How Does Hospice Work?

Seeking out good hospice care can feel overwhelming at first. You probably have a lot of questions without knowing where to find the answers. There is a lot to think about when it comes to hospice care and it is important that every decision is made with as much knowledge and education as possible.

We’re going to walk you through each facet of the process to help you get a better understanding of this form of care – who should receive it, how it works, and the financial considerations that must be made as you or someone you loves enters into this type of treatment option.

What Does Hospice Do?

Hospice is care that preserves the quality of life for patients managing terminal diagnoses in the advanced stages of illness. Hospice emphasizes compassion to help the patient live a complete, comfortable life with dignity and respect. Throughout this phase of treatment, hospice is focused on managing the symptoms of the illness and not the illness itself.

Hospice care is not treatment that is targeted at curing or healing terminal disease, but simply to focus on the well-being of the individual for the remainder of his or her time.

Hospice is administered by a group of caregivers who work in concert with one another to reduce the symptoms of the illness so the patient can live in peace and without suffering. This form of treatment takes the concerns of the family into account when decisions relating to the patient must be made.

Choosing the right group of hospice professionals is crucial. They are tasked with organizing all aspects of care, from placing orders for all the necessary hospice equipment and supplies to prescribing the proper medications to manage symptoms. The hospice team typically includes a series of physicians and nurses but also in-home care providers and social workers, all of whom are ready to guide the patient and other stakeholders through hospice treatment.

Remember, the hospice team is there to assist in managing the symptoms of a terminal illness. Those symptoms can manifest as both physical and psychological for the patient and the loved ones who are preparing themselves for this emotional loss.

Entering the final phase of life is an extraordinary time. Hospice care is about empowerment and empathy. This extends to the manner in which the services are paid for by the patient.

How Does a Patient Pay for Hospice Care?

Patients have a number of choices for covering the costs of hospice care. The most common are Medicare, Medicaid, and private insurance, but if you or your loved do not have any of these at your disposal, we will be able to provide you with the necessary resources needed to facilitate initiating the hospice program .

How Does Hospice Work with Medicare and Medicaid?

The Medicare hospice program was created in 1983 as a way to give terminally ill individuals the means to receive end of life care without assuming the financial responsibilities for that care. But there are stringent eligibility requirements in place for patients who wish to start receiving benefits.

In order to be eligible for hospice through Medicare, the patient must meet this criteria:

  • The patient must have been given a diagnosis where he or she has six months or less to live.
  • The patient prefers living in comfort instead of curative care
  • The patient has Medicare Part A coverage.

If the patient is deemed eligible by these requirements and decides to pursue hospice care, Medicare will pay out the appropriate benefits over a number of benefit periods. Once a benefit period has been paid out, the patient must meet the criteria again in order to remain eligible for hospice care under the Medicare guidelines.

Individuals with Medicaid coverage may use it in conjunction with their current Medicare coverage. If the patient would like to utilize the hospice benefits from Medicaid, he or she must meet the following eligibility criteria. (Keep in mind, each state maintains its own eligibility requirements, but in most cases, the following must be met):

  • The patient must have received a certification of a terminal diagnosis from a physician.
  • The patient complete an election form declaring acceptance of hospice treatment.
  • The patient must declare that he or she has been given a limited life expectancy as defined by the state eligibility requirements for every certification period.
  • All patients over the age of 21 must discontinue any curative care.

What to Know about Hospice Eligibility

Hospice offers care for patients who are dealing with serious medical conditions that have left them with terminal diagnoses. As a result, the individual is in need of care and support as part of a daily routine. When applying for care and determining eligibility under the Medicare and Medicaid requirements, there is no set standard to be met with respect to symptoms beyond the eligibility criteria that has been described in the previous sections above.

The Four Levels of Hospice Care

Under the Medicare guidelines, a patient may be eligible for one or more levels of hospice care. Those levels are as follows:

Home Hospice Care

The acceptance of home hospice care means the patient will begin to receive a regimen of care that is designed to ease the pain and discomfort of the illness and not the illness that has been diagnosed. This typically includes pain and symptom management in an effort to improve and sustain as high a quality of life as possible. In addition to the comfort of the patient, the hospice team will provide care in the form of nutritional services, helping with day-to-day tasks and errands, therapeutic care, and counseling for the patient and any family members who wish to have it.

These services are all offered inside the home. It does not matter where that home is located as hospice care may be provided in the patient’s own home, inside of an assisted living home, a nursing facility, or any other place the patient calls home.

Continuous Hospice Care

This level of hospice is provided to the patient should his or her symptoms become intensified or worsen, or if the patient suffers a significant health crisis that requires emergency attention. Twenty-four hour care may be necessary at this time, allowing the patient to receive the urgent care and support needed as well as giving the immediate family the opportunity to spend time with their loved one as family members and not caregivers.

Inpatient Hospice Care

This level of hospice may be offered should the patient experience a severe setback that results in their symptoms becoming unmanageable inside the home. The objective, as always, is to reduce pain and discomfort and stabilize the symptoms back to manageable levels so the patient is comfortable and may return to his or her home.

Respite Hospice Care

Moving the patient into an inpatient hospice center may provide respite care that allows for home hospice patients to receive the same high quality hospice in a facility while family, friends, and loved ones receive a respite from being caregivers for a short period of time.

Choosing the Right Level of Hospice Care

The medical professionals providing care for the patient will offer advice and guidance on which level of hospice is appropriate. Whenever that decision (or any other concerning the patient in question) is made, the only goal is to minimize pain and discomfort of the individual while providing top notch medical care and support for all parties involved.

What to Know about Hospice Eligibility Requirements

The eligibility requirements for receiving hospice care is defined by a more comprehensive set of criteria that is related to the guidelines set forth under Medicare and Medicaid. The following can play a role in determining the Medicare and Medicaid requirements, but these definitions of a patient’s health and well-being may be considered separately as basic conditions for receiving hospice care.

  • The patient has been given six or fewer months to live as the result of a terminal illness or other
    life-limiting condition in the event curative treatments are suspended.
  • The patient has been hospitalized frequently over the past six months.
  • The patient is experiencing progressive weight loss.
  • The patient is suffering an increase in weakness and fatigue.
  • The patient is demonstrating a significant decline in their functional and cognitive capacities.
  • The patient has shown compromised ability in performing simple daily activities like walking or moving, feeding, dressing, bathing oneself, using the bathroom, and continence.
  • The patient is demonstrating a steady deteriorating of mental faculties.
  • The patient has sustained multiple infections and skin irritation or breakdown.
  • The patient’s overall health and well-being has steadily declined.

Final Thoughts

Entering into a hospice care arrangement is no small decision. There are many factors to keep in mind as you or your loved one makes the transition from curative treatment of an illness into hospice care intended solely to ease the symptoms of that illness. This information should be used to help base your decision on the facts of your particular condition or that of your loved one.

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