Hospice

About End of Life Care

What are Hospice, Palliative and End of Life Care?

At the center of hospice, palliative and end of life care is the belief that each of us has the right to excellent pain and symptom management and to have our physical, emotional and spiritual concerns addressed. We should expect compassionate care which provides an experience of death with dignity, free from discomfort and in an environment which is respectful and clinically competent, and which provides our families the necessary support during the process and after.

The term ‘end of life care’ is an overarching concept which includes four ways to address important needs in our life. Picture an umbrella. Its arching shelter is ‘end of life care,’ and gathered under it are advance care planning, palliative care, hospice care, and bereavement care.

Advance care planning

is a need all of us will have at some point in our adult lives – whether we are healthy or not, and with or without the responsibility of caring for someone else. In particular, members of the ‘sandwich’ or caregiver generation (those born between 1950 and 1975) will turn to advance care planning as they consider care for parents, children and themselves. As you develop an advance care plan, you will explore your options for care, reflect on those options and your values, talk with your loved ones, and finally, record your wishes. Your plan may change over time, as your situation or wishes change. Click here for more information on Advance Care Planning.

Considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury, hospice and palliative care involve a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes. Support is provided to the patient’s loved ones as well.

Hospice

focuses on caring not curing, and, in most cases, care is provided in the patient’s home. Hospice care also is provided in freestanding hospice centers, hospitals, and nursing homes and other long-term care facilities. Hospice services are available to patients of any age, religion, race, or illness. Hospice care is covered under Medicare, Medicaid, most private insurance plans, HMOs, and other managed care organizations.

Hospice provides four levels of care to meet the changing needs of patients and families. Most hospice care is provided at the Routine (or primary) level of care. This level of care is based on an expectation of the patient’s decline as the disease process moves along its natural course. Symptoms are managed in the patient’s residence – home, nursing facility, assisted living community – and the hospice provides individualized support to the patient, family and/or caregiver staff. If the patient’s symptoms become unmanageable, then the patient may receive a higher level of care for a brief period in a clinical environment staffed by registered nurses. This is called General Inpatient Care and is intended to be a short-term, high-intensity level of care provided in a hospice inpatient facility (or “hospice house”) or in a hospital setting with the focus on returning the patient to a state of comfort and managed symptoms. Another level of care available is Respite Care, which is a short (5-day) period of inpatient care where symptoms are stable, but the caregiver or family members need a break from the daily care of the patient. This level of care is available as it is needed and must be coordinated with the hospice. Finally, if symptoms become so unmanageable that the caregiver or staff find it overwhelming to provide care to the patient and the desire is for the patient to remain in the home setting, Continuous Care level of care is available. This is also a short-term, high-intensity level of care intended to bring the patient’s symptoms under control and support the caregiver during the process of daily care. All levels of care must be coordinated by the hospice team and the hospice clinicians are responsible for determining when the level of care must change.

Palliative care

extends the principles of hospice care to a broader population that could benefit from receiving this type of care earlier in their illness or disease process. No specific therapy is excluded from consideration. An individual’s needs must be continually assessed and treatment options should be explored and evaluated in the context of the individual’s values and symptoms. Palliative care, ideally, would segue into hospice care as the illness progresses.

Both palliative and hospice care are philosophies, or concepts of care. Neither is limited to a location or practice, and both address the many ways illness can affect a person’s life. Both are available to people of all ages and illnesses.

Bereavement care

How does hospice care work?

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

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

The patient’ s personal physician;
Hospice physician (or medical director);
Nurses;
Home health aides;
Social workers;
Clergy or other counselors;
Trained volunteers; and
Speech, physical, and occupational therapists, if needed.

What services are provided?

Among its major responsibilities, the interdisciplinary hospice team:

Manages the patient’s pain and symptoms;
Assists the patient with the emotional and psychosocial and spiritual aspects of dying;
Provides needed drugs, medical supplies, and equipment;
Coaches the family on how to care for the patient;
Delivers special services like speech and physical therapy
when needed;
Makes short-term inpatient care available when pain or
symptoms become too difficult to manage at home, or the caregiver needs
respite time; and
Provides bereavement care and counseling to surviving
family and friends.

How is Hospice Paid For?

Hospice coverage is widely available. It can be provided through Medicare and Medicaid in Georgia as well as by most private insurance plans. If coverage is not available, hospice will assist in investigating other resources the family may not be aware of. Barring this, most hospices provide care by using money raised in the community from memorials, special events, foundation gifts, or other contributions.

Medicare Hospice Benefit

More than 90% of hospices in the United States are certified by Medicare. Medicare defines a set of hospice core services, which many hospices surpass through voluntary, community-based efforts.

The Medicare Hospice Benefit, initiated in 1983, is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive a full scope of non-curative medical and support services for their terminal illness. Hospice care also supports the family and loved ones of the patient through a variety of services, enhancing the value of the Medicare Hospice Benefit.

The Medicare Hospice Benefit provides for:

Physician services
Nursing care
Medical appliances and supplies
Drugs for symptom management and pain relief
Short-term inpatient and respite care
Homemaker and home health aide services
Counseling
Social work service
Spiritual care
Volunteer participation
Bereavement services

Medicare has three key eligibility criteria:

The patient’s doctor and the hospice medical director use their best clinical judgment to certify that the patient is terminally ill with a life expectancy of six months or less, if the disease runs its normal course;

The patient chooses to receive hospice care rather than curative treatments for their illness; and

The patient enrolls in a Medicare-approved hospice program.

Payment for Hospice:

Medicare pays the hospice program a per diem rate that is intended to cover virtually all expenses related to addressing the patient’s terminal illness.

Because patients require differing intensities of care during the course of their disease, the Medicare Hospice Benefit affords patients four levels of care to meet their needs: Routine Home Care, Continuous Home Care, Inpatient Respite Care, and General Inpatient Care. Ninety-six percent (96%) of hospice care is provided at the routine home care level .

The Hospice Benefit rates have increased annually based on the Hospital Market Basket Index. With the advent of costly new drugs and treatments like palliative radiation, the average cost to hospices has risen much faster than the hospice benefit reimbursement rates.

Hospices that are Medicare-certified must offer all services required to palliate the terminal illness, even if the patient is not covered by Medicare and does not have the ability to pay.

Hospice

About End of Life Care

What are Hospice, Palliative and End of Life Care?

How is Hospice Paid For?

Medicare Hospice Benefit

The Medicare Hospice Benefit provides for:

Medicare has three key eligibility criteria:

Payment for Hospice:

Ready to Join?