Frequently Asked Questions

What is Hospice?

Hospice is specialized end-of-life (EOL) care that involves 4 levels of care including routine hospice care, continuous home care, respite inpatient care, and general inpatient care delivered by a specially trained interdisciplinary team (IDT) of clinicians.​

 

Who is part of the interdisciplinary team?

The core members include a registered nurse, physician, social worker, and clergy.  Nursing assistants/aids, therapists, and volunteers can also be part of the team.

 

Who pays for Hospice?

In the US, more than 80% of hospice care is paid by the Medicare Hospice Benefit (MHB) that is a special benefit of Medicare part A.  Medicaid and Medicare Advantage (Medicare part C) subscribers also have full access to the MHB.

 

Who is eligible for Hospice?

Anyone, at any age who for any reason or reasons is felt by two physicians to likely have less than 6 months to live if their medical condition or conditions run their natural course.

 

Where can someone receive Hospice care?

For those who are eligible for hospice and have someone to care for them (primary hospice caregiver), most people receive hospice care in their own homes or place of residence.  For those without a primary hospice caregiver, they can receive hospice care at a nursing home or residential hospice house.

 

How is Hospice care different than traditional care?

Hospice care is focused not just on physical illness or disease like traditional care, but also addresses the emotional/psychological, spiritual and now cultural components of health and wellness, and offers support services for your family as well.

 

Can you get hospice and traditional care together?

Unfortunately not for whatever illness or illnesses qualify you for hospice care.  If you have a medical condition that is not related to your hospice medical diagnosis it will be covered by traditional Medicare as usual.

 

What is inpatient hospice care?

1 in every 4 hospice patients develops a crisis during the year, and needs short-term crisis management such as treatment for uncontrolled pain.  This requires a higher level of care then can be delivered in your home.  This care must be delivered by a registered nurse 24/7 either in a hospital, skilled nursing facility or ideally in an inpatient hospice facility where the clinicians are specially trained and experienced in end-of-life care.

 

Does hospice pay for all medications?

Increasingly, Medicare wants Hospice providers to manage all medical conditions of hospice patients, so it is possible that the hospice team will recommend stopping all medications that are not beneficial to you or are interacting to cause you problems.  Hospice may charge you $5.00 for any non-formulary medication.  If you want to continue a medication that hospice wants to stop, you can always pay for it yourself.

 

How often will the Hospice team see me?

If in your home, the hospice team will see you as often as necessary to achieve and maintain your comfort.  They will see you at least once every two weeks, or daily if needed for approximately 90 minutes.  They will put emergency medications in your home and teach your primary hospice caregiver how to use them to make you comfortable.

 

Will Hospice supply oxygen or other equipment like a bed?

Yes, all necessary durable medical equipment (DME) needed to achieve your comfort like a hospital bed, bedside commode, and oxygen will be delivered and set up at your house at no additional cost.

 

How long can I stay in Hospice?

You can use the Medicare Hospice Benefit for as long as you remain eligible for hospice.  After the first 6 months in hospice, a hospice physician will see you in-person and every 2 months afterwards to renew your hospice benefits.  If the physician feels at any time that you are no longer eligible for hospice, you will be discharged from the service.  Once discharged, your full traditional Medicare benefits will resume.

 

Can I go to the hospital while I am in Hospice?

While in hospice, all of your care is coordinated by the hospice team.  If there is a crisis or emergency, you must call your hospice provider.  If they tell you to go to the hospital, then you can go.  If you go to the hospital by yourself without calling your hospice provider, you will likely be responsible for the cost of your care, not the hospice provider.

 

How do I decide on my Hospice provider?

The choice of hospice provider is completely yours and your family’s decision, it is not your physician’s choice, but your doctor can help you decide.  A doctor does not write an order for hospice.  It is for you to choose to be in hospice, your hospice provider, and your hospice physician and you can change your mind about all at any time.

 

What happens if my hospice caregiver needs a break?

If your family caregiver develops “caregiver fatigue” and needs to recharge, your hospice provider will move you temporarily to another facility either a nursing home or more ideally to an inpatient hospice facility for care so your caregiver can rest and renew themselves as a respite.

 

What is Palliative Care?

Palliative care is supportive care that focuses on improving the quality of someone’s life whatever that means to them, and not necessarily the quantity of someone’s life.  Palliative care reduces distress and anxiety from illness by treating pain, symptoms, and all other causes of suffering.

 

How is Palliative Care different from Hospice?

Hospice is a type of palliative care that provides comfort for those approaching or at the end of their lives.  Palliative Care is supportive care for anyone at any time in their lives who wants to reduce their suffering from any serious medical illness.

 

What type of doctor can deliver palliative care?

Any licensed physician can help patients with medical decision making, advanced care planning, health literacy, and goals of care clarification, these competencies are referred to as “primary palliative care”.  Only a specialist trained and certified in palliative medicine can provide exquisite pain and symptom management, complex chronic care management, complex patient and family communications, and complex shared decision making, and goals of care discussions, this is referred to as “specialist palliative care”.

 

Does insurance pay for palliative care services?

Yes, services in the hospital are universally covered by Medicare (part A), Medicaid, Medicare Advantage (Medicare part C), and most private health insurances.  Out of hospital services (community-based palliative care) are covered by Medicare (part B), Medicaid, many Medicare Advantage plans, and a few private health insurances.

 

Can someone receive palliative care in their home?

Yes, home palliative care is a component of community-based palliative care for those with a serious illness and reduced mobility, as is palliative care in a specialist’s office or in an outpatient clinic for those who can leave their home.

 

How often will I be seen by the palliative care specialist?

For those receiving chronic care management you will be seen at least once a month or more frequently if needed.  For those receiving pain and symptom management you will be seen at least once every two weeks or more frequently as needed.

 

What is advanced care planning?

Advanced care planning (ACP) involves making medical decisions regarding your preferences for care in specific situations while you can still make decisions for yourself.  ACP requires discussion with both your doctors and your family so that you have all of the information you need to make the best decisions for yourself, and you can appoint someone you know and trust to be your legal surrogate medical decision maker when you are unable to make decisions for yourself.

 

Why is advanced care planning important?

ACP is a way to preserve your right to make medical decisions for yourself when you can’t speak or are so ill you lose the capacity to make your own decisions.  Life is uncertain, and your situation and condition can change suddenly.  Without knowing your preferences, the emergency medical staff, doctors, and even your family may make a medical decision under stress that would not be what you would want.  Only 25-30% of Americans have an advanced directive.