HOSPICE CARE

 

HOSPICE

INTRODUCTION AND BACKGROUND
 
Within our society dying has historically happened at home. However, this has changed and now most people die in medical institutions(hospital, nursing home, etc.).
it is the goal of medical care to cure people - to make us better.  There can be a focus on one aspect of a person's life.
Hospice care wants to help us to have a dignified death. This approach tends to be more holistic.
 
 

DEFINITION

This is a way to care for people with a terminal illness and also their loved ones.

It strives to meet all of an individual's needs:

  • Physical
  • Emotional
  • Social
  • Spiritual
 

Hospice also works with loved ones.

It enables people with terminal illnesses to make decisions about how and where they want to spend the rest of their lives.

GOALS OF CARE

The overall goal is to help people to live as comfortably as they can for as long as they live and to help their family/caregivers to live with them.

 

Pain Control

This is a major fear of many who are seriously ill. Hospice will attempt to achieve control over pain without impacting level of alertness.

Living Life

Individuals are helped to achieve physical and emotional comfort in order to concentrate on living.

Treating individuals and Their Loved Ones as a Unit

An individual's loved ones feel the pain of the terminal illness. Hospice provides relief to caregivers.

COMPONENTS OF CARE

Physical Needs

Hospice tries to help individuals to use their physical abilities as fully as possible. People can be more comfortable with:

  • Pain and symptom relief
  • Changes in body position
  • Back rubs
  • Attention to personal hygiene

Social Needs

Seriously ill individuals may not be as active as they used to be but we are all still social beings and hospice can help with:

  • Favorite foods
  • Listening to music
  • Sharing time with family and friends
  • Being well dressed and groomed
  • Putting financial matters in order

Emotional Needs

Individuals and their families cope with loneliness, isolation and fear. Hospice:

  • Treats them so they know they are important to each other.
  • Gives honest compassionate answer to their questions.
  • Encourages all to express how they think and feel.
  • Help families and friends to express their emotions.

Spiritual Needs

Spiritual matters are important for the terminally ill individual and others. Hospice can help:

  • Contact the individual's own spiritual leader
  • Bring in the hospice's own chaplain
 
MEDICARE AND HOSPICE
 
Medicare has a hospice benefit for those who are at home, in a hospital, or  a nursing home. The following describes the requirements and characteristics of this benefit. Services are available for caregivers.
 
Requirements to obtain the Medicare Hospice Benefit(most other insurance carriers follow the medicare criteria but check with a specific carrier to be sure).
 
 
  • Must be eligible for Medicare Part A.
  • A MD and also the Hospice medical director certifies there is a life limiting illness (previously it had to be six months left to live). 
  • Curative treatment will no longer be sought.
  • There must be an available caregiver.
     
  • Sign a statement to choose Hospice care instead of other Medicare benefits to treat the terminal illness.(Medicare continues to pay for health problems unrelated to the terminal illness).
     
Coverage covers:
 
 
  • Medical care
  • Nursing care
  • Social worker
  • Home Health aide and homemaker
  • Physical and Occupational therapy
  • Speech therapy
  • Dietary counseling
  • Grief and loss counseling(including the family)
  • Medical equipment and supplies
  • Medications(for symptom control and pain relief)
  • In-patient care(short term for symptom management)
  • Respite care(for caregivers)
     
Coverage Does not Include:
 
 
  • Treatment to cure the terminal illness
  • Medications to cure the terminal illness(rather than for symptom control or pain relief)
  • Room and Board(for example, in a nursing home Medicare will not pay for these services. This  may have  to be paid out of pocket).
  • Care by other providers
  • Care in an Emergency room, ambulance, inpatient facility unless arranged by the hospice team or if the medical problem is unrelated to the terminal illness.
Location of Services:
 
 
  • Home(including assisted living)
  • Nursing Home
  • Hospital
  • Hospice House(Residential)
 
Team
 
Care is provided by a team which should include:
 
 
  • Doctor
  • Nurse
  • Home Health aide
  • Homemaker
  • Social Worker
  • Counselors
  • Chaplin
  • Volunteers
 
There has been some concern about the rise in hospice programs of which many seem to be for profit agencies. CMS asked the Office of Inspector General to engage in an investigation of Hospice programs under Medicare.
Following is a summary of that report and final Medicare regulations(unrelated to that report)nut also about Hospice.
 
Summary of OIG Report
 
Background:
 
  • Between 2005 and 2009 hospice payments by Medicare increased 53 %. In nursing homes the increase was almost 70%.
  • In 1992 13 % of hospice programs were for profit and in 2009 they were 56 %.
 Findings: 
 
  • 82 % of hospice claims for those in nursing homes did not meet Medicare coverage requirements in 2009.
  • 63% of Medicare hospice claims did not meet plan of care guidelines.
  • In 46 % of hospices surveyed health deficiencies were cited most often.
 
Another OIG report found:
 
  • Many hospices had more than 2/3 of their beneficiaries in nursing homes.
  • OIG labeled them "high percentage hospices".
  • Often the beneficiaries required less complex care but required hospice care for longer periods.
  • These hospices billed Medicare more on average per beneficiary
  • "High percentage hospices" are more likely to be non-profit.
 
CMS will:
 
  • Monitor hospices which depend heavily on nursing home care
  • Reduce Medicare payment for hospice care in nursing homes.
 
 
 
 
 
Final Medicare Hospice Regulations in August, 2011
 
 
The Centers for Medicare and Medicaid(CMS) is publishing new regulatons about payments and reviews of hospice services.
 
  • Some new requirements include the following:
  • 2.5 % increase in Medicare payments for fiscal year 2012.
  • Changes the way hospice patients are counted.
  • Implements a quality reporting program
  • Hospices will be required to collect quality data by october 2012 and to report in 2013.
For more information from the Federal Register go to: www.federalregister.gov/inspection.aspx
 
 
 
 
 
CONTACT/ RESOURCE INFORMATION
 
*MEDICARE
1-800-633-4227(MEDICARE)
www.medicare.gov
 
HOSPICE ORGANIZATIONS
:
 
NATIONAL HOSPICE & PALLIATIVE CARE ORGANIZATION
 
 
 
HOSPICE ASSOCIATION OF AMERICA
Within Mass:
 
HOSPICE & PALLIATIVE CARE FEDERATION OF MASS
  • 800-536-6300
CENTRAL MASSACHUSETTS PARTNERSHIP TO IMPROVE CARE AT THE END OF LIFE
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