What is “Hospice”? Hospice is a philosophy of care that focuses on pain management and comfort for those who are terminally ill. Efforts to cure are suspended because the patient and family have accepted the patient’s physical ailments as terminal.
This hospice care concept had its roots in England in the 1960s. It was based on the idea of offering “hospitality” to weary and sick travelers. It made its way into the United States in the 1970s where it has grown steadily in popularity. Hospice care was generally provided in a patient’s home. However, hospice is now also available in hospitals, nursing homes, and assisted living centers or in a private hospice facility.
Why would a family ever want to use the hospice program for a loved one? There are several reasons:
1) Comfort Care – when the family and their doctor have determined that the patient has a terminal illness that effort to cure cannot reasonably help, the focus switches from curative care to comfort care. The hospice staff – including nurses, doctors, social workers and counselors – treats the person rather than the disease. Every effort is made to provide a compassionate environment that looks to the physical and spiritual needs of the individual. Pain management is also given along with anything else that will improve the quality of life for the patient during their final days. Unity with the family is one of the high concerns. In sum, the philosophy of care does not seek to hasten or postpone death but rather to provide pain relief and management of other symptoms so that the patient’s last days can be spent surrounded by family and friends in a loving environment.
2) Moral Support – Hospice programs typically have support teams, including counselors and social workers, who attend to the needs of the dying person’s family. During this time of grief, such support can be essential to maintain emotional health for both the family and the dying person. There is also follow-up support even after the patient passes away, with some hospice teams providing emotional support for the spouse and children for up to a year after the death. While this type of support is provided to some degree by the nursing home or assisted living staff, hospice generally provides this to a further degree. Hence, where there is a spouse or family members who need this extent of support hospice would be a good alternative.
3) Financial Support – At this point in time there is funding for the hospice program through Medicare, Medicaid and most private insurance companies. The commonly provided financial coverage insures that most persons who can qualify for the program will not have to struggle with the ability to pay the high costs of care during their final months of life.
Regarding financing for hospice, there is plenty of confusion about what the three main funding sources will pay for. The funding options are generally limited as follows:
a) Medicare – The Medicare Hospice Benefit was initiated in 1983, and covers hospice under “part A” hospital insurance benefits. Medicare covers the following hospice services and pays nearly all of their costs:
- Doctor services
- Nursing care
- Medical Equipment (like wheelchairs or walkers)
- Medical supplies (like bandages and catheters)
- Drugs for symptom control and pain relief
- Short term care in the hospital, including inpatient for pain and symptom management
- Home health aide and homemaker services
- Physical and occupational therapy
- Speech therapy
- Social work services
- Dietary counseling
- Grief support to help the patient and their families
Medicare will not pay for the following when the person is on hospice: curative treatments; medications not related to the hospice diagnosis and care from a provider other than the hospice team that is the same type of care. Nursing home room and board are also not paid for by Medicare.
b) Medicaid -- In 1986 states were given the option to include hospice services in their Medicaid programs and most of them did (including Michigan). A person who has qualified for Medicaid will continue to receive coverage for all aspects of the hospice program not covered by another source, including room and board if the person is in a nursing home. However, if there is private insurance that will pay for the room and board, Medicaid will expect that the private insurance pay first.
c) Private Insurance – Most private insurance programs do cover the hospice treatments. However, not all of them provide coverage for room and board while the person is on hospice. Some insurers, for example Blue Cross, do provide a certain amount of coverage for room and board (typically about 210 days) while the person is on hospice. Unfortunately, the insurance contract may require that the person be in “skilled care” setting, and thus may not pay for hospice room and board while the person is in assisted living, only in a nursing home. Still, a person on Medicaid who can get months of insurance coverage for room and board at a nursing home from a private insurer will be able to keep all of their income (social security, pension, etc), which normally would have to be paid to the nursing home as a “patient pay” amount.
One common aversion to using hospice is the fear that it will mean “giving up” and convey a message of no hope to the ill person. Such persons need to know that this is not true; if the person’s condition improves or the disease goes into remission that person can be discharged from hospice and return to active treatment if desired. Hospice can be continued again at a later time. Hence, those struggling to live can make use of hospice without fearing that they will be locked into a program with the only end being death.
New Rules for 2018 - The Centers for Medicare & Medicaid Services (CMS) has issued three final rules outlining 2018 Medicare payment rates for skilled nursing facilities, hospice, and inpatient rehabilitation facilities. The final rules are effective for fiscal year (FY) 2018 and reflect a broader Administration strategy to streamline administrative requirements for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care. “These announcements take important steps to support innovation in the delivery of care in order to promote a Medicare program that is responsive to patients’ unique needs and ensure that patients have access to high-quality skilled nursing, hospice, and inpatient rehabilitative care,” said CMS Administrator Seema Verma. “These rules update quality reporting requirements and allow providers to spend less time and fewer resources on cumbersome paperwork, so they can increase their focus on the needs of Medicare patients.”
Families who are unsure whether a loved one can qualify for hospice should consult with their family doctor and local hospice provider. Questions about insurance coverage can be answered by a review of the contract with an attorney. Working together, we as a society can help those with terminal illnesses get the care they need and the support that will help foster a loving atmosphere during this most critical time in each person’s life