Hospice Care

Hospice care focuses on quality and comfort of life

Published in Church Health by Dr. Susan Nelson
Hospice is a word that some people are afraid of.

For some, it conjures the image of a patient who has “given up” on medical treatment. Others may worry that they won’t get the medical care they need once in hospice.

However, hospice care doesn’t mean all medical treatment stops. It just means you and your family have decided to focus on what makes your life more comfortable, rather than continue to seek treatment for a disease that has no cure. Hospice care is 100% covered by Medicare, and 15% of hospice patients survive more than 6 months and actually get better for a time.

Over the years, I’ve had many patients in hospice care, and almost every one of them – and their families – told me they wished they had started it sooner. Hospice helps patients and families prepare for death in a dignified way that focuses on the quality and comfort of life that remains.

Rather than being a “last resort”, I think hospice offers patients and families the chance to be at home, together during this important time in life’s journey.

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Asset Expert Explains What Long-Term Insurance Covers

Published in SmartAsset by Ashley Chorpenning

While Medicare and Medicaid both help aging adults afford some of their medical expenses, they may not cover the cost of an extended illness or disability. That’s where long-term care insurance comes into play. Long-term care insurance helps policyholders pay for their long-term care needs such as nursing home care. We’ll explain what long-term care insurance covers and whether or not such coverage is something you or your loved ones should consider.

Long-Term Care Insurance Explained
Long-term care insurance helps individuals pay for a variety of services. Most of these services do not include medical care. Coverage may include the cost of staying in a nursing home or assisted living facility, adult day care or in-home care. This includes nursing care, physical, occupational or speech therapy and help with day to day activities.

A long-term care insurance policy pays for the cost of care due to a chronic illness, a disability, or injury. It also provides an individual with the assistance they may require as a result of the general effects of aging. Primarily, though, long-term care insurance is designed to help pay for the costs of custodial and personal care, versus strictly medical care.

When You Should Consider Long-Term Care Insurance
During the financial planning process, it’s important to consider long-term care costs. This is important if you are close to retirement age. Unfortunately, if you wait too long to purchase coverage, it may be too late. Many applicants may not qualify if they already have a chronic illness or disability.

According to the U.S. Department of Health and Human Services, an adult turning 65 has a 70% chance of needing some form of long-term care. While only one-third of retirees may never need long-term care coverage, 20% may need it for five years or longer. With a private nursing home room averaging about $7,698 per month, long-term care could end up being a huge financial burden for you and your family.
Most health insurance policies won’t cover long-term care costs. Additionally, if you’re counting on Medicare to assist you with these extra expenses, you may be out of luck. Medicare doesn’t cover long-term care or custodial care. Most nursing homes classify under the custodial care category. This classification of care includes the supervision of your daily tasks.

So, if you don’t have long-term care insurance, you’re on the hook for these expenses.
However, it’s possible to get help through Medicaid for low income families. But keep in mind, you may only receive coverage after you deplete your life savings. Just know that Medicare may cover short-term nursing care or hospice care, but little of the long-term care in between.

What Does Long Term Care Insurance Cover
So what does long term care insurance cover, Well, since the majority of long-term care policies are comprehensive policies, they may cover at-home care, adult day care, assisted living facilities (resident care or alternative care), and nursing home care. At home, long-term care may cover the cost of professional nursing care, occupational therapy, or rehabilitation. This may also include assistance with daily tasks, including bathing or brushing teeth.

Additionally, long-term care coverage can cover short-term hospice care for individuals who are terminally ill. The objective of hospice care is to help with pain management and provide emotional and physical support for all parties involved. Most policies allow beneficiaries to obtain care at a hospice facility, nursing home, or in the comfort of their own home. However, most hospice care is not considered long-term care and may receive coverage through Medicare.

Also, long-term care insurance can help cover the costs of respite care or temporary care. These policy extensions provide time off to those who care for an individual on a regular basis. Usually, respite care provides compensation to caregivers for 14 to 21 days a year. This care can take place at a nursing home, adult daytime care facility, or at home

What Long-Term Care Doesn’t Cover
If you have a pre-existing medical condition, you may not be eligible for long-term care during the exclusion period. The exclusion period can last for several months after your initial purchase of the policy. Also, if a family member provides in-home care, your policy may not pay them for their services.
Keep in mind, long-term care coverage won’t cover medical care costs. Many of your medical costs will fall under your coverage plan if you’re eligible for Medicare.

