Hospice

FAQ

1. What is hospice?
2. Isn’t hospice a specific kind of house or facility?
3. Is hospice care only for cancer patients?
4. What is the hospice philosophy towards death?
5. How does a patient qualify for hospice?
6. What if the patient lives longer than 6 months after electing hospice care?
7. What does the hospice admission process involve?
8. What services are provided by hospice?
9. What is the difference between “palliative care” and “hospice care”?
10. How is hospice paid for?
11. Is hospice care available in a nursing home?
12. What is a hospice “inpatient unit”?
13. What is “residential hospice”?
14. Does a hospice provide around-the-clock care?
15. What is the usual amount of staff provided by hospice?
16. What is “continuous care”?
17. What is respite care?

We also invite you to call our professional staff to discuss your personal concerns about Jewish hospice care, assisted living hospice care, and NJ hospice care at 888-313-0369
1. What is hospice?
Hospice is a program of palliative care for the terminally ill. The goals of hospice are to provide comfort to the patient and support to the patient’s family. Core services include medical care, nursing care, medical social services, counseling, and spiritual services. Hospice provides medical equipment and medications related to the terminal diagnosis. Many patients and families also receive services from trained volunteers, therapists and home health aides.

2. Isn’t hospice a specific kind of house or facility?
No. Hospice is a kind of care—specifically, comfort care for the terminally ill. The vast majority of hospice care is provided in the home of a patient or a family member, or in a long-term care facility such as a nursing home. Hospice care is also available in a small number of hospice residences and hospice units in hospitals.

3. Is hospice care only for cancer patients?
Hospice care is provided for all “end-stage” diseases that have progressed to a point where the patient is given a prognosis of 6 months or less to live by their doctor. While many hospice patients do have cancer, hospice also provides services to patients at the end stage of other degenerative illnesses such as cardiovascular disease, stroke, lung disease, Alzheimer’s disease, ALS (Lou Gehrig’s Disease) and other neurological diseases, and HIV/AIDS.

4. What is the hospice philosophy about death?
Hospice care affirms life and regards dying as a normal process. It neither hastens nor postpones death, but works to achieve the best quality of life for patients and their families by managing pain and symptoms and by providing emotional and spiritual support as needed and requested.

5. How does a patient qualify for hospice?
A patient will qualify for hospice care if two doctors certify that the patient is terminally ill and is expected to live less than six months if the disease follows its normal course. One of these doctors is the patient’s own physician; the other is the hospice medical director. This is the sole medical requirement for admission to hospice. The patient or designated representative must sign an election of hospice care stating that the patient is no longer seeking curative treatment and instead seeks care for comfort.

6. What if the patient lives longer than six months after electing hospice care?
Hospice care does not “cut off” at the end of the initial six-month period. Many patients live well beyond their original six-month prognosis. Hospice benefits continue as long as the hospice physician continues to certify a six-month life expectancy and the patient wishes to continue hospice care.

7. What does the hospice admission process involve?
The hospice in NJ will contact the patient’s physician to make sure that he or she agrees that hospice care is appropriate for the patient at this time. The patient or representative will be asked to sign consent and insurance forms. These are similar to the forms a patient signs when he/she enters a hospital. The hospice election form says that the patient understands that the care is palliative (that is, aimed at pain relief and symptom control) rather than curative. It also outlines the Jewish hospice services available. The form Medicare patients sign also describes how electing the Medicare hospice benefit affects other Medicare coverage.

8. What services are provided by hospice?
Hospice services in NJ include a registered nurse who acts as the case manager, a social worker, chaplain, home health aide, hospice physician, and non-medical trained volunteers. Our Jewish hospice care extends not only to the patient but to their family and significant others who would benefit from interventions (e.g., the nursing home staff, patient’s roommate, etc.). NJ hospice nursing staff are available on-call to the patient and their family members 24 hours/day, 7 days/week.

Additionally, hospice is responsible for the cost of providing treatment related to the patient’s terminal medical condition. This includes medications, medical supplies, transportation and medical services rendered. All supplies and equipment must be ordered through the hospice.

Hospice also provides bereavement services to the patient’s family for up to 13 months following the death of the patient, based on the family’s needs.

