Frequently Asked Questions About Hospice
Who is eligible for hospice care?
In general hospices will accept any patients who have symptoms of advanced cancer, AIDS, or other terminal illnesses.
Patients choose hospice care for different reasons. Hospice can help when the patient:
- wants medical treatment to focus on comfort;
- needs to keep pain or other physical symptoms under control;
- needs assistance with personal care and grooming;
- wants emotional and spiritual support for self and significant other persons;
- would like a professional to take care of coordinating services.
Who may refer a patient to hospice care?
Referrals are accepted from anyone who identifies the need for hospice care. Applications for admission can be obtained by contacting the hospice directly. Hospice provides resources to enable families to take care of their loved ones at home for as long as possible. Many hospices also have their own inpatient units, or may contract beds in other institutions, when such care is required for limited periods of time.
What services are available through hospice?
A wide range of hospice services are provided by professionals and support staff. The services include:
- comprehensive care which includes nursing care, social services pastoral care (spiritual support) and counseling, home health aide and homemaker services, nutritional and pharmacy services.
- pain and symptom management
- continuous home care (8-24 hour periods of skilled nursing care on a short-term basis during a medical crisis)
- physical, occupational, and speech therapy
- direct telephone access to hospice nurses 24 hours a day, 7 days a week
- respite care for the primary care person
- trained volunteers for support
- all medications, infusion therapy, supplies and equipment
- inpatient admission to a special unit at the hospice itself or at a designated hospital for short-term inpatient care.
How does hospice help the patient’s family and friends?
Hospice recognizes the impact of an advanced illness on all those close to the patient. Supportive counseling services including music and art therapy are available to all members of the family and close friends. Special consideration is given to the needs of young children.
If the primary care-partner needs a rest, the patient may be admitted to the inpatient unit for several days even if he/she does not have any symptoms.
Must a patient give up a private physician to join a hospice program?
Patients are encouraged to maintain their relationship with their private physician. Hospices will work with any physician licensed in the state. If the patient does not have a private physician, the hospice will assign a physician. The patient makes individual arrangements with the physician for payment of services. Physicians may bill the insurance company if a benefit is available for this. Medicare Part B covers physician visits in the hospital and the home for hospice patients.
Does the patient have to acknowledge that he or she is terminally ill?
Hospices generally require only that a patient sign a consent form that includes an acceptance of “palliative rather than curative care.”
Are patients accepted for hospice care who are undergoing “curative” treatment?
Hospice does not provide care aimed at curing the disease. Patients are carefully screened to determine if they are appropriate candidates and are not accepted to the program if it is believed that they could benefit from curative-type treatments. Patients are not excluded who are using non-traditional means to achieve a cure as long as they understand that hospice care is palliative and not curative.
Does a patient need to agree to a DNR order to be admitted to the hospice program?
A hospice may not discriminate against a patient for not agreeing to a DNR (Do-Not-Resuscitate) order. Hospice does not provide resuscitation (either at home or in the inpatient unit), but patients and/or families are informed that they may call 911 if this is desired. If a patient wishing resuscitation needs inpatient care, he or she would be admitted to a hospital that provides this and hospice services would be discontinued until the patient is discharged.
Is a patient who lives alone eligible for hospice care?
Hospice has no requirement for a live-in caregiver, simply that there be a “contact person,” someone who is available to the patient and the hospice regarding decision-making, personal and financial matters, and funeral arrangements. If a patient has no one among their family and friends who is available in this manner, hospice can arrange for a volunteer to assume these responsibilities.
Patients are encouraged to appoint a close friend or relative as a health care proxy and to make a living will whenever possible.
What happens if a patient needs long-term institutional care?
The hospice will assist the patient and/or family with a referral to a nursing home or other long-term care facility of their choice. Hospices often have contracts with nursing homes; the patient may continue to receive hospice services as a resident of the nursing home.
Does a physician or EMT need to pronounce a patient’s death on a hospice program?
Check the laws in your state. In New York State, anyone may pronounce a death, but a physician must certify by signing a death certificate. Hospice has an understanding with the medical examiner’s office that if a death is from natural causes, funeral homes may accept a body as long as a signed death certificate is available within 48 hours.
How is hospice care paid for?
Medicare, Medicaid, and most private insurance plans cover hospice care for their beneficiaries. The patient and family should discuss payment options with the hospice staff. Physician services are not included as part of the hospice program.
How does someone qualify for the Medicare Benefit?
A physician must certify that the patient has less than 6 months to live, if the disease runs its normal course. The patient signs an election statement indicating that he or she understands that hospice care is palliative and not curative. By signing the statement, the patient surrenders rights to other Medicare benefits related to the terminal illness. (A family member or health care agent may sign the election statement if the patient is unable to do so.) A patient may revoke his election to hospice care at any time and resume the standard Medicare benefits.
The Medicare/Medicaid Hospice Benefit covers all services including drugs related to terminal illness (Medicare pays 95% of the cost of drugs; the patient is responsible for 5% up to a maximum of $5.00 per drug), respite care, in-home medical equipment, medical supplies and bereavement counseling. There are no deductibles or co-insurance for hospice care.
If someone has no insurance coverage, how would hospice care be covered?
The hospice will explore with the patient and family ways to provide care to ensure that the patient receives the services he/she needs. No one is denied services solely because of inability to pay.
For how long is hospice coverage provided by insurers?
A hospice is prohibited by state law from discharging a patient whose insurance has run out. The patient’s physician and the hospice team regularly evaluate the patient’s need for continued services. If a patient does not need hospice care any longer, the hospice will arrange for referral to another level of care. If a patient’s condition deteriorates subsequent to discharge, the patient may call the hospice for readmission.
(This information courtesy of Cabrini Hospice, New York, NY)