Delivery of Hospice Care

According to the National Hospice and Palliative Care Organization, (NHPCO, 2015) the interdisciplinary hospice team is responsible for establishing a care plan, that

• Manages the patient’s pain and symptoms
• Orders requisite medications, medical supplies and equipment.
• Provides assistance with psychosocial and spiritual aspects of dying.
• Helps the family care for the patient and cope with the death of a loved one
• Provides assistance service such as hospice aides, homemakers and volunteers.
• Manage acute symptom issues by instituting continuous home care or hospitalization.
• Provides respite in patient care as needed
• After the death of the patient, provides bereavement support for the family and friends (p. 11).

Where care is provided

Hospice care is generally provided in the home. If a person is living in an assisted living facility, that is considered to be their home. Nurses and aides can come to that facility from homecare agencies.

There are free standing hospice facilities that provide care along with hospitals and skilled nursing facilities.

According to the NHPCO (2015), 58.9% of patients in 2014 received hospice care at home with 31.8% receiving care in a hospice inpatient facility.

The International Association for Hospice and Palliative Care attempts to monitor and post on their website hospice and palliative care facilities. Go to their website and find those closest to you in their global directory of programs and services. http://hospicecare.com/home/

Coverage for hospice services

Coverage for hospice services can be provided by private insurance, Medicaid, and Medicare, under the Medicare hospice benefit. Private insurance plans provided by employers and managed care plans often include a hospice benefit or provide an option to add a hospice benefit. Medicaid, offered by all states and the District of Columbia, offers a hospice plan. There may be some variation in the hospice benefits provided by private insurers and Medicaid but generally they follow the coverage provided by the Medicare benefit which is discussed here in detail. In 2014, 85.5% of hospice care was covered by the Medicare hospice benefit. In addition, Medicare law states no person can be refused hospice care if they are unable to pay. Hospice facilities do fund raising to provide care for those who need financial assistance (Hospice Directory, 2016).

Medicare hospice eligibility

The Medicare Hospice benefit is usually available to individuals who meet the following criteria:

• eligible for Medicare Part A (MEC)
  • U.S. citizen or a permanent legal resident for at least five continuous years.
  • age 65 and older
  • if less than 65, already receiving Social Security benefits or have received disability payments for 24 months, or
  • are eligible for Medicare due to end-stage renal disease or amyotrophic lateral sclerosis.
• certified by a hospice medical director and a primary physician to have a life-limiting illness with a probable life-expectancy of less than six months.
• have signed agreement, to receive hospice services that maintain comfort and control the symptoms of the certified life-limiting illness and are willing to stop treatments designed to prolong life. (Medicare benefits will still cover services for any health problem that is not related to the life-limiting illness.)
• hospice care must be provided by a Medicare-certified program.

What is covered under the Medicare Hospice Benefit

• A onetime hospice consultation with a hospice medical director to discuss care options before joining hospice is recommended for patients and family.
• Payment for all prescription drugs related to the terminal illness is covered. This would include pain medications and other medications used to control symptoms. Medications for other conditions, such as insulin, is covered by regular Medicare/Medicaid or private insurance, which ever the patient ordinarily uses.

Physician services

The hospice medical director works with the hospice team to develop the plan of care and is available to consult with the primary doctor.

Nursing services

Homecare services vary depending upon the needs of the patient. Nurses are responsible for monitoring symptoms, assessing and communicate changes in patient condition and preferences. They educate patients and family members. They also report any major changes to the doctor and the hospice team. A nurse will increase the number of visits as needed by the patient and family. A nurse is on call 24-hours a day, seven days a week. They will make additional visits when situations occur that call for skilled care.

Nursing services and aide services do not provide 24 hour care in the home, except in times when severe symptoms need management. It is crucial family members realize that. Medicare does not pay for what is termed custodial care.

Medical equipment

Typical equipment would include a hospital bed, wheelchairs, walkers and bedside commodes. These are all paid for by Medicare

Medical supplies

Bandages, catheters, irrigation fluid are typical supplies again paid for by Medicare.

Instant feedback

Which of the following is covered under the Hospice Medicare Benefit?

Payment for all prescription drugs related to the terminal illness and other illnesses.
Nursing services

 

References:

• Global Directory of Palliative Care Services, Hospices and Organizations (2016). International Association for Hospice and Palliative Care. April 14, 2016 retrieved from http://hospicecare.com/global-directory-of-providers-organizations/
• Hospice Care in America (2015). NHPCO’s Facts and Figures. April 14, 2016 retrieved from http://www.nhpco.org/sites/default/files/public/Statistics_Research/2015_Facts_Figures.pdf
• Hospice Directory. Paying for Hospice: Medicare/Medicaid/More Options. Accessed at www.hospicedirectory.org/cm/about/paying on April 20, 2016.
• Medicare Hospice Benefits (2016). U.S. Department of Health and Human Service. Centers for Medicare & Medicaid Services: Baltimore, MD. April 14, 2016 retrieved from https://www.medicare.gov/Pubs/pdf/02154.pdf.
• Medicare and Minimum Essential Coverage (MEC) U.S. Department of Health and Human Service. Centers for Medicare & Medicaid Services: Baltimore, MD. May 14, 2016 retrieved from https://www.cms.gov/medicare/eligibility-and-enrollment/origmedicarepartabeligenrol/index.html