Long-Term Care Insurance Costs
Some of the following factors may affect the cost of your long-term care policy:

1. The age of the policyholder.
2. The maximum amount the policy will pay per year.
3. The maximum number of days the policy will pay.
4. The lifetime maximum amount that the policy will pay
5. Any additional options or benefits you choose.

If you’re in poor health or you’re currently receiving long-term care, you may not qualify for a plan. However, it’s possible to qualify for a limited amount of coverage with a higher premium rate. Some group policies don’t even require underwriting.
According to the American Association for Long-Term Care Insurance (AALTCI), a couple in their mid-50s can purchase a new long-term care policy for around $3,000 a year. The combined benefit of this plan would be roughly $770,000. Keep in mind, some policies limit your payout period. These payout limitations may be two to five years, while other policies may offer a lifetime benefit. This is an important consideration when finding the right policy.

Bottom Line
While it’s highly likely that you may need some form of long-term care, it’s wise to consider how you will pay for this additional cost as you age. While a long-term care policy is a viable option, there are alternatives you can consider.

One viable choice would be to boost your retirement savings to help compensate for long-term care costs. Ultimately, it comes down to what level of risk you’re comfortable with and how well a long-term care policy fits into your bigger financial picture.

Retirement Tips
If you’re unsure what long-term care might mean to your retirement plans, consider consulting a financial advisor. Finding the right financial advisor that fits your needs doesn’t have to be hard. SmartAsset’s free tool matches you with financial advisors in your area in 5 minutes. If you’re ready to be matched with local advisors that will help you achieve your financial goals, get started now.

The looming costs of long-term care may have you thinking about how much money you’ll need for retirement. If you aren’t sure how much your 401(k) or Social Security will factor into the equation, SmartAsset’s retirement guide can help you sort out the details.

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Ask an Attorney: Understanding Medicare’s hospice benefit in cases of terminal illness

Published in The Middletown Press By Robert Scalise
Caring for a loved one during the final stages of life is difficult both physically and emotionally. Thankfully, Medicare can help ease the burden.

Medicare’s hospice benefit covers any care that is reasonable and necessary for easing the course of a terminal illness. It is one of Medicare’s most comprehensive benefits, and can be extremely helpful to both a terminally ill individual and his or her family, but it is little understood and underutilized. Understanding what is offered ahead of time may help Medicare beneficiaries and their families make the difficult decision to choose hospice if the time comes.

The focus of hospice is palliative care, which helps people who are terminally ill and their families maintain their quality of life. Palliative care addresses physical, intellectual, emotional, social and spiritual needs while supporting the terminally ill individual’s independence, access to information, and ability to make choices about health care.

To qualify for Medicare’s hospice benefit, a beneficiary must be entitled to Medicare Part A, and a doctor must certify that the beneficiary has a life expectancy of six months or less. If the beneficiary lives longer than six months, the doctor can continue to certify the patient for hospice care indefinitely.

The beneficiary must agree to give up any treatment to cure his or her illness and elect to receive only palliative care. This can seem overwhelming, but beneficiaries can also change their minds at any time. It’s possible to revoke the benefit and reelect it later, and to do so as often as needed.

Medicare will cover any care that is reasonable and necessary for easing the course of a terminal illness. Hospice nurses and doctors are on call 24 hours a day, seven days a week to give beneficiaries support and care when needed. Services are usually provided in the home. The Medicare hospice benefit offers:
• Physician and nurse practitioner services
• Nursing care
• Medical appliances and supplies
• Drugs for symptom management and pain relief
• Short-term inpatient and respite care
• Homemaker and home health aide services
• Counseling
• Social work services
• Spiritual care
• Volunteer participation
• Bereavement services

