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Hospice

Hospice care is provided to patients who have a limited life expectancy. Hospice care emphasizes palliative, rather than curative treatment, comforting those who are nearing the end of their lives and easing their pain as much as possible. These patients have made a decision to spend their last months at home or in a homelike setting. Although 90% of hospice patients are cared for in their homes, care can also be delivered in nursing homes or hospice centers.

The patient and family are both included in the care plan and emotional, spiritual and practical support is given based on the patient's wishes and family's needs. Trained volunteers can offer respite care for family members as well as meaningful support to the patient.

One of the first things hospice will do is assist families in finding out whether the patient is eligible for any coverage they may not be aware of. Barring this, most hospices will provide for anyone who cannot pay using money raised from the community or from memorial or foundation gifts.

The following are signs that looking into hospice care may be an appropriate step:

  • If life expectancy is six months or less. If the patient outlives this initial prognosis, the primary care physician may recertify the patient for a supplementary 60 day periods. Patients who stabilize may also come on and off hospice, as per their doctor's evaluation.
  • If there are no more options for curative treatment and/or the individual does not wish to pursue further curative treatment.
  • If pain and symptoms have begun to interfere with the quality of life and it becomes too difficult for them to stay at home without assistance.
  • If adult children wish to learn more about the options for a parent's care and how to cope with the final stage, death.

Medicare Hospice Benefit

Medicare Part A has a hospice benefit. The Medicare benefit includes many services not generally covered by Medicare and more than 90% of the more than 2,500 hospices in the United States are certified by Medicare. Medicare will cover any care that is reasonable and necessary for easing the course of a terminal illness. The Medicare Hospice Benefit provides for:

  • Physician services
  • Nursing care
  • Medical appliances and supplies
  • Drugs for symptom management and pain relief (maximum $5 copay)
  • Short-term inpatient and respite care
  • Homemaker and home health aide services
  • Counseling
  • Social work service
  • Spiritual care
  • Volunteer participation
  • Bereavement services

Services are considered appropriate if they are aimed at improving the patient's life and making him/her more comfortable. Physical, occupational and speech therapy, and even chemotherapy, may be covered if they are for comfort, not cure.

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 added a new hospice benefit: Medicare will pay for a hospice physician to consult with terminally ill patients who are not yet in a hospice. The consult, which could occur in a hospital, nursing home, other facility, or at home, may include a pain assessment as well as counseling on care options and advance care planning.

To be eligible for Medicare's hospice benefit, a beneficiary must be entitled to Medicare Part A and be certified by a physician to have a life expectancy of six months or less if the illness runs its expected course. Living longer than six months does not mean the patient loses the benefit. After the initial certification period, each beneficiary receives an unlimited number of additional 60-day periods. People can live for years on the hospice benefit as long as their physician or hospital medical director still believes that they have a life expectancy of six months or less.

In addition, the patient must sign a statement electing the hospice benefit. By doing so, he is foregoing treatment to cure his illness and electing to receive only care to make his last days more comfortable. This is a big step for many patients and their families. The patient himself must make this election, provided he has capacity. If the patient does not have capacity, then his/her decisions about health care can be contained within an advance medical directive. However, a patient is not locked into hospice once he elects it. It is possible to revoke the benefit and re-elect it later, and to do this as often as needed. There also is no requirement that the hospice beneficiary be homebound.

Benefit recipients are allowed to keep their regular physician (or nurse practitioner, under the new Medicare law), and there may be a value in having an independent medical professional overseeing the care a patient receives from a hospice. The Medicare hospice benefit does not cover room and board in a nursing home, but if Medicaid (or some other payer) foots this bill, Medicare will pay for care related to the terminal illness. However, there must be a contract between the nursing home and the hospice providing the care, and this is something to look into when selecting a nursing facility.

Contact the Elder & Disability Law Center through this Web site, by phone at 202-769-0207, 866-399-4324, or by e-mail.