9. What is the difference between “palliative care” and “hospice care”?
Both types of care share a number of convictions:

• Care, not cure
• Considers patient and family as a single unit
• Emphasizes dignity, quality of life and spiritual needs
• Encourages patient and family to participate in decision making

“Palliative care” is invoked earlier in an illness, treating uncomfortable or distressing symptoms aggressively and sometimes utilizing medical treatments that may prolong life. Care is often given within a “medical model” employing hospitals, ambulatory clinics or other support services.

“Hospice care” begins later when a terminal diagnosis of less than six months to live has been made. It focuses on the dying process, keeping the patient as pain- and symptom-free as possible and as alert as he or she chooses to be.

10. How is hospice paid for?
About two-thirds of hospice patients in New Jersey have their hospice care covered through Medicare Part A, specifically the Medicare Hospice Benefit. This benefit pays for all hospice services related to the terminal illness.

Hospice is also covered under many policies of insurance companies and managed care companies. A Medicaid Hospice Benefit is available for patients who are eligible for Medicaid.

Patients without Medicare, Medicaid or private insurance may pay privately for hospice care. These fees are set by the hospice agency itself, such as The Martin and Edith Stein Hospice in NJ. The hospice may choose to use a “sliding scale” for families in very difficult financial circumstances and may choose to provide care without charge in very exceptional cases. Each hospice has its own policies on these matters.

11. Is hospice care available in a nursing home?
Hospice care can be provided wherever the patient lives as long as it is a safe environment for the patient and the hospice caregivers. Many, but not all nursing homes have contracts with hospices to provide hospice services in their facility. Hospice care in the nursing home is paid for by Medicare Part A. Medicare does not include nursing home room and board services; room and board and basic services of the nursing facility are paid for either by Medicaid or on a private pay basis. Additionally, some Medicare-certified skilled nursing facilities have a contract with a hospice program to provide an “inpatient” level of care to patients requiring acute pain or symptom control.

12. What is a hospice “inpatient unit”?
Some hospitals or skilled nursing facilities have a “hospice unit,” which is a section of the hospital designed to provide an environment where patients can receive hospice services provided by 24-hour staff. Patients admitted to an inpatient unit usually have special needs not readily managed in a home setting, such as complicated pain or symptom management. Stays in an inpatient unit are usually of short duration and payment arrangements vary by the individual hospice agency or insurance.

13. What is “residential hospice”?
There are a few “hospice houses” in New Jersey, also called “hospice residences.” These are freestanding facilities run by a licensed hospice for patients who have no other appropriate site to receive end-of-life care. They are homelike settings in which hospice patients are expected to remain until they die. Most New Jersey hospices do not have a hospice house. Policies regarding admission and room and board payment are determined by the individual hospice agency.

14. Does a hospice provide around-the-clock care?
Hospice care is an intermittent care program, meaning that care is provided through visits by hospice team members. Hospice does not provide ongoing 24-hour care for the patient at home. Hospice care provides support to the family—it does not replace the family. Hospice care is delivered through visits by nurses, counselors and volunteers (if the family wishes), and by home health aides (if the hospice determines appropriate need). If the family feels they must hire a companion for the patient for a portion of the day, they are free to do so privately.

15. What is the usual amount of staff provided by hospice?
Frequency of visits is based on the patient’s condition and is determined by the hospice. In cases of severe pain or symptom management, daily nursing visits may be necessary, but they are unlikely to be needed for most patients. Home health aide visits provide support in personal care related to the patient’s illness. All hospice services are available to families based on need, as determined by each hospice. Every case is considered for aide services, but there is no “requirement” that a hospice agency provide aide services on every case, nor that any set number of hours be provided.

16. What is “continuous care”?
Continuous care is one of four levels of hospice care and payment under the Medicare and Medicaid Hospice Benefits. It designates a short period—usually a day or less—when the continuing presence of the hospice staff is required in the home, as determined by the hospice. Usually these are periods when a person’s pain has suddenly increased or when symptoms need special attention. Most patients do not require any periods of continuous care.

17. What is respite care?
Respite hospice care is a period of up to 5 days during which the patient is moved to a caregiving facility (typically, a nursing home or hospital) to receive hospice care. Respite care is designed to give a tired or stressed family a break from caregiving or the opportunity to tend to personal business.