Services are considered appropriate if they are aimed at improving the beneficiary’s life and making him or her more comfortable.
Because the beneficiary is electing palliative care over treatment, there are things the hospice benefit will not cover:
• Treatment to cure the beneficiary’s illness
• Prescription drugs, other than those for symptom control or pain relief
• Care from a provider that wasn’t arranged by the hospice team, although the beneficiary can choose to have his or her regular doctor serve as the attending medical professional
• Room and board. If the beneficiary is in a nursing home, hospice will not pay for room and board costs. However, if the hospice team determines that the beneficiary needs short-term in-patient care or respite care services, Medicare will cover a stay in a facility.
• Care from a hospital, either inpatient or outpatient, or ambulance transportation, unless arranged by the hospice team. The beneficiary can use regular Medicare to pay for any treatment not related to the beneficiary’s terminal illness.

Medicare now has a hospice compare site that allows patients or their families to evaluate hospice providers according to several criteria. Visit the site at medicare.gov/hospicecompare.

To download Medicare’s booklet on the hospice benefit, go to medicare.gov.
Robert A. Scalise Jr. is a partner of Ericson, Scalise & Mangan, PC in New Britain. For information, visit esmlaw.com.

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How to Make My Uncle Comfortable in Hospice Care?

Published in Collegian by Jacob Maslow
My uncle has a terminal disease, and after years of fighting, he has been given just a few months to live. He is going to be put in hospice care at-home, and I would like to make him as comfortable as possible. Do you have any recommendations on what I can do to make sure his last days are comfortable?

Hospice doesn’t mean that your loved one will be gone in a month or two. In general, hospice means that a patient will live for six months or less. But we’ve all heard stories of a person living for much longer than their doctors suggest. Doctors often underestimate the time a person has left to live, and if the person lives longer, no one generally complains.

The goal will be to keep your loved one comfortable.

Hospice care will help with pain management, and this is best left to the professionals. Hospice caregivers will come to the home and ensure that your loved one is giving the best pain medication and following their treatment plans. But you can help in other ways. As a person becomes weaker, they’ll have trouble with everyday tasks, even including eating and balancing. Independent living aids can help a lot.

“With independent living aids and other products including reachers, grab bars, eating utensils, thickening powder and more, you can make simple changes in your home that will make your loved ones feel safer, more independent and, most importantly, more at home,” explains AvaCare Medical.

Lack of preparation has been associated with:
• Anxiety
• Depression
• Grief

Discuss your uncle’s needs with his doctor. The doctor will be able to alert you of any items that you can purchase or have in the home that will best help your uncle.

Bed placement will be equally important. The bed, if your uncle is bed ridden, should be accessible by friends and family. Your uncle doesn’t want to be locked away in a room alone at all times. Family time, sharing memories and doing things will keep his spirits up.
If he is stable enough and can walk or be put in a wheelchair, bring him out to a ball game or to a restaurant.

Family time can lift a loved one’s spirits.

One of the things I remember my mother complaining about towards the end of her life was that she was so bored and wanted to do things. She was on oxygen, so she was slightly limited in her ability to go out for long periods of time.

Find activities to do with your uncle even if that means watching his favorite movies or going for a stroll around the neighborhood. If he is stuck in the home with nothing to do, depression will start to set in. Comfort is also important, and this means ambient lighting and soothing sounds. Try your best not to disturb your uncle, and also make it a point to keep the room at a temperature that is comfortable for him. He may have hot flashes, or medication can make him feel cold. Cater to these needs as best as you can.

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Hospice Care & Palliative Care – When to use them

Published in parentyourparents.com by Petr Horcik

Hospice a word that is synonymous with “end of life” care. Palliative – a little more confusing and often confused with ‘end of life’. The two are very different therapies but Palliative Care is an offshoot of Hospice.

Hospice is a service for patients who are terminally ill and have decided not to take any more medication that might “cure” them (i.e. chemotherapy for a cancer patient). The focus becomes relief from pain and symptoms and not a cure. There are some who say that going into Hospice means you’re giving up or that you will no longer receive the medical care you need. That is not true – you have chosen to focus on your quality of life not the quantity and the medication used is to do just that. 

A Hospice team usually includes a doctor, nurse, social worker and chaplain (if you wish). They work together to meet the patients physical, emotional and spiritual needs. This team also cares for the family who can be against the choice to, in their eyes, “give up.” There is counseling, hugs and support from a good Hospice team – my Mother’s team was unbelievable and supported and counseled our entire family through the last three days of her life.

