Who is eligible for Hospice
Care?
Hospice care is available when the following criteria are met:
- The patient and family must
request hospice
- The patient’s doctor and
Crossroad’s medical director must certify that the patient has a
limited life expectancy
- The patient and understand
that Crossroad’s concept of care is comfort care and not curative
in its goals. This, simply put, means care focused on symptom
management, pain control, and whatever is required to make the
patient and family more at ease and comfortable.
How can I determine if a
patient qualifies for hospice care?
Sometimes it is difficult to determine whether a patient meets
criteria for hospice services. If you suspect a patient is
declining, that patient would qualify for a courtesy evaluation to
determine if he/she meets criteria for hospice services.
Who pays for Hospice
Care?
Medicare pays 100% for those eligible, that is to say those who have
been certified by their physician to have a life limiting illness.
Private insurance may, pay all or part. Crossroads provides hospice
care on the basis of need, not the ability to pay.
What does hospice pay
for and what does it not?
Hospice pays for anything related to the terminal illness and
anything that will provide comfort to the patient. This includes
certain medications, wound care supplies, tube feeding formulas,
equipment, personal care items, such as incontinence briefs,
incontinence pads, specialty mattresses, oxygen and some
antibiotics. Decisions about payment are based on the diagnosis of
the patient and varies from patient to patient.
Hospice cannot pay for
anything that is deemed aggressively curative in nature. Hospice
cannot pay for items such as Television sets, radios, IV hydration
therapy, most blood transfusions, "Hyperal" therapy, electrolyte
replacement therapy, appetite stimulants or any Vitamin/Mineral
therapy.
Can a patient/family
change their minds?
Absolutely. If a patient or family decides to stop hospice services
at any time, all that is required is a signature on a discharge
form. The Medicare benefit resumes to pre-hospice status
immediately. The patient can be re-admitted at a later date.
Can a hospice patient go
to the hospital, and do they lose their Medicare benefit by going?
A patient receiving hospice services may go to the hospital.
Although, the hospice must be notified prior to transport so that we
can notify the hospital billing office of the correct way to submit
the bill. This eliminates the possibility of losing the hospice
benefit and allows the hospice to determine if hospitalization is
related to the terminal illness.
What happens if the
patient lives past the Six-month period?
The "six month or less" clause is not an issue whatsoever, as long
as the patient continues to meet criteria for hospice. In fact, the
National Hospice Organization, Medicare and State and Federal
regulatory committees are attempting to eliminate the "six month"
clause, due to the fact that most physicians are referring patients
to hospice too late due to this clause. The patient will not be
removed from hospice, regardless of their length of stay, if they
continue to meet criteria for hospice care.
Is there a limit to the
number of patients or patient days per facility?
NO! As long as patients are appropriate for hospice care, any
patient, regardless of the number of patients already receiving
hospice care, qualifies for hospice service. There is NO limit to
the number of days that any patient, in any facility, can receive
hospice care. The hospice continues to closely monitor each patient
individually for continued appropriateness, regardless of his or her
length of time receiving service.
Is there a clear
distinction between palliative, comfort measures and curative care?
Not always. Sometimes it is difficult to determine what could be
considered curative vs. palliative. This is evaluated on an
individual basis. As long as a treatment will promote comfort but
not alter the outcome of life expectancy, it will be provided.
Do you have to stop a
patient’s tube feeding once they are admitted to hospice?
Absolutely not! The fact that a patient is receiving external
feedings does not disqualify that patient for admission to hospice;
in fact, if it is related to the terminal illness, Crossroads will
supply the tube feeding formula, machine, and associated supplies.
How do the “Medicare
Hospice Benefit” periods work?
Medicare has changed the Benefit Election Period to:
- Initial 90-day period
- Second 90-day period
- Indefinite 60 day period(s)
There are an unlimited number
of 60-day periods, which, as stated earlier, do not run out as long
as the patient continues to meet criteria.
The Primary Physician and the
Hospice Medical Director must determine the initial certification.
The Hospice Medical Director
reviews and determines the recertification.
Can a patient receive
Physical, Occupational or Speech Therapy, while receiving hospice
services?
Yes. Although, due to Medicare regulations, any therapy has to be
provided for comfort if it is related to the terminal diagnosis.
There are exceptions to this rule and the hospice clinical director
can clarify whether a patient is entitled to other types of therapy.
What if a patient “gets
better” while on hospice care?
It is not uncommon for a patient to actually "improve" initially
after admission to hospice. This is partially due to the increased
interaction and care provided. If the patient continues to improve,
he/she will be discharged by the hospice until he/she becomes
appropriate at a later date. They cannot lose any future hospice
benefit even if they are discharged.
What can hospice provide
that a nursing facility cannot?
Hospice "specializes" in dealing with the terminally ill. Much like
other areas of health care, such as Physical Therapists, Wound Care
Specialists, Laboratory Technologists, Respiratory Therapists,
Cardiovascular Surgeons, Obstetricians, etc., even though we all
have a basic knowledge in most areas of health care, we cannot
replace the expertise of others. LTC facilities specialize in
dealing with long-term residential patients and the difficulty
associated with dealing with this type of care. Hospice devotes its
entire time to dealing with the special problems associated with the
terminally ill patients and their families. As a team, with other
ancillary health care professionals, we all can improve the quality
of patient's lives. |
