An aging population and growing incidence of chronic illness and disability in the population, have focused more attention on how best to provide care to individuals who are suffering from a terminal illness. Although home health care is often mentioned as an option for those who want to avoid entering a long-term care facility, at the onset of at terminal illness an often overlooked option involves using hospice care during the onset of a terminal illness in order to provide the greatest amount of comfort for a person living with a terminal illness, their caregivers and family.
Understanding Hospice Care
For people facing a life-limiting illness or injury hospice care is often not considered until when terminal illness has advanced to its late stages. However, hospice care can be considered earlier on during a life-limiting condition providing a valuable benefit to the patient and their caregivers by offering a higher level of support and palliative care. Unfortunately due to the misconception that hospice care is only available to individuals in the latter stages of terminal illness, terminally ill individuals and their loved ones often fail to account for the fact that hospice can be used much earlier on during the progression of a terminal illness than commonly thought. Further, individuals with a terminal illness and their loved one’s often fail to recognize that hospice care is covered in for a longer term under Medicare Part A and other private insurance plans. Before discussing how individuals can best use hospice services, it is important to consider what hospice care entails.
Hospice care according to the National Hospice and Palliative Care Organization, “involves 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.” The guiding principle which underlies hospice care is that every person has the right to die pain-free and with dignity while providing families with the necessary support to allow their loved one to do so.
Palliative care, according to the National Cancer Institute, incorporates a goal of preventing or treating, as early as possible, the symptoms and side effects of the disease and its treatment, in addition to the related psychological, social, and spiritual problems. Palliative care is also called comfort care, supportive care, and symptom management. The goals and methods employed in hospice care and palliative care overlap and are frequently used in conjunction with each other.
Requesting Hospice Care
Hospice care is requested by through a formal request or a ‘referral’ made by the patient’s doctor to a provider of hospice care. A representative of a hospice program will follow up on the referral within 48 hours to collect information on the patient’s condition, and evaluate the scheduling and level of care needed. Hospice care is usually ready to commence within a few days of the referral with an expedited process in urgent cases.
How Are Hospice Services Delivered
Hospice services are delivered at home by an interdisciplinary team consisting of hospice volunteers, registered nurses, social workers and home health aides. A hospice doctor is also part of the interdisciplinary team, which in some cases can be fulfilled by the patient’s regular doctor. To supervise care. For each patient, a care plan is prepared to guide the patent’s care and specify the particular roles each member of the interdisciplinary team will fulfill in providing hospice care. The care plan is frequently reviewed to make sure any changes and new goals are in the plan.
The amount of care received by the patient will vary according to the care plan and the amount of support offered by the patient’s family. Further, hospice services are available on an “on-call” basis 24 hours a day, seven days a week.
For patients suffering from terminal illnesses that involve pain and other symptoms, palliative care may be provided as part of hospice services. In this case, hospice staff will work with the patient’s physician to make sure that medication, therapies, and procedures are designed to reduce pain, discomfort, and distress.
Paying for Hospice Care
Hospice care is covered under the Medicare program when qualifying criteria are met and documented. To receive hospice care benefits the patient must be entitled to receive Medicare Part A. If the patient is eligible for Medicare Part A, the following additional criteria must be met:
- The hospice doctor and your regular doctor must certify that the patient is terminally ill and is expected to live six months or less. A beneficiary is considered to be terminally ill if the medical prognosis for life expectancy is six months or less if the illness runs its normal course. However, living longer than six months does not necessarily mean the patient loses the benefit. After the initial certification period, each beneficiary receives an unlimited number of additional 60-day periods.
- The patient will accept palliative care rather than care to cure the illness.
- The patient signs a statement choosing hospice care instead of other Medicare-covered treatments for the terminal illness and related conditions.
Patients must pay the deductible and coinsurance amounts for all Medicare-covered services to treat health problems that are not related to the terminal illness and related conditions.
Patients may also receive respite care, in instances where a caregiver such as a family member needs a rest. The patient may receive up to five days of inpatient care, in a Medicare-approved facility. Respite care may be provided multiple times. However, the criteria for granting respite care multiple times is discretionary.
The type of hospice care a patient requires will be determined by the care plan. Covered hospice services can include:
- doctor services,
- nursing care,
- medical equipment,
- medical supplies;
- prescription drugs that are taken for symptom control or pain relief,
- hospice aide and homemaker services,
- physical and occupational therapy,
- speech-language pathology services,
- social worker services, dietary counseling,
- grief and loss counseling for the patient and their family,
- short-term inpatient care (for pain and symptom management),
- short-term respite care, and any other Medicare-covered services needed to manage your terminal illness and
- related conditions, as recommended by the interdisciplinary team.
Advance Directives and Hospice Planning
Discussing end of life decisions while a person is still healthy, may be a difficult subject for some families. However, proactive planning can reduce a great deal of stress and uncertainty down the road in the event a loved one becomes terminally ill. Although, it may not be comfortable to do so now is the best time to learn more about hospice and begin planning for the end of life care and decision making rather than after a terminal illness diagnosis. Most families who plan ahead will attest to the fact that this can greatly reduce stress when the time for hospice is needed. Armed with an end of life plan patients and their families are not forced into making these decisions when decision making and planning becomes even more difficult.
One way in which families can do end of life planning involves creating “advance directives,” or instructions about future medical care if an individual is unable to make decisions on their own. There are two types of advance directives: a living will and a medical power of attorney.
A living will, much like a will that would provide instructions for the disposition of an individual’s estate upon their death, however living will provides instructions regarding medical treatment or other matters while the individual is still living, yet unable to make decisions. A living will may include instructions as to managing a disabled individual’s affairs including health care decision making such as using hospice care in the event of a terminal illness.
Similarly, a medical power of attorney is a document that enables an individual to appoint someone to make decisions about medical care in the event of disability. The person appointed to act as a health care power of attorney is authorized to speak on behalf of someone in case of disability. Executing a power of attorney before a health care crisis such as sudden disability or can eliminate the need for planning under the emotional stress and uncertainty of a sudden terminal illness and can offer families added piece of mind found in making major health care decisions with clarity and input from all of those involved.
Using Hospice Care
Using hospice care can provide a person with a terminal illness the right to die pain-free and with dignity while providing families with the necessary support to allow their loved one to do so. The process of using and paying for hospice services can be simplified an advanced planning that establishes what will happen in the event a loved one is stricken with a terminal illness. By understanding that hospice that can be used as a longer term solution for the care of an individual with a terminal illness and that hospice care directives should be considered as part of end of life planning while a person is still healthy, a great deal of stress and emotional strain can be reduced in an already difficult time. Contact Harbor Light Hospice for more information.
