Hospice provides comfort care to the terminally ill patient and support to the patient’s family. Services include medical and nursing care, social and spiritual support. 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.
No, hospice is a kind of care, specifically comfort care for the terminally ill. A majority of hospice care is provided in the home of a patient or a family member, or in a long term care facility (nursing home or assisted living).
Less than half of all hospice patients have cancer. Hospice care is provided for all “end-stage” diseases, that is when a disease has progressed to a point where the patient is given a prognosis of 6 months or less to live by their doctor. Hospice cares for patients at the end stage of illnesses such as lung and cardiovascular disease, stroke, Alzheimer’s disease, ALS and other neurological diseases.
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.
A patient qualifies for hospice care if two doctors sign a document that he/she is terminally ill and is expected to live less than six months. 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.
Hospice care does not “cut off” at the end of the initial 6 month period. Many patients live well beyond their original 6 month prognosis. Hospice benefits continue as long as the physician certifies a 6 month life expectancy and the patient wishes to continue hospice care.
The patient or representative will be asked to sign consent and insurance forms. The hospice election form says that the patient understands that the care is aimed at pain relief and symptom control rather than cure. It also outlines the services available. Medicare and insurance coverage is explained.
Hospice services include: a registered nurse who acts as case manager, a social worker, chaplain, home health aide, hospice physician, and non-medical trained volunteers. Hospice cares for the patient and their family and significant others who would benefit from support (for example, the nursing home staff, patient’s friend or roommate, etc.). Hospice nurses are available on-call for the patient and family members 24 hours a day, 7 days a week. Hospice is responsible for the cost of providing treatment related to the patient’s terminal medical condition. This includes medications, medical supplies, transport and medical services rendered. All supplies and equipment ordered for a patient 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.
The Medicare Hospice Benefit pays for all hospice services related to the terminal illness, except that there may be a co-payment of up to $5 for each prescription related to the terminal illness. Hospice is also covered under Medicaid and by many private insurance companies.
Hospice care can be provided wherever the patient lives as long as it is a safe environment for the patient and the hospice caregivers. Hospice care in the nursing home is paid for by Medicare Part A. Medicare does not include nursing home room and board services — basic services of the nursing facility are paid for either by Medicaid or on a private pay basis.
Patients admitted to an inpatient unit usually have special needs that cannot be readily managed in a home setting such as complicated pain or other symptoms, the absence of a caregiver in the home, or problems with the safety of the patient’s home environment. Stays in an inpatient unit are usually of short duration. Some hospitals or nursing facilities have a “hospice unit”, a section where patients can receive hospice services by 24-hour per day staff.
These are freestanding facilities for patients who have no other appropriate site to receive end of life care. Most New Jersey hospices do not have a hospice house.
Hospice care is an intermittent care program, meaning care is provided through visits by hospice team members. Hospice does not provide ongoing 24-hour care. Hospice care provides support to the family—it does not replace the family. If the family feels they must hire a companion for the patient for a portion of the day, they can do so privately.
All hospice services are available to families based on need. Frequency of visits is based on the patient’s condition and determined by the hospice. In cases of severe pain or symptom management, nursing visits may be daily, but are not usually needed for most patients. Home health aide visits provide support in personal care related to the patient’s illness. Every case is considered for aide services, but there is no requirement that a hospice provide aide services in every case.
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—where the continuing presence of the hospice nurse is required, 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.