Question: What services does hospice provide?
Answer: Hospice includes the services of an interdisciplinary team of health care professionals:

• Physicians (the patient’s own physician and the hospice physicians, who are specialist in controlling pain and other symptoms of serious illness) prescribe medications and other methods of pain and symptom control.
• Nurses are experts at maintaining patient comfort. They assess the patient frequently and help family members provide the necessary support.
• Certified nurse assistants and home health aides provide personal care and help the patient and family with activities of daily living. They also provide companionship and valuable emotional support.
• Social workers coordinate community resources and help the patient and family with non-medical concerns. They can help family members mend damaged relationships, plan for the future and ease other emotional difficulties.
• Chaplains and spiritual counselors help patients and families cope with spiritual questions and concerns at the end of life, either directly or by coordinating services with the patient’s and family’s spiritual advisors.
• Bereavement coordinators help patients and families deal with grief. Grief support services continue for at least one year after the death of a hospice patient.
• Volunteers provide companionship and emotional support and offer help in myriad ways.

Question: Who pays for hospice care?
Answer: Hospice is covered by most insurance plans, including Medicare and Medicaid, with few out-of-pocket costs to the patient. The Medicare hospice benefit covers costs related to the terminal illness, including the services of the hospice team, medication, medical equipment and supplies. Medicare reimburses for different levels of hospice care recognizing sometimes patients require special attention.

• Medications: The Medicare hospice benefit covers medications needed to treat the patient’s terminal illness. Generally hospice providers will order medications for you, and you can get them from the pharmacy or arrange for delivery. Medications for a condition not related to the terminal illness - allergy medication for example - are not covered by the hospice benefit.
• Medical supplies: The physician and nurse will work with the family to determine which medical supplies and equipment the patient needs. Again generally most hospice providers will order the equipment and have it delivered to the home.

Question: When should patients and families consider hospice?
Answer: After a diagnosis of life-limiting illness, patients and their families should consider their choices for care. A patient does not have to be bed-bound or critically ill to be admitted to hospice. A hospice representative would be happy to talk with you or your family about the hospice option.

Question: Who is eligible for hospice care?
Answer: A physician must certify that a hospice patient has an illness and an estimated life expectancy of six months or less if the illness runs its usual course. The patient must agree to hospice care. Generally most hospice providers accept everyone who meets those criteria, regardless of the patient’s financial situation or insurance coverage. The patient does not have to have family caregivers in the home in order to receive hospice services.

Question: Doesn’t accepting hospice care mean giving up?
Answer: Hospice involves acknowledging that most diseases in their advanced form cannot be cured. It does not mean giving up hope. The focus of hope shifts towards helping the patient achieve maximum physical comfort and peace of mind.

Question: What are the different levels of hospice care?
Answer: Most hospice patients live at home or in a nursing home. Routine home hospice care covers the services, of the interdisciplinary hospice team, medications and equipment. Other categories of care are available when needed.

• Inpatient Care: Sometimes pain or symptoms cannot be controlled at home, and the patient is taken to a hospital or other inpatient care center. When the symptoms are under control, the patient returns home. Insurance usually covers the cost of inpatient room and board.
• Respite care: Many patients have their own caregivers, often family members. When caregivers need a rest from their care giving responsibilities, patients can stay in a nursing home or hospice residential care center for up to five days. Medicare covers the cost of room and board, as do many other insurance plans.
• Continuous care: Sometimes a patient has a medical crisis that needs close medical attention. When this happens, we can arrange for inpatient care, or the hospice provider staff can provide round-the-clock care in the home. When the crisis is over, the patient returns to routine home care.

Question: What if I choose hospice and then live more than six months?
Answer: Hospice care does not automatically end after six months. Medicare and most other insurers will continue to pay for hospice care as long as a physician certifies that the patient continues to have a limited life expectancy.

Question: What if my condition improves.
Answer: Occasionally, the quality of care provided by hospice leads to substantially improved health, and life expectancy exceeds six months. When this happens, the hospice provider will transfer care to a non-hospice care provider. Later, when patients become eligible for hospice, they can re-elect the hospice benefit. There is no penalty for getting better!

Question: How does hospice manage pain and other symptoms?
Answer: Hospice physicians and nurses are experts at pain and symptom control. They are continually developing new protocols for keeping patients comfortable and as alert and independent as possible. They know which medications to use simply and in combination to provide the best results for each patient.

Question: Doesn’t pain control medications make people feel “doped up”?
Answer: When morphine and other pain control medications are administered properly for medical reasons, patients find much-needed relief without getting “high” or craving drugs. The result is that hospice patients remain more alert and active because they are not exhausted by uncontrolled symptoms.

Question: What kind of emotional and spiritual support does hospice provide?
Answer: Hospice recognizes that people are more than a collection of symptoms. People nearing the end of their lives often face an enormous emotional and spiritual distress. They are dismayed as their physical abilities begin to fail. They don’t want to be a burden on their families. They worry how their loved ones will manage without them. Sometimes, they feel deep regret about things they have done or said – or things left undone and unsaid. Hospice professionals and volunteers are trained to be active listeners and to help patients and families work through some of these concerns so that they can find peace and emotional comfort in their final days.

HOSPICE MYTHS

Myth: A person must have a 24-hour caregiver to receive hospice care.
Truth: There are no requirements for having or not having a caregiver.

Myth: The patient must first stop all current treatments to receive hospice care.
Truth: Patients may continue their treatments as long as they do not change the prognosis.

Myth: Hospice means “giving up”.
Truth: Patients don’t have to give up hope when turning to hospice. It is the goal of hospice to help enable individuals to live their lives as fully and pain-free as possible.

Myth: The patient and family must be “ready” for hospice or “ready” to accept the patient’s prognosis to have hospice care.
Truth: There is nothing in the Medicare regulations that state patients and their families must accept that the patient is dying prior to receiving hospice care. Denial is an accepted coping mechanism. Hospice helps patients live all of their days to the fullest.

Myth: Hospice is a place.
Truth: Hospice is comprehensive care – physical, emotional and spiritual – for persons facing end-of-life illnesses.

Myth: Patient must have only six months to live to be eligible for the Hospice Medicare Benefit.
Truth: Hospice is a lifetime benefit, and a patient may continue service as long as he or she is eligible.

Myth: The patient must have a Do Not Resuscitate Order (DNR) to be eligible for hospice.
Truth: The law states that hospices cannot discriminate against eligible patients because of any advanced directive choices they have or have not made.

Myth: If a person elects hospice, that patient must give up his or her own regular doctor.
Truth: The patient chooses his or her own attending physician as desired.

Myth: The doctor or caregiver are the ones to arrange for a patient’s hospice care.
Truth: Anyone can make a referral to hospice. Admission requires a physician’s certification of eligibility, but it is every eligible person’s right to receive hospice care if they want it.