Sometimes, the most challenging things in life involve sad, necessary, and life-changing decisions. Such is the decision to choose hospice care for yourself or your loved ones.
Choosing hospice care is a difficult decision. We are discussing end-of-life care, a challenging topic by itself. Added to the difficulty, we have to weave through the Medicare coverage for hospice care benefit guidelines and choose an organization to provide these services.
While the decision and overall can be difficult, it is important to understand your options when trying to obtain Medicare coverage. Let’s walk through this process together.
Hospice Eligibility with Medicare – Qualifications
To qualify for the hospice benefit, a physician must certify that the person is terminally ill, and if the illness runs its normal course, the person has six months or less to live.
When you decide to use hospice care, you agree to comfort care – which means instead of care to heal your illness, you will be receiving the care needed for symptom management and pain relief. It does not matter if you choose to stay at home to receive this care or if you are presently in an assisted living, skilled nursing center, or hospital.
Medicare Coverage for Hospice Care
Hospice is a covered benefit for a person with Medicare or Medicare Advantage, a federal program covering Americans age 65 or older. This coverage falls under Medicare Part A and covers:
1. Medical Supplies – like bandages, medical gloves, diapers, and oxygen.
2. Nursing – This care is needed to assess symptoms, change a dressing, administer medication, teach family members to care for the patient, and make a care plan.
3. Social Worker – A person may need dietary assistance, counseling, or spiritual care – these are a covered portion of the hospice benefit. The Social Worker will help you get the necessary services.
4. Drugs needed for pain management and symptom control will be covered under the hospice benefit. Other medications that you take for an illness, such as hypertension or diabetes, that are unrelated to your Hospice diagnosis, will still be covered under the regular Medicare.
5. Aide and Homemaker Services – Medicare covers continuous home care (CHS) or more than 8-hours during acute phases. Otherwise, a person will receive this care two to three times a week, depending on needs. A person’s family is also responsible for carrying out some of the required care and is trained by the hospice staff to provide this care.
6. Equipment – Hospital beds, wheelchairs, walkers, and other equipment needed to keep you comfortable are covered benefits.
7. Spiritual and Grief Counseling – for you during your hospice care and for your family after your death.
A person that is certified and receiving hospice may receive benefits for two 90-day periods and then may be recertified for an unlimited number of successive 60-day periods.
Medicare Coverage for Hospice Care at Home
Most people choose to remain in their homes for end-of-life care. The Medicare hospice benefit allows you to stay at home and receive care; in fact, 55.6% of the people who utilized the hospice benefit remained at home, according to a recent study.
The Medicare Hospice Benefit covers all of the services listed above, but the visits will happen in your home by the hospice providers that you choose.
Additional home services are the Symptom Management Hospitalization and Respite Care for the caregiver or family member assisting you during this time.
- Symptom Management Hospitalization: This is provided for an individual when hospice care alone cannot manage pain and symptoms at home. This stay is typically short-term and happens in a hospital, skilled nursing facility, or hospice facility.
- Respite care – Care of the Caregiver: Inpatient respite care will be arranged at a Medicare-approved facility like a nursing home or hospital. This gives your caregiver a break. The covered period is a five-day stay and may be used more than once, but only occasionally.
What Medicare Will Not Cover
- Room and Board- This is not a covered benefit, other than the short respite stays or hospice approved inpatient.
- Drugs to Cure your Illness – Only symptoms and pain medications are covered for your hospice diagnosis.
- Care for emergency room visits – you need to contact your hospice provider for emergencies.
- Inpatient Hospital or Ambulance Services unless it is arranged by your Hospice Provider
What to Consider When Choosing a Hospice Provider
There are many things to consider when choosing a Hospice Provider. The first question you need to answer is if they are a Medicare approved provider or licensed by the state or federal government. This link will help you find a Medicare Hospice Provider.
10 Questions to ask a Hospice Provider
1. What services does the hospice provider offer?
2. Does the hospice service have additional or alternative approaches for pain therapy, for example, music or massage therapy?
3. How many patients are assigned to each caregiver?
4. Will the caregivers remain the same, or will you have different staff each visit?
5. How does the staff respond to after-hour emergencies?
6. Do they have healthcare workers ready 24 hours a day, seven days a week, and holidays?
7. In an emergency, what is their average response time?
8. Does the hospice physician work with your physician in coordinating care?
9. How long has the organization been in operation – longevity is a good sign of quality.
10. Can the hospice care meet your specific needs?
Another essential question is how are nurses paid? Some hospice nurses are paid hourly. As a result, they may be able to spend more time with a patient if that patient requires it. Other nurses are paid per patient or per house.
This isn’t always the case, but such an incentive structure could cause these nurses to spend less time with each patient. Refer to Medicare’s questions when choosing a hospice for additional questions to ask.
Stopping Hospice Care
You have the right under Medicare to stop hospice at any time. It may be because your illness went into remission, or you have decided you want treatment for your condition. You also have the right to elect to restart hospice as long as you continue to have a qualifying diagnosis.
While choosing to initiate hospice care is difficult, it can also be a relief. To see more information on hospice and its dignified care, refer to the Medicare’s Hospice Booklet and the National Institute on Aging.
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