The Lincoln Squirrel

News, features and photos from Lincoln, Mass.

CoA speaker explains what hospice is—and isn’t

by

erinBy Alice Waugh

The vast majority of people with a terminal medical condition want to die peacefully at home rather than in a hospital, but many seniors don’t know that Medicare will cover hospice care with no out-of-pocket expenses, a hospice representative said at a Council on Aging talk.

Erin Sanford, a patient transition representative from AseraCare Hospice, explained what hospice offers and how Medicare covers it while also dispelling some misconceptions at the November 16 session in Bemis Hall.

The word hospice is related to hospitality, or “providing a place of shelter for weary travelers,” Sanford said. The first hospice was founded in 1967 in London by Dame Cicely Saunders, who felt that end-of life care should provide pain relief, preserve the patient’s dignity, and help the patent and family with the psychological and spiritual pain of death. Medicare added a hospice benefit in 1983. Medicaid, MassHealth and most private insurance plans also have a hospice benefit.

“Hospice is not a place to go; it’s a philosophy of care” that focuses on the entire family and not just the patient, Sanford said. Each patient’s hospice team—which includes a registered-nurse case manager, a home health aide, a social worker, bereavement counseling for the family, and a chaplain, if desired—administers palliative (comfort) care to maximize the patient’s quality of life.

“It treats the person rather than the illness when doctors have done all they can do” for an incurable condition, she said.

For patients to be eligible for hospice coverage, they must have certification from a doctor that they have less than six months to live if their disease follows its normal course.

Terminal illnesses can include cancer, heart disease, lung disease including chronic obstructive pulmonary disease or COPD (emphysema), dementia, liver disease, ALS (Lou Gehrig’s disease), kidney failure, HIV, and failure to thrive.

The doctor bases this six-month judgment on specific criteria for various terminal medical conditions, but each patient is different—some live less than that and others will live much longer, Sanford said. During the initial six-month period and any time thereafter, the doctor can recertify that the patient has six months to live from that point. Medicare allows an unlimited number of “certification periods” as long as the patient is still declining.

Enrolling in hospice care does not mean forgoing all medical care except pain management, does not hasten or prolong death, and does not require the patient to have a DNR (do not resuscitate) order in place, Sanford said. The RN case manger will work with the patient, family and physician to determine the best plan for maximum comfort and peace.

And hospice doesn’t mean the patient is bedbound or homebound; if he or she wants to travel, her local hospice provider can contract with a provider at her destination to step in if he or she experiences any discomfort. “We do that all the time, where someone takes off for a week at their lake house or in Florida. That’s excellent; that’s quality of life,” Sanford said.

A hospice patient is also free to “quit” hospice any time and resume more aggressive medical care.

“People hear the word hospice and say ‘I’m not ready to give up,'” Sanford said. “But if you go on hospice and your doctor goes to a conference next month and comes back with a new chemotherapy treatment, you can stop your hospice benefit and then go back on hospice later after a course of treatment if you need to,” she said. “It’s not the last decision you’ll ever make”.

Once a patient is enrolled in hospice, Medicare will not pay for hospitalization or other aggressive measures related to the patient’s terminal condition, though it will still cover separate conditions. For example, if a patient has diabetes as well as terminal COPD, Medicare will cover insulin injections for the diabetes and hospice care for the COPD, but hospitalization or surgery to treat the COPD won’t be covered.

There are four levels of care that Medicare requires hospice programs to offer:

  • Routine home care—Hospice caregivers visit the patient wherever he or she is (at home or in a nursing home). Routine home care constitutes 96 percent of hospice care, Sanford said.
  • Inpatient respite care—A hospice patient at home may be temporarily admitted to an inpatient hospice facility to provide a break for his or her home-based caregivers.
  • Inpatient care—A hospice patient may be admitted to an inpatient hospice facility for recalibrating pain medications, starting an IV, or other symptom management that can’t be done in the home.
  • Continuous care—When a hospice patient is very close to death, caregivers may stay at the bedside for up to eight hours at a time.

The hospice RN case manager and doctor determine the level of care needed at any given time, Sanford said.

In addition to the professional caregivers, Medicare’s hospice benefit also covers medications, medical equipment and supplies needed for comfort, with no copayments or out-of-pocket expenses. “It’s the only Medicare benefit that’s inclusive like that,” Sanford said. And it’s much less expensive than hospital or nursing home care. “Hospice is saving Medicare a lot of money,” she added.

“I’m enlightened. I’m so glad I came—I misunderstood the whole thing” about hospice, said Lincoln resident Connie Fusillo, who attended the talk. “Whoever thought Medicare would pay for all that? If you can get your heart and mind around it, it’s sort of a no-brainer.”

Further reading:

Print Friendly, PDF & Email