Many families may wonder how they’ll cover the costs of hospice and if their loved one could benefit from the services. If you have Medicare, you may receive assistance through the program.
What is Hospice Care?
Hospice care is a type of medical care that helps a patient deal with a terminal illness. The goal of hospice care is not to treat the patient, but rather to increase their qualify of life. When receiving hospice, the patient receives care from caregivers, nurses, and other medical providers to address their physical, psychological, and spiritual concerns.
When discussing, what is hospice, there are four main levels of hospice care, which include:
Routine care is when a patient receives scheduled care in their home. It most often occurs at the patient’s private residence, assisted living facility, or in a group setting. Routine care may be provided by doctors, nurses, or caregivers who offer services based on the medical needs of the patient. Routine care is the most common level of hospice care.
General Inpatient Care
General inpatient care is for patients with symptoms that can’t be managed at home. There are a few hospitals that may have inpatient units that work closely with skilled nursing facilities. In this type of environment, patients receive around-the-clock care, but it’s not a permanent living arrangement. Inpatient care is reserved for temporary visits when symptoms get worse.
Respite care offers caregivers a break. Hospice patients receive five respite days per certification through the Medicare program. These days can be used at once, or broken up. This type of respite care is primarily for the benefits of the family, or their permanent professional caregiver, allowing them to focus on themselves.
Continuous care is when the patient receives continuous care at home. This type of care allows the patient to stay at home, while still receiving 24/7 care.
Your loved one’s healthcare provider and you can decide which type of hospice care is right for your loved one. It’s also important to note that needs may change over time.
When is Hospice Respite Care Provided?
Hospice care is typically ordered when a patient is diagnosed with a terminal illness. The patient’s medical provider must report that there is no treatment available, or that the person doesn’t want to seek treatment any longer. To be terminal, it usually requires that the patient has less than six months to live and that they are rapidly declining and unable to perform activities of daily living. To be eligible for hospice, the patient’s physician must certify that they have a terminal illness. A second physician must also certify the statement.
While treatments may be available to some patients, hospice may also be used if the patient has decided to forgo them and focus on comfort.
Respite care is the service of offering caregiver relief. Caregivers can easily burn out from the stresses of working closely with their loved ones. Because of the high costs of in-home care or hospice, many family members may take on some, or all, of their loved one’s caregiving needs and duties.
Hospice respite occurs when a trained professional caregiver sits with the person to provide a break to the full-time caregiver. Respite may also take place in a respite center, but it most commonly occurs at home. The respite caregiver may or may not be medically trained. They may have the primary duty of just sitting with the patient.
What Does Hospice Care Include?
It’s important to know what hospice benefits include, and what they don’t. This can help you prepare for any costs that you and your family may be responsible for paying yourself. Hospice care may come from a team of interdisciplinary members. It may include services like:
- Medical checkups by physicians or nurses.
- Medications to control pain.
- Medical equipment.
- Physical or occupational therapy.
- Spiritual adviser visits.
- Dietary counseling.
- Intermittent inpatient care.
- Short-term respite care.
- Grief and loss counseling for the family members.
Hospice doesn’t include:
- Treatment to extend life.
- Prescriptions to treat conditions.
- Cost of living in a hospice facility.
- Emergency room care.
The primary purpose of hospice care is to maintain symptoms and improve the quality of care for patients. For this reason, Medicare doesn’t typically cover treatments or ER care.
What is the Difference Between Hospice and Palliative Care?
Hospice care is different from palliative care. Hospice care refers to a type of care that is reserved for managing the symptoms and qualify of life for those who have six months or less to live. A person on hospice is typically aware that they are terminally ill and may have already tried numerous treatments that haven’t been effective.
Palliative care refers to helping patients who are suffering from serious medical