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Hospice For The Elderly

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What is it? Who needs it? Why? When?

Hospice provides comfort care for terminally ill patients. If you have or acquire a terminal illness with a prognosis of six months or less, do you want treatment of the illness or the symptoms? (Hospice treats the symptoms.)
The Hospice Foundation of America has a directory and resource information available.

Hospice Directory

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To qualify for Hospice services, a doctor must certify that a patient has a likely lifespan of six months or less. The goal of Hospice is to control pain and symptoms, making the patient as comfortable and independent as possible, but not to cure the underlying illness, such as cancer, heart or lung disease, or dementia.

Hospice provides comfort care for terminally ill patients. Hospice caregivers can help with the patient's daily activities and medical needs and also help the patient, family and loved ones deal with the psychological and spiritual needs when facing the end of life. Hospice care can be received at home or in a facility. Family and friends often provide what comfort care they are able, with skilled help from the Hospice staff tailored to their needs. Hospice providers do not necessarily provide round-the-clock care and the length of time for services (for example nursing, social work, etc.) varies.

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How do you pay?

While Hospice care is a covered benefit under Medicare and many insurance plans, Hospices also rely heavily upon community support for donations to provide care to those who cannot otherwise afford it. Each Hospice has its own policies concerning payment for care, it is a principle of Hospice to offer services based upon need rather than the ability to pay.

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Check Medicare Eligibility

Learn about who is covered, what are the benefits, how to apply, Medicare plans, and medigap insurance coverage. Social services and social workers are the experts in dealing with Hospice issues and helping to understand coverage and possible sources of payment for Hospice care. Consult with the hospital social worker or your county social services department to get help in determining eligibility.

Who Is Covered

Medicare is a federal health insurance program for people age 65 and older, some disabled people under 65, adults who receive Social Security payments, and those with end-stage renal disease. Medicare coverage has two parts:

Part A

Hospital insurance pays for most inpatient hospital care, some inpatient skilled nursing home care, some home health care, and Hospice care.

In order for to be covered by Medicare Part A:

  • The Hospice provider must be certified by Medicare;
  • A doctor and the Hospice medical director must verify that the patient is terminally ill — meaning that he or she probably has less than six months to live if the illness runs its normal course; and
  • The patient or his or her medical representative must sign a statement choosing Hospice care instead of standard Medicare-covered benefits — although Medicare will continue to cover health problems unrelated to terminal illness.

Medicare generally covers an initial 90-day period of benefits once both the patient's doctor and Hospice doctor certify that Hospice care is fitting. After that, the Hospice doctor is responsible for recertifying the patient, who may elect an additional 90 days of care, followed by an unlimited number of 60-day periods.

Medicare Review

What Is Covered

Medicare pays a fixed amount for most Hospice services, including:

  • Doctor services and nursing care;
  • Physical therapy, occupational therapy, and speech-language pathology services;
  • Medical social services, Hospice aide services, and homemaker services;
  • Medical equipment, such as wheelchairs and walkers, and medical supplies, such as bandages and catheters;
  • Drugs for symptom control or pain relief; a copayment is sometimes required;
  • Counseling, including dietary counseling, counseling about care of the terminally ill patient, bereavement counseling; and
  • Short-term inpatient care for pain control and symptom management and for respite, with a 5% co-pay amount.

If a Hospice's charges are more than Medicare will pay, the patient may be responsible for paying the rest. Before care begins, the Hospice must tell the patient how much of the bill Medicare will pay. The agency must inform the patient, in writing, of any items or services that are not covered by Medicare and how much will be due for them. The Hospice then sends bills directly to Medicare.

An individual may be charged for:

  • Treatments or services designed to cure a terminal illness or not related to comfort care;
  • Room and board if the patient is receiving Hospice in a facility — except for temporary respite are; and
  • Care in an emergency room or inpatient facility and ambulance transportation — unless arranged by the Hospice provider or unrelated to the terminal illness.

For more information, review your program with your social service worker: See the Centers for Medicare & Medicaid Services booklet, Medicare Hospice Benefits,

For more information on Medicare coverage and its costs, including free individual counseling, contact the local offices the state health insurance program(need site).

