The CDC tracks mortality rates by place of death; the data reveals a pattern of end of
life care in America. The majority of U.S. residents die in the acute care
setting, whether in the emergency department, out-patient, or inpatient areas.
Nursing Home Long-term
The clear majority of patients end their lives in acute care treatment facilities. It should be
noted that acute-care hospitals, focus on
curative treatment. Many patients die in intensive
care units, or other hospital rooms, receiving prolonged futile "therapy" in an
environment that does not lend itself to a peaceful death.
Skilled nursing facility:
Skilled nursing facilities may contract to provide
hospice care. Some of theses SNFs have staff who have been specially trained to provide end of life care and pain management,
but that is not true of all skilled nursing facilities.
The majority of patients
die in an acute care facility.
Hospice/ Hospice home care:
Hospice care shares the goals of palliative care including: comfort, pain control and symptoms management. The difference lies in the populations served. Palliative care is delivered to patients seeking curative treatment. Hospice care serves patients with a terminal diagnosis and a life expectancy of less than six months.
Hospice care is a growing health care service. According
to the National Hospice and Palliative Care Organization (NHPCO), 29% of all Americans
who died in 1999 received some form of hospice service. By 2009, the NHPCO estimates that 41.6% of deaths in the U.S. were under the care of a hospice program:
- 1 .56 million patients received services from hospice
- 294,000 remained alive into the next year under the care of hospice services
- 243,000 were discharged from hospice services for various reasons including: extended prognosis, desire to seek curative treatment, etc.
- 1,020,000 patients died in hospice care
The Medicare hospice
benefit was created in 1983. According to Medicare law, most hospice care is to be delivered to people at home,
or whatever constitutes home. Not all people who need hospice care
are eligible for Medicare. Some insurance companies and state Medicaid systems
also provide hospice benefits, but these benefits can be quite limited.
Hospice care is an elected benefit covered under Medicare Part A for a beneficiary who meets all of the following requirements::
- The individual is eligible for Part A;
- The individual is certified as having a terminal illness with a prognosis of six months or less if the illness runs its normal course;
- The individual receives care from a Medicare-approved hospice program; and
- The individual signs a statement indicating that he or she elects the hospice benefit and waives all other rights to Medicare payments for services for the terminal illness and related conditions. In addition to covered hospice services, Medicare will continue to pay for covered benefits that are not related to the terminal illness.
The Medicare hospice benefit includes the following hospice services for the terminal illness and related conditions:
- Physician services furnished by hospice-employed physicians and nurse practitioners (NP) or by other physicians under arrangement with the hospice;
- Nursing care;
- Medical equipment;
- Medical supplies;
- Drugs for symptom control and pain relief;
- Hospice aide and homemaker services;
- Physical therapy;
- Occupational therapy;
- Speech-language pathology services;
- Social worker services;
- Dietary counseling;
- Spiritual counseling;
- Grief and loss counseling for the individual and his or her family;
- Short-term inpatient care for pain control and symptom management and for respite care; and
- Any other services as identified by the hospice interdisciplinary group.
Medicare hospice benefits
are provided in periods of care that require certification:
- 90 days with first certification
- 90 days with second certification
- 60 days with each subsequent
certification (theoretically, can be recertified unlimited numbers of times)
Once a patient has been
certified for a time period, a hospice will receive Medicare payment for each day at 1 of 4 different rates, depending upon the care provided on a given
day. Medicare payment rates to hospices vary according to regional labor costs.
- Routine home care
(in whatever is designated as home) covers care provided
in the home;
- Continuous home care covers care at home during a period of crisis when continuous care is
- General inpatient
care covers inpatient care when necessary for acute or chronic symptom
- Inpatient respite
inpatient care to provide the caregiver a period of respite and is
limited to not more than 20% of total patient care days.
Patient Coinsurance Payments
- Prescriptions and biologicals - co-pay of up to $5.00 per prescription.
- Inpatient respite care - up to 5% of the medicare payment made to the hospice for a respite care day. The amount of an individual’s coinsurance liability for respite care during a hospice coinsurance period may not exceed the inpatient hospital deductible applicable for the year in which the hospice coinsurance
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