Other categories of care are available when needed.

• Routine Care:  Standard level of care given in the home, long term care facility or assisted living facility.  Care includes visits from the hospice nurse, chaplain, social worker and home health aides as well as 24-hour on call nursing support.
• Inpatient Care:  Sometimes pain or symptoms cannot be controlled at home, and the patient is taken to a hospital or other inpatient care center. When the symptoms are under control, the patient returns home. Insurance usually covers the cost of inpatient room and board.
• Respite Care:  Many patients have their own caregivers, often family members. When caregivers need a rest from their care giving responsibilities, patients can stay in a nursing home or hospice residential care center for up to five days. Medicare covers the cost of room and board, as do many other insurance plans.
• Continuous/Crisis Care:  Sometimes a patient has a medical crisis that needs close medical attention. When this happens, we can arrange for inpatient care, or the hospice provider staff can provide round-the-clock care in the home. When the crisis is over, the patient returns to routine care.

What if my condition improves?

Occasionally, the quality of care provided by hospice leads to substantially improved health, and life expectancy exceeds six months. When this happens, the hospice provider will transfer care to a non-hospice care provider. Later, when patients again become eligible for hospice, they can re-elect the hospice benefit. There is no penalty for getting better!