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Frequently Asked Questions
How is hospice different
from other medical care?
Some of the ways that
hospice is different from standard medical care are:
Hospice
looks at all the patient’s and family’s needs. A coordinated team of
hospice professionals, assisted by volunteers, works to meet the patient’s
and family’s emotional and spiritual needs, as well as the patient’s
physical needs.
The
emphasis is on controlling pain and symptoms through the most advanced
techniques available and on emotional and spiritual support tailored to
the needs of the patient and family.
Hospice
recognizes that a serious illness affects the entire family as well as the
person who is ill. The family, not just the patient, is the "unit of care"
for hospice professionals. Sometimes other family members actually need
more attention than the patient.
What
services does hospice provide?
Hospice includes the services of an
interdisciplinary team of health care professionals:
Physicians (the patient’s
own physician and the hospice physicians, who are specialist in
controlling pain and other symptoms of serious illness) prescribe
medications and other methods of pain and symptom control.
Nurses are experts at
maintaining patient comfort. They assess the patient frequently and help
family members provide the necessary support.
Certified nurse assistants
and home health aides provide personal care and help the patient and
family with activities of daily living. They also provide companionship
and valuable emotional support.
Social workers coordinate
community resources and help the patient and family with non-medical
concerns. They can help family members mend damaged relationships, plan
for the future and ease other emotional difficulties.
Chaplains and spiritual
counselors help patients and families cope with spiritual questions and
concerns at the end of life, either directly or by coordinating services
with the patient’s and family’s spiritual advisors.
Bereavement coordinators
help patients and families deal with grief. Grief support services
continue for at least one year after the death of a hospice patient.
Volunteers provide
companionship and emotional support and offer help in myriad ways.
Hospice also provides
medications, medical equipment and supplies necessary to promote comfort
at home or in other hospice settings.
Hospice staff are
available by phone at all times, 24 hours a day, 365 days a year.
Who pays for hospice care?
Hospice is covered by most
insurance plans, including Medicare and Medicaid, with few 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.
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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. Medications
for a condition not related to the terminal illness - allergy medication
for example - are not covered by the hospice benefit.
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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 should patients and families
consider hospice?
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.
Who is eligible for hospice care?
A physician must certify that a
hospice patient has an illness and an estimated life expectancy of six
months or less if the illness runs its usual course. The patient must agree
to hospice care.
Generally most hospice providers accept everyone who
meets those criteria, regardless of the patient’s financial situation or
insurance coverage. The patient does not have to have family caregivers in
the home in order to receive hospice services.
Doesn’t accepting hospice care mean
giving up?
Hospice involves acknowledging that most
diseases in their advanced form cannot be cured. It does not mean giving up
hope. The focus of hope shifts towards helping the patient achieve maximum
physical comfort and peace of mind.
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: 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 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 home care.
What if I choose hospice and then
live more than six months?
Hospice care does not
automatically end after six months. Medicare and most other insurers will
continue to pay for hospice care as long as a physician certifies that the
patient continues to have a limited life expectancy.
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 become
eligible for hospice, they can re-elect the hospice benefit. There is no
penalty for getting better!
How does hospice manage pain and other symptoms?
Hospice physicians and nurses are experts at pain and symptom control. They
are continually developing new protocols for keeping patients comfortable
and as alert and independent as possible. They know which medications to use
simply and in combination to provide the best results for each patient.
Doesn’t pain control medications make people feel "doped up"?
When morphine and other pain control medications are administered properly
for medical reasons, patients find much-needed relief without getting "high"
or craving drugs. The result is that hospice patients remain more alert and
active because they are not exhausted by uncontrolled symptoms.
What kind of emotional and spiritual support does
hospice provide?
Hospice recognizes that people are more than a collection of symptoms.
People nearing the end of their lives often face an enormous emotional and
spiritual distress. They are dismayed as their physical abilities begin to
fail. They don’t want to be a burden on their families. They worry how their
loved ones will manage without them. Sometimes, they feel deep regret about
things they have done or said – or things left undone and unsaid. Hospice
professionals and volunteers are trained to be active listeners and to help
patients and families work through some of these concerns so that they can
find peace and emotional comfort in their final days.
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