To qualify for Hospice your doctor must state that the patient’s death is expected in 6 months or less. If a patient chooses Hospice then changes his or her mind it isn’t an issue. The patient simply goes back into the curative therapy with their doctor. You can also change your mind again and be readmitted . . . there is no pressure – it’s about what you, the patient want.

Palliative Care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illness. This type of care is focused on providing relief from the pain, symptoms and stress of a serious illness for both the patient and family.

Again, it’s a team of specially-trained doctors, nurses and other specialists who work in partnership with the patient’s other doctors to provide an extra layer of support. It can be used at any age and at any stage in a serious illness. The services are offered in tandem with the curative treatment. A good example of Palliative Care use is in Parkinsons or Multiple Sclerosis when there are flare ups.

Both Hospice and Palliative Care are paid for by most insurance companies including Medicare and Medicaid. Both are offered in your home, nursing homes, assisted living centers, hospitals and provide respite care when the caretaker family needs a break. What these two services offer us are choices in treatment for serious illnesses.

We each have our own journey and whilst none of us hope it comes to either of these services, we can make informed decisions for us or our loved ones knowing that they exist. No matter how strong you are physically and emotionally – watching a loved one suffer is often intolerable. There are teams out there to support and comfort. Use them if you need them.

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Study: Hospice Concurrent With Cancer Treatment Reduces Costs

Published in hospicenews.com by Jim Parker

A study of more than 13,000 veterans in Veterans Affairs Medical Centers (VAMCs) found that patients receiving hospice care concurrent with chemotherapy or radiation therapy were less likely to use aggressive treatments or be admitted to intensive care compared to similar patients who were not enrolled in hospice, significantly reducing medical costs.

Unlike organizations reimbursed through the Medicare Hospice Benefit, the Veteran’s Health Administration (VHA) does not require hospice patients to forgo curative care, making VAMCs a prime environment for researching concurrent treatments.

Currently, Medicare beneficiaries must opt out of or revoke the hospice benefit in order to receive curative treatment such as chemotherapy and radiation therapy. However, many hospice organizations provide services similar to hospice through palliative care programs. Beneficiaries are eligible to pursue curative treatment while receiving palliative care, which is also designed to alleviate symptoms, such as pain, as well as the emotional stress associated with serious illness.

“When hospice became a more widely available and referred service in the VHA, there was no requirement that patients stop receiving any other treatment,” study co-author Vincent Mohr, Professor of Health Services, Brown University School of Public Health, told Hospice News.” Our study took advantage of the fact that hospice use expanded without any prohibitions on receiving other services.”
In addition to fighting cancer, radiation and chemotherapy can help providers achieve goals of hospice and palliative care, such as pain reduction.

“There are many instances in which radiation therapy is used to alleviate bone pain due to bone metastases. Also, there are now many chemotherapeutic agents that may reduce the pressure that the tumor is placing on vital organs,” Mor said. The study focused on patients who suffered from newly diagnosed end-stage lung cancer in 133 VAMCs who had received hospice care, cancer treatment, or both concurrently during the last month of life. The study authors aggregated data obtained from inpatient and outpatient records, pharmacy claims, and similar sources.

“Stage IV non–small cell lung cancer has a very short life expectancy,” Mor explained. “About 60% or more die within 6 months of diagnosis. We chose this diagnosis precisely because all had a very short expected life span.”
Though beneficiaries enrolled in the hospice benefit currently must forgo curative treatment, the U.S. Centers for Medicare & Medicaid Services is exploring alternatives to that policy through the test of its Medicare Care Choices Model, which the agency launched in 2016 and plans to conclude in 2020.

The model allows participating hospices to provide services that are currently available under the Medicare hospice benefit, but cannot be separately billed under Medicare Parts A, B, and D, while enrollees are also pursuing curative treatments. CMS pays participants a fee ranging from $200 to $400 per patient, per month while they are delivering services under the model, including care coordination, case management, symptom management, and other support for beneficiaries and families.

