A Guide to Hospice Care
Hospice Can Provide Terminally Ill with Comfort, Support and Dignity
Hospice continues to be a preferred choice for terminally ill patients and their families. The majority of persons requiring hospice care are elderly. According to the National Center for Health Statistics, 68 percent of hospice care recipients are aged 65 or older. These services are provided by both home health agencies and hospices. Although hospice care is available as an inpatient service, the majority of services are provided in the patient's home. In addition, family and friends of the patient usually help provide care to the patient when in-home care is chosen.
Hospice care is provided by an interdisciplinary team of professionals, including nurses, physicians, social workers, therapists, home health aides, volunteers, and chaplains. Together this team attends to the medical, psychological, social, and spiritual needs of the patient and their loved ones. The emphasis of hospice care is on providing comfort and support to the patient rather than on extending life, and also on maximizing the patient's independence throughout the dying process. Hospice takes into account the importance of family and friends in the dying process and also provides resources to address their needs.
Medicare, Medicaid, and many private insurance companies reimburse hospice care costs for persons with a terminal illness whose life expectancy is six months or less. The Medicare hospice benefit typically covers hospice care for up to 210 days, as long as the hospice program is Medicare certified. It helps pay for hospital care as well as for a variety of services not usually covered by Medicare, including homemaker services, nutritional services, counseling, and prescription drugs.
When choosing a hospice, you should seek out references from people you know and professionals in your community, and also speak with hospice staff and family members and patients using the hospice services. You also need to consider and be aware of a number of other things:
Acceptance factors: Hospices usually base eligibility policies upon life expectancy and certain other conditions. Many require that a designated primary caregiver be available for home hospice care.
Inpatient care: Hospices have varying arrangements for providing inpatient care. Some hospices own inpatient facilities, while others lease beds from hospitals or skilled nursing facilities and provide staffing or care plan supervision. Hospices also have different policies regarding the requirements for an inpatient admission and the length of stay.
Special services: Some hospices provide access to medical rehabilitation therapists, dietitians, psychologists, or family counselors. They may also provide music therapy and special day programs, among other special services. Some hospices can arrange for medical equipment and supplies to be delivered to the home.
Care plan: The hospice agency should work with each new patient and their family members to develop a care plan. The care plan lists the specific services required, the name and telephone number of the professional in charge of administering the services, and the days and times when the services will be delivered. The care plan should be revised as the needs of the patient change.
Accreditation: Hospices that are accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCOAHO) must pass inspections and meet higher standards of care than those hospices that are not JCOAHO accredited. The JCOAHO is an independent, nonprofit organization that evaluates and accredits health care organizations.
Certification and licensure: Hospice agencies that are Medicare certified have met federal minimum requirements for patient care and management and will be covered by Medicare. Medicare-certified hospice programs are required to provide certain services, including home health care, inpatient respite care, medical social services, physical therapy, and 24-hour access to professional care. Most states also license hospice programs.
Hospice services are often underused because doctors and families are reluctant to acknowledge that the patient has less than six months to live. However, staying open to the option of hospice can ease the burden of death for patients and their families. Hospice can also offer a very humane alternative to the sterility and denial of hospital end-of-life care.