Another source of free information about Hospice services, including Medicare coverage, is the – American Hospice Foundation; Hospice Association of American

Other sources of funding:

  • Have you checked your Medigap insurance for Hospice coverage?
  • Medicare supplemental insurance is designed to cover the "gaps" between what Medicare does and does not pay. In Nevada standard Medigap plans sold by private insurance companies are available. These plans are regulated by state and federal law and must be clearly designated as Medicare supplements, identified by the letters A through J. For home Hospice care, the most common gap needing coverage is aide services – provided on more than a part-time or intermittent basis, or when there is no skilled care component. Of particular importance to those considering Hospice care are Plans K and L, which generally cover Hospice care co-insurance and copayments.
  • Have you checked out whether your life insurance, annuities, health insurance, or long term care insurance can help you pay for Hospice care?
  • Have you checked assets with you family or your personal assets, such as reverse mortgages?
  • Have you checked other options, such as charitable funds, veteran's benefits, county indigent care programs, or Indian Health Services?
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How do you choose?

While there are a great number of Hospice services — offering a variety of types of care and philosophies — not all services are available in every community. And not every Hospice provider is equipped to give every medical and personal service that a particular patient needs.

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What are your needs

Consider the unique advantages and disadvantages of Hospice care to decide whether it is right for your situation.

For many people, Hospice represents an important choice — allowing more autonomy and choice in directing final medical care than traditional treatment that focuses on life-saving procedures and cures. But the option is not the best fit for every patient who has a terminal disease — particularly those who feel strongly that Hospice care signifies "giving up on life" rather than facilitating a good death.

Potential Advantages

Hospice may be most fitting for those who want to:

  • Be treated at home or in a more homelike setting and avoid hospital admissions;
  • Focus on treating their symptoms rather than on curing their illness; and
  • Have the help of a team of people to assist with their comfort care, and emotional and spiritual needs.

Potential Disadvantages

Hospice care is probably not a good choice for those who:

  • Worry that working with a number of different health care workers may invade their privacy;
  • Wish to pursue experimental treatments or clinical trials for their conditions; or
  • Are they more comfortable receiving medical care in a traditional hospital setting.

The decision about whether Hospice care meets an individual's personal, physical, and medical needs should be determined by the patient and medical practitioners who are familiar with him or her. It may also be important to get input from family members and friends who may be responsible for providing some of the Hospice care.

Locate Hospice Providers

Hone your list of potential programs based on availability and services -

Assess the Staff

Learn the right questions to ask to ensure that your needs will be met by the Hospice staff. Visit the Hospice and meet the staff. If you are young and healthy and only planning far ahead, maybe you will want to volunteer at a Hospice.

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How do you prepare?

The reality of Hospice care requires a number of adjustments — from accommodating the annoyance of having strangers around performing intimate care tasks to facing the fact that death is near. There are steps to take and resources to turn to for help in arranging for ongoing care and in making the mental and physical adjustments that may be needed.

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Create a Care Plan

Because the team care concept involves many players, you will need a good plan to coordinate it. The Hospice team will do this.

Hospice care is based on a team concept in which care is coordinated among doctors, nurses, home health aides, social workers, clergy or other bereavement counselors, therapists, nutritional counselors, volunteers, and a primary caregiver. Hospice care begins when the patient, primary caregiver, or health care surrogate visit with the Hospice admission team. They then create a specific plan of care and schedule subsequent visits by the nurse, social worker, and others.

It is essential that the patient and family members are involved in setting up the type and plan of care, so that patients can have more control over their lives and more fitting care in the final days. It is also important to find a Hospice provider the patient and family can work with, and one that will provide the patient with comfort and respect — important reasons to carefully screen the Hospice care agency.

Deal with Personal Issues

Take some steps to preserve a sense of privacy as caregivers come and go from your home.

To cover emergencies, be sure that all care providers have complete contact information for those who should be notified — and that they are aware of the patient's medical preferences and directives, such as Do Not Resuscitate (DNR) orders and advance directives.

Make Modifications for Care at Home

Consider a number of ways to ensure a residence is free from hazards and supports care at home. (See the Health Services section for more on Home Modifications/Remodeling)

Receiving Hospice care at home is simply not an option for many people unless changes are made to their existing homes. To provide a safe place in which to receive care, there are some easy and obvious changes to make — and some more drastic changes that may require professional construction help.

Of course, choosing which modifications to make and deciding whether to invest the time, expense, and disruptiveness in making the more ambitious changes will depend on a number of factors — most importantly the patient's condition and whether it is likely to deteriorate quickly.

Overview of Hospice and Palliative Care

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