Answers to your most frequently asked questions.
The prospect of losing a loved one is one of the greatest challenges any of us face in life. Hospice care can make that journey a less fearful and more peaceful one for both the patient and their family/caregiver.
Hospice care is a philosophy of medical care focused on providing comfort, dignity, and support to people with terminal illnesses or nearing the end of life. Hospice care is not curative. When a cure is no longer an option, the hospice team provides relief of physical symptoms—including managing pain—as well as emotional and spiritual support for the patient, family/caregiver(s).
Hospice care is delivered wherever the patient is—home, nursing facility, or other type of residence. Patients on hospice never need to go to a medical office, hospital, or pharmacy to receive care or medications. Hospice Services are provided by a team of specially trained professionals and volunteers, and assistance is available 24/7. Hospice also offers a variety of counseling and bereavement services to families before and after a loved one passes.
All of the following criteria must be met for a person to receive Medicare hospice benefits:
The patient is eligible for Medicare Part A (hospital insurance).
The patient’s doctor and the hospice medical director certify the patient has a life-limiting illness and, if the disease runs its normal course, death may be expected in six months or less.
The patient signs a statement choosing hospice care instead of routine Medicare-covered benefits related to their life-limiting illness.
The patient receives care from a Medicare-approved hospice program.
You’ve just received the upsetting news that you or your loved one has been diagnosed with a terminal illness. Your physician may have determined that a cure isn’t possible at this time and that treatment may do little to prolong life or may in fact diminish quality of life. You or your loved one may decide to stop treatment intended to cure the illness and pursue care that focuses on comfort and quality of life.
The patient, family, and/or physician can make the initial call to hospice to get the process started. Physicians may be reluctant to recommend hospice care, so you may have to propose this option to your doctor. The Hospice staff will contact the patient’s personal physician, the patient, and the family to discuss eligibility, appropriate services, needs, and expectations. A plan of care will be developed specifically to meet the needs of the patient and their family.
Hospice care is paid for from a variety of sources. The types of payment coverage available and the services covered are discussed below.
Medicare: The Medicare Hospice Benefit is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive the full scope of medical and support services related to the terminal illness (and related illnesses) as determined to be medically necessary by the hospice physician.
Medicaid: In 48 states and the District of Columbia, Medicaid provides coverage for hospice services. In general, Medicaid hospice benefits parallel the Medicare benefit, although there may be some variations in certain states.
Private Insurance: Most insurance plans issued by employers and many managed care plans offer a hospice benefit. In most cases, the coverage is similar to the Medicare benefit although there may be some variations among employers depending on hospice providers in/out of network.
Tricare: Tricare is the health benefits program for military personnel and retirees. Hospice is a fully covered benefit under Tricare if services are provided by a Medicare-certified hospice.
Private Pay: If insurance coverage is unavailable or insufficient, the hospice social worker or finance advisor can discuss private pay and payment options with the patient or patient’s family.
Most people don’t know anything about hospice care until they’re faced with their own end-of-life issues or those of a loved one.
The criteria for hospice eligibility is that the patient has a terminal illness as a result of a chronic illness and has a life expectancy of six months or less. The physician will certify that the patient is no longer responding to aggressive treatment and has a life expectancy of six months or less if the disease runs its normal course.
Such a prognosis is only a prediction and doesn’t mean a person will pass away within six months, because everyone is different. If the patient lives longer than six months and there’s no improvement in their condition or they continue to decline, they may be re-certified by a physician for additional time. Some patients improve on hospice, occasionally to the degree that they’re healthy enough to no longer be eligible for the service and “graduate” from hospice. Of course, the patient is eligible for hospice again if his/her condition begins to decline again.
Generally, care begins within a day or two of the referral to hospice. It is initiated by a visit from the hospice nurse who assesses the patient to make sure they meet hospice guidelines. In urgent situations, service may begin sooner. The hospice nurse will review with the patient and family the services hospice offers and then sign the necessary forms to allow care to begin.
The role of caregiver for a terminally ill loved one is physically and emotionally demanding and often draining. Hospice understands this and provides a number of services to support the caregiver(s) during this challenging time. In addition to being available 24/7 for questions and concerns, all hospice providers offer respite care for the caregiver and grief counseling prior to and after the loss of a loved one. The family should ask a prospective hospice provider what services are available.