Following the conclusion of the program CMS will begin an evaluation phase expected to last two to three years. In addition to assessing the impact on costs, CMS is studying the impact of the model on patient satisfaction and the quality of care.

Currently 96 hospices nationwide are participating. Though participants hospices reported that they were losing revenue via the program in the early phases, CMS theorizes that losses could be offset by increased utilization.

“Having to forgo Medicare payment for treatment aimed at curing the terminal condition may impede the choice of electing hospice care,” the agency indicated in a 2017 announcement of hospices the agency selected as participants. “[The model] tests whether eligible Medicare and dually eligible beneficiaries would choose to receive hospice support services, if they could also continue to receive treatment for their terminal condition.”

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What you can expect from hospice care

Published in considerable.com by Walecia Konrad
This service can bring dignity and grace to the end of life

When Gina Raiford, 54, enrolled her 95 year old grandmother into hospice care two years ago, she was heartbroken. Her grandmother was coping with serious heart failure and had suffered several episodes during which she became non-responsive and needed hospitalization. Eventually hospital staff suggested hospice.

That upset Raiford even more. “You hear the word hospice and you think to yourself, this person is going to die and I don’t want that,” she says. “Worse, you think by agreeing to hospice you’re helping the person die.”

Those feelings are not uncommon, says John Mastrojohn, chief operating officer of the National Hospice and Palliative Care Organization. “Most people don’t fully understand what hospice really means,” he says.

While people’s fears about hospice are understandable, quality hospice care is what many caregivers and health care professionals have come to believe is the most dignified and graceful way to deal with a terminal illness. It can offer physical and emotional support to the entire family, not just the patient. But all too often, patients and caregivers are introduced to the idea of hospice during a time of high emotions, says Mastrojohn. That’s not the best time to make decisions—or do the necessary due diligence to find the highest quality care.

What hospice is—and isn’t
Hospice care is offered to individuals considered to be in the terminal phase of an illness with a life expectancy of six months or less. It doesn’t necessarily take place in a stand-alone facility: Patients may also receive services in a hospital or at home. The goal is to provide the patient with comfort from pain, management of symptoms, and emotional and spiritual support at a time when curative treatment is no longer beneficial.

Patients can also move out of hospice care if their condition improves, with the understanding that services can be re-instated when needed. Gina Raiford’s grandmother, for instance, has moved in and out of hospice for the past two years. Last month she celebrated her 97th birthday with her granddaughter, son and entire hospice team.

A wide range of services
According to the guidelines provided by Medicare, hospice services include almost anything related to pain and symptom management, including on-call care to manage acute pain episodes. It also extends to spiritual care, bereavement and counseling services, and in many cases art and music therapies. Private insurers generally cover all this, too. Many caregivers and health care professionals believe hospice is the most dignified and graceful way to deal with a terminal illness.

Because hospice is designed to support family and caregivers along with patients, respite care is often covered as well. With this service the patient may be admitted to a hospice facility or hospital for a certain number of days to provide a break for the caregiver. In Raiford’s case, her grandmother responded well to hospice services and they helped support her as a caregiver, during what became a very tough time. “My mother died and I had to tell my grandmother her oldest daughter had passed. The entire hospice team—everyone including the chaplain, the nurse, the social worker—helped me tell her. They helped me so much with everything during that time.”

Finding quality care
Unfortunately growth in the hospice industry has led to troubled providers with faulty management entering the field. The result can be large gaps in service, inadequate care and even outright fraud.

Be alert to anyone offering extra caregiving or pain management services without using the word hospice.
Last year the Office of the Inspector General (OIG) released a government report documenting lapses in care that sometimes left patients in pain for days. In other cases, service on weekends was rare and routine visits were often skipped. If you’re looking for hospice services for a loved on, be alert to anyone offering extra caregiving or pain management services without using the word hospice or explaining hospice rules.

You should also check on the following:
What services are offered. Quality hospice should offer, at minimum, 24-hour on-call service, in-person visits, medical equipment, related medications, inpatient care to manage acute bouts of pain, and continuous care in the home. The most recent satisfaction survey. Most hospice facilities conduct satisfaction surveys. Ask to see this data, says Mastrojohn. You’ll get a sense right away of how well the program is functioning.

