FAQ.

Consider hospice care not only for those bedridden or in their final days of life; its benefits are most pronounced when initiated early. This proactive approach allows patients and their families to access the myriad advantages of hospice care for an extended period, provided they meet the medical criteria.

Hospice should be contemplated when:

1. There is a significant deterioration in physical and/or cognitive health despite medical interventions. This might manifest as heightened pain or other symptoms, substantial weight loss, severe fatigue, breathlessness, or weakness.

2. The aim is to enhance comfort and forgo the often debilitating treatments that have proven unsuccessful in curing or halting a life-threatening illness.

3. Physicians estimate a life expectancy of six months or less.

4. The individual has reached the end stage of Alzheimer’s or dementia.

The typical hospice service offerings align with Medicare requirements, ensuring essential care for managing the primary illness:

• The dedicated care team's time and expertise, including visits from the hospice physician, nurse, medical social worker, home health aide, and chaplain/spiritual adviser.

• Medications for symptom relief, notably pain management.

• Provision of necessary medical equipment like hospital beds, wheelchairs or walkers, and supplies such as oxygen and bandages.

• Access to additional therapies like physical and occupational therapy.

• Any other Medicare-covered services deemed vital for addressing pain and other symptoms related to the terminal illness, as recommended by the hospice team.

• Grief and loss counseling for both the patient and their loved ones, recognizing the potential for anticipatory grief. Family members can access counseling for up to 13 months following a loss.

Excluded from hospice coverage are:

• Treatment aimed at curing a terminal illness or any unrelated condition, unless the latter contributes significantly to symptom escalation.

• Prescription drugs and supplies for treating illnesses or conditions not directly related to the hospice diagnosis.

• Costs associated with room and board in nursing homes or hospice residential facilities.

• Emergency room visits, inpatient facility care, or ambulance transportation, unless specifically authorized or coordinated by the hospice team.

Hospice care extends to patients wherever they reside.

• Services are administered in various settings, including the patient's private residence, a family member's home, assisted living facilities, nursing homes, or occasionally, hospitals.

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• Certain hospices operate their own long-term residential centers where care is delivered. In such cases, patients and their families are responsible for covering residence-related expenses, akin to any other household.

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• Should a patient require round-the-clock care, hospices may transfer them to a dedicated inpatient facility temporarily to address symptoms, aiming to reintegrate them back into their home environment afterward.

The majority of hospice patients qualify for Medicare, which comprehensively covers hospice care and services. Hospice services typically entail no deductible under Medicare, although there might be nominal co-payments for prescriptions and respite care. Similarly, Medicaid in most states offers comparable coverage.

While many privately obtained health insurance plans, such as those acquired through employers or state or national exchanges, include a hospice benefit, the scope of coverage may vary from Medicare and among different plans.

Military families are covered for hospice through Tricare, while the Veterans Health Administration provides hospice services directly or through partnerships with local community hospices. Veterans enrolled in the VHA Standard Medical Benefits Package are eligible for hospice care without any co-pay.

For those without insurance coverage, hospices accept private payment, known as "self-pay," as an alternative option.

Hospice care operates within specific benefit periods. Patients can receive hospice care for two 90-day periods initially, followed by an unlimited number of 60-day periods. While medical eligibility typically hinges on a physician's assessment indicating a life expectancy of six months or less, neither the patient nor the physician faces penalties if the patient lives beyond this timeframe. Recertification is possible as long as the patient remains medically eligible.

Occasionally, a patient's condition under hospice care stabilizes or even improves to the extent that they no longer meet the medical eligibility criteria. In such instances, the patient is "discharged" from the hospice program, and their Medicare benefits revert to their pre-hospice coverage.

Some hospice patients may opt to pursue curative therapies, such as participation in a clinical study for new medications or procedures. To do so, the patient must withdraw their hospice care selection, known as "revocation."

Patients who are discharged or choose to leave hospice care can re-enroll without penalty whenever they meet the medical eligibility criteria again.