Frequently Asked Questions
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Considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury, hospice care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes. Support is provided to the patient’ s loved ones as well. At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so.
Hospice focuses on caring, not curing and, in most cases, care is provided in the patient’s home. Hospice care also is provided in freestanding hospice centers, hospitals, and nursing homes and other long-term care facilities. Hospice services are available to patients of any age, religion, race, or illness. Hospice care is covered under Medicare, Medicaid, most private insurance plans, HMOs, and other managed care organizations.
Typically, a family member serves as the primary caregiver and, when appropriate, helps make decisions for the terminally ill individual. Members of the hospice staff make regular visits to assess the patient and provide additional care or other services. Hospice staff is on-call 24 hours a day, seven days a week.
The hospice team develops a care plan that meets each patient’s individual needs for pain management and symptom control. The team usually consists of:
• The patient’ s personal physician;
• Hospice physician (or medical advisor);
• Home health aides;
• Social workers;
• Clergy or other counselors
• Trained volunteers; and
• Speech, physical, and occupational therapists, if needed.
Among its major responsibilities, the interdisciplinary hospice team:
• Manages the patient’s pain and symptoms;
• Assists the patient with the emotional, psychosocial and spiritual aspects of dying;
• Provides needed drugs, medical supplies, and equipment;
• Coaches the family on how to care for the patient;
• Delivers special services like speech and physical therapy when needed;
• Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time; and
• Provides bereavement care and counseling to surviving family and friends.
Anyone can request hospice services with a physician’s order and verification that there is an illness with a life-limiting prognosis of less than 6 months and the desire for comfort care. Care is available for patients with diagnosis of cancer, end-stage heart disease, ALS, Chronic obstructive pulmonary disease, renal failure, AIDS, and Dementia/ Alzheimer’s.
Sea Crest bills Medicare, Medi-Cal and/or private insurance for hospice care on your behalf. These benefits normally cover all hospice care including medications, supplies and equipment that are related to the terminal illness. Generally there is no additional cost to you.
At any time during a life-limiting illness, it’s appropriate to discuss all of a patient’s care options, including hospice. By law the decision belongs to the patient. Most hospices accept patients who have a life-expectancy of six months or less and who are referred by their personal physician.
The patient and family should feel free to discuss hospice care at any time with their physician, other health care professionals, clergy or friends.
No. Many communities have more than one hospice. Medicare requires certified hospices provide a basic level of care but the quantity and quality of all services can vary significantly from one hospice to another. To find the best hospice for your needs, ask your doctor, healthcare professionals, clergy, social workers or friends who have received care for a family member. You may want to call or meet with the hospices and ask questions about their services.
Certainly. If the patient’s condition improves and the disease seems to be in remission, patients can be discharged from hospice and return to aggressive therapy or go on about their daily life. If the discharged patient should later need to return to hospice care, Medicare and most private insurance will allow additional coverage for this purpose.
One of the first things the hospice program will do is contact the patient’s physician to make sure he or she agrees that hospice care is appropriate for this patient at this time. (Most hospices have medical staff available to help patients who have no physician.) The patient will be asked to sign consent and insurance forms. These are similar to the forms patients sign when they enter a hospital. The form Medicare patients sign also tells how electing the Medicare hospice benefit affects other Medicare coverage.
Your hospice provider will assess your needs, recommend any equipment, and help make arrangements to obtain any necessary equipment. Often the need for equipment is minimal at first and increases as the disease progresses. In general, hospice will assist in any way it can to make home care as convenient, clean and safe as possible.
There’s no set number. One of the first things a hospice team will do is to prepare an individualized care plan that will, among other things, address the amount of caregiving needed by the patient. Hospice staff visit regularly and are always accessible to answer medical questions.
In the early weeks of care, it’s usually not necessary for someone to be with the patient all the time. Later, however, since one of the most common fears of patients is the fear of dying alone, hospice generally recommends someone be there continuously. While family and friends do deliver most of the care, hospices may have volunteers to assist with errands and to provide a break and time away for primary caregivers.
Hospice patients are cared for by a team consisting of a physician, a nurse, social workers, counselors, home health aides, clergy, therapists, and volunteers. Each one provides assistance based on his or her own area of expertise. In addition, hospices provide medications, supplies, equipment, and other services related to the terminal illness.
Hospice staff is on call for emergencies 24 hours a day. Hospice care does not include a nurse in the home 24/7. If you require more care than can be provided in the home, some hospices have their own inpatient facilities. Most communities have nursing homes, inpatient residential centers and hospitals with hospice care options.
Hospice neither hastens nor postpones dying. Just as doctors and midwives lend support and expertise during the time of child birth, hospice provides its presence and specialized knowledge during the dying process.
No. Hospice patients receive care in their personal residences, nursing homes, hospital hospice units and inpatient hospice centers.
Hospice believes that emotional and spiritual pain are just as real and in need of attention as physical pain, so it can address each. Hospice nurses and doctors are up to date on the latest medications and devices for pain and symptom relief. In addition, physical and occupational therapists can assist patients to be as mobile and self sufficient as they wish, and they are sometimes joined by specialists schooled in music therapy, art therapy, massage and diet counseling. Finally, various counselors, including clergy, are available to assist family members as well as patients.
Very high. Using some combination of medications, counseling and therapies, most patients can attain a level of comfort they consider acceptable.
Usually not. It is the goal of hospice to have the patient as pain free and alert as possible. By constantly consulting with the patient, hospices have been very successful in reaching this goal.
No. While some churches and religious groups have started hospices (sometimes in connection with their hospitals), these hospices serve a broad community and do not require patients to adhere to any particular set of beliefs.
Hospice coverage is widely available. It is provided by Medicare nationwide, by Medicaid in 47 states, and by most private insurance providers. To be sure of coverage, families should, of course, check with their employer or health insurance provider.
The Medicare Hospice Benefit covers the full scope of medical and support services for a life-limiting illness. Hospice care also supports the family and loved ones of the person through a variety of services. This benefit covers almost all aspects of hospice care with little expense to the patient or family.
The first thing 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, some hospices will provide for anyone who cannot pay using money raised from the community or from memorial or foundation gifts.
Most hospices provide continuing contact and support for caregivers for at least a year following the death of a loved one. Many hospices also sponsor bereavement groups and support for anyone in the community who has experienced a death of a family member, a friend, or similar losses.