Accreditation. Any hospice you are considering should be approved as a Medicare provider. In addition look for extra accreditations from NHPCO and other industry organizations.

The 24 hour on-call service. Even if the facility says they provide it, you need to dig deeper. One of the most common complaints found in the OIG report concerned patients and caregivers who needed help during an acute episode. But no one from hospice showed up, leaving both the patient and caregiver in a panic. That’s exactly the scenario hospice is designed to avoid.

So ask: Does the hospice guarantee calling back within a certain amount of time? Ask how many people are on call during the daytime, evening, night and weekends. Is there’s a back-up person or people to cover when assigned staff is busy?

There’s no reason to be afraid of good quality hospice care, says Raiford. “It has made my life and my grandmother’s life better in ways we never expected.”

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How to Choose Hospice Care

Important questions to consider before you arrive at a decision

Published in NextAvenue By Liz Seegert

Part of the LIVING TO THE END OF LIFE SPECIAL REPORT

(Editor’s note: This story is part of a special report for The John A. Hartford Foundation.)

Making the decision to transition your loved one to hospice care (for people whose medical conditions mean they are expected to die within six months) is a time of emotional upheaval. It’s often accompanied by confusion, with little understanding of available options or how hospice actually works.

Knowing ahead of time which hospice services are available and the tasks you may be required to take on can help you make the right choices when decision time comes.

Home Hospice, Hospital-Based Care or Stand-Alone Facility

One of the first things you will need to decide is whether to use a home hospice service, hospital-based care or — if available — a stand-alone facility. Nursing homes may also have hospice units or hospice floors.

There are advantages and disadvantages to each, according to Gilbert Oakley, a hospice nurse with Visiting Nurse Service of New York, who’s been providing home hospice care for over a decade.

You’ll have to balance what the person who is dying wants versus what you and the family can realistically provide.

If opting for in-home hospice, a home hospice agency will work with you to determine whether an adequate support system exists. Can the family pitch in with necessary tasks — from administering pain medication to bathing to helping the person toilet? Are you financially prepared to pay for additional help beyond what insurance covers?

Medicare-reimbursed hospices (for people 65 and older) all provide the same basic services. However, there still may be differences between providers that might make one a better choice for you over another, according to the Hospice Foundation of America. The best way to know is to compare. Medicare’s Hospice Compare provides lists and ratings of hospice providers in your community.

Your loved one’s physician, hospital discharge planner or social worker can recommend specific hospice agencies or facilities. Geriatric care managers can also be a good resource. Often a physician has privileges at certain facilities, which may limit choices. Ask these experts questions about their experiences working with the agencies or facilities. Then contact a few for informational appointments.

Hospice Questions to Think About

Credit: Adobe Stock

Many of the questions are the same whether you opt for in-home hospice or facility care. Here are some important questions to consider:

Is the hospice Medicare certified? Most are, and are therefore required to follow Medicare rules and regulations. This is important if your loved one receives the Medicare home hospice benefit.

Is the hospice nationally accredited?  This designation lets you know that the agency or facility meets certain quality standards. While accreditation isn’t required, it can be a clue to the agency’s commitment to quality.

Has the facility or agency been cited in a negative way in the last few years by a state or federal oversight agency? Find out whether any violations or deficiencies been corrected.

Are the hospice’s doctors and nurses certified in palliative care (providing relief from the symptoms and stress of a serious illness)? Experience counts for a lot, but having the credential indicates specialized study in palliative medicine and/or nursing.

How quickly is a plan of care developed for the individual? Some hospices can begin the admissions process and start hospice services within a few hours — even at night or on weekends. Others may only provide intake during normal business hours. Depending on your loved one’s situation, a hospice’s ability to start services quickly might be very important.

How often will a nurse visit my loved one? Medicare only requires one visit every 14 days, but your family member may need more support, according to Perry Farmer, CEO of Crossroads Hospice, a for-profit provider. Find out the answer to this: How often do social workers, care aides, clergy, volunteers or bereavement support counselors come?