If you, a family member, or a friend needs hospice care or if you think the time may be close, the first step is to contact SAHC and request a consultation or ask your primary doctor to contact us and request an evaluation. Once you have contacted us, we will schedule a time for our clinical liaison to meet with you to explain hospice services and obtain clinical information on the patient, as well as written consent from the patient, or next of kin if the patient is unable to sign. After consents are signed, a Registered Nurse will review clinical information with the Hospice Medical Director to determine Hospice Eligibility.
In order to be eligible for hospice care a patient must have a terminal diagnosis with a life expectancy of 6 months or less. If the patient is determined to be eligible, the RN Case Manager will admit patient hospice services and order any appropriate medical equipment and medication per the Hospice Medical Director’s order. Within 5 days of admission, a Spiritual Care Coordinator and Medical Social Worker will make contact to explain their role and the services they provide and set up a time to evaluate the patient/family’s specific needs. For more detailed information about the admission process, please feel free to reach out to San Antonio Hospice Care today.
It’s important to be well informed about a hospice agency that you’re considering to provide services for you or your loved one. The following are suggested questions to ask when deciding on a hospice care provider:
Accreditation: Is the hospice agency accredited by a nationally recognized accrediting body such as the Accreditation Commission for Health Care (ACHC)? If a hospice has voluntarily sought accreditation, this indicates the organization is committed to providing quality care. ACHC is an independent, not-for-profit organization that evaluates and accredits healthcare organizations and is an important indicator in determining the quality of healthcare services provided.
Certification: Is the hospice program Medicare certified? Medicare certification means the program has met federal minimum requirements for patient care and management. Note: The hospice provider must be Medicare-approved to receive Medicare payment for its patients. To find out if a certain hospice provider is Medicare-approved, ask the hospice provider, check the HospiceDirectory.org website, or consult your state hospice organization.
Licensor: Is the program licensed by the state if your state requires this?
Consumer Information: Does the hospice provide written materials outlining services, eligibility criteria and payment procedures?
Admission Policy: How flexible is the hospice in applying its policies to each patient and their differences? If you’re uncertain whether you or your loved one qualifies for hospice is the hospice agency willing to conduct an assessment to help you make a decision?
Plan of Care: Does the hospice organization create a unique plan of care for each patient? Is the plan carefully and professionally developed to include input from the patient and family? Is the plan of care routinely updated as the patient’s needs change?
Physician Collaboration: How will the hospice physician collaborate with the hospice team and/or referring physician.
Staff Communication with Patient and Family: Does the hospice staff meet regularly with the patient and family/caregiver to discuss care?
Family Caregiver: What help can the hospice offer in coordinating and supplementing the family’s efforts, and will it accommodate job schedules, travel plans, or other family responsibilities? If the patient lives alone, what alternatives to a live-in caregiver does the hospice suggest?
Preliminary Evaluation: Who on the hospice staff conducts the preliminary evaluation of the types of services needed in the patient’s home (Nurse, Social Worker, Spiritual Care Coordinator etc.)? Is this evaluation performed in the home or over the telephone? Are members of the family consulted for their input?
Personnel: Does the hospice agency train, supervise, and monitor its caregivers and volunteers? Does the hospice agency perform background checks done on these personnel? How often does the hospice agency send a nurse to the patient’s home to review the care being provided?
Assistance/Concerns: Which person at the agency should you call with questions or concerns?
Costs: How does the agency handle payment and billing? If you need financial assistance, what resources does the agency provide?
Telephone Response: Does the hospice have a 24/7 telephone number to call when you have questions or concerns, prior to or after enrolling in hospice service? Your first experience calling a hospice provider to get information is a great indicator of what kind of care you can expect.
After-Hours Emergencies: How does the hospice staff respond to after-hour emergencies?
Services: How quickly can the hospice initiate services? What are its geographic service boundaries? Does the hospice provide medical equipment—such as hospital beds, walkers, etc.—or other items to increase the patient’s comfort and safety?
Inpatient Care: What are the hospice program’s policies regarding inpatient care? Where is such care provided? What happens if the patient no longer needs inpatient care and wants to return home?
Patient’s Rights and Responsibilities: Does the hospice agency provide the patient and/or family/caregivers a copy of the patient’s rights and responsibilities?