What are the options for inpatient care? Patients being cared for at home at some point may need to go to an inpatient unit for management of complicated symptoms or to give their family respite. Facilities vary — from the hospice having its own private inpatient unit to leased beds in a hospital or nursing home. If possible, visit the facilities (or delegate the task to a trusted family friend) to ensure that they are conveniently located and that you are comfortable with what they offer.

How rapid is crisis response? You want to know who would be available after normal business hours, on weekends and holidays. Ask about the hospice’s average response time and who will make the visit. Some hospices offer limited in-home support on nights and weekends, while others are able to send staff out to a patient’s home no matter when a crisis arises.

What are the expectations for the family’s role in caregiving? See whether the hospice’s expectations are consistent with what the family can provide. Often the care partner has no idea what it’s going to take to be with someone as they die at home — administering medication, helping with bathing and toileting and more. Will the hospice provide training to family caregivers?

How quickly can we expect pain and/or symptoms to be managed? Pain management is a key part of hospice care. Ask about the process if medications don’t seem to sufficiently address pain or symptoms, and how quickly they can be adjusted.

What out-of-pocket expenses should the family anticipate? Original Medicare’s hospice benefit covers everything needed related to the terminal illness, from doctor and nursing care to short term respite and grief counseling. This is true even if the individual chooses to also remain in a Medicare Advantage Plan or other Medicare health plan. There may be a small co-pay for some services like respite care. Medigap and Part D prescription drug plans pay for other care and certain medications.

Taking this all into a account, having a plan of care is vital, according to Oakley. The caretaker(s) need to be aware of what the hospice can or cannot provide and what you or other family members must do.

If your loved one is a veteran, it’s important to select a hospice with the necessary, appropriate experience. Next Avenue published a story detailing how the toll of war on veterans can complicate end-of-life care and present unique needs that must be addressed. You may want to check out the We Honor Veterans program which works with experienced providers of this type of care.

Oakley also recommends finding out how the hospice handles patient and family concerns. Is there a clear process for sharing issues with appropriate hospice staff and ensuring the concerns are addressed, including a process for escalation if the concern is not adequately resolved at lower levels?

Facility-Based Care or Hospice Houses

There are times when patients with very complex symptoms or conditions cannot be cared for at home. Sometimes family members are geographically distant or just don’t have the emotional or physical resources to deal with the situation on a day-to-day basis.

One alternative is a freestanding facility known as a hospice house. Hospice houses offer a more home-like atmosphere than typically found in a hospital or nursing home. They’re designed for short stays and may be a good option when the person requires around-the-clock care. Some hospice house programs mandate that a patient be within a month or two of death, so be sure to ask about admission criteria.

“If you have an opportunity to go with a free-standing hospice house, jump wholeheartedly into it because the environment is created specifically to help people as they die and the family members of people as they die,” said Dr. Rebecca Allen, a geropsychologist and professor of psychology at the University of Alabama’s Research Institute on Aging.

Bereavement Support

Allen recommends asking all hospices about available bereavement services. Grief support can vary widely. It may include individual counseling, support groups, educational materials and outreach letters. If you opt for individual or group support, find out what credentials the session leader has.

What’s Most Important

Think about your general impressions after the initial contact with the provider. What was your reaction to the people you spoke with?

Remember to focus on what is most important to your family — most importantly the person who is dying.

Keeping that at the center will help narrow the field, whether there are three options or 30.

New York-based journalist Liz Seegert has spent more than 30 years reporting and writing about health and general news topics for print, digital and broadcast media. Her primary beats currently include aging, boomers, social determinants of health and health policy. She is topic editor on aging for the Association of Health Care Journalists. Her work has appeared in numerous media outlets, including Consumer Reports, AARP.com, Medical Economics, The Los Angeles Times and The Hartford Courant.

 

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Hospice month celebrates success of nation’s first coordinated care model

Published in The Hill by Edo Banach, Opinion Contributor

While there’s no shortage of partisan disagreements on Capitol Hill, one hopes the combative environment that’s become the norm in Washington might take a brief pause now that midterm elections are behind us. At a time when unity and common ground are sorely needed in our politics and our policymaking, one health care program stands out as a reminder of how bipartisanship works at its best: the Medicare Hospice Benefit.

This extraordinary policy achievement was made possible by lawmakers who put aside their differences in the interest of the Americans they served. Enacted as a demonstration in 1978 and a Medicare benefit in 1982, hospice programs have served millions of Americans and their families with compassionate care to relieve pain, manage symptoms, supported beneficiaries and their family caregivers, and provided bereavement services for individuals following the death of a loved one. The benefit has been invaluable to patients and lifesaving for families. And it never would have happened without lawmakers who were committed to the concept, and to working together.

Democrats, including Sens. John Glenn (Ohio) and Bill Bradley (N.J.), joined with Republican senators like Bob Dole (Kan.) and Chuck Grassley(Iowa) to pass what then-Rep. Leon Panetta (D-Calif.) called a “political miracle.” Sen. John Heinz (R-Pa.) personally collected commitments from 68 senators to pass the Heinz-Dole-Packwood amendment to provide hospice services to terminally ill Medicare patients.

Not only did this bipartisan act show how a diverse group of legislators could come together for the good of the country but the hospice benefit itself has become an example of how our fragmented health care system can – and should – work together for the betterment of patients. As America’s original coordinated care model, hospice brings together a multidisciplinary team of providers to meet all aspects of a dying patient’s physical, spiritual and emotional needs. No other health care sector is required to address all aspects of a patient’s, and their family’s, health and wellbeing.

Those elected to serve in the upcoming Congress should know that hospice is a program that works and a Medicare benefit that matters to their constituents. As seasoned and novice legislators alike consider health policy reforms, they should look to the success of the hospice model as an example of preserving what works, and help expand access to comprehensive, coordinated care and person- and family- centered care to all patients with serious, advanced and life-limiting illness. We should also reinforce the foundation of hospice to ensure access, choice and quality care at the end of life.

Hospice is not only best for patients at the end of life, it is also good for the Medicare program. Study after study show hospice care improves quality of life, delivers on patient and family satisfaction and reduces unnecessary costs for Medicare beneficiaries at the end of life. Thirty-plus years later, hospice is a reminder that there are policy solutions that work for both sides of the aisle and across our nation for all Americans. The fruits of cooperation live on today in a Medicare benefit that serves 1.43 million Americans annually.

It’s sometimes unclear if the dust will ever settle in Washington, and if we’ll ever get back to a place of collegiality and bipartisanship in Congress. If our nation’s remarkable hospice benefit is any indication, great things can certainly happen if it does.

Edo Banach is President and CEO of the National Hospice and Palliative Care Organization (NHPCO).

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NHPCO Highlights Importance of Hospice in Healthcare Since 70s

November begins National Hospice & Palliative Care Month. National Hospice & Palliative Care Organization (NHPCO) writes that hat began as primarily a volunteer-driven, grassroots movement in the 1970’s, is now an integrated part of our nation’s health care delivery system that provides care to more than 1.43 million Medicare beneficiaries and their families every year.

“Enacted as a demonstration in 1978 and a Medicare benefit in 1982 as our nation’s first coordinated care model, hospice programs have served millions of Americans and their families with compassionate care to relieve pain, manage symptoms, support patients and their family caregivers, and provided bereavement services for individuals following the death of a loved one,” said Edo Banach, president and CEO of NHPCO. “The benefit has been invaluable to patients and lifesaving for families.”

NHPCO offers a snapshot of hospice care with representative statistics from the current edition of its report, Facts and Figures: Hospice Care in America (PDF):

NHPCO provides a valuable abundance of resources with data and statistics on hospice. The organization is integral to a broad spectrum of efforts in leading the public’s understanding of hospice and palliative care and advancing the ever more vital role of hospice across the healthcare industry.

In addition, this month honors the home care and hospice community including the millions of nurses, home care aides, therapists, and social workers who make a remarkable difference for the patients and families they serve.

These heroic caregivers play a central role in our health care system and in homes across the nation.
  • In 2018, home care providers will travel about 8 billion miles to deliver the best health care in the world’
  • Ninety percent of Americans want to age in place, and home care is the preferred method of health care delivery among the disabled, elderly, and chronically ill; and
  • Home care provides high-quality, compassionate care to more than 5 million Americans annually.

As we approach the giving season, November is the perfect time to recognize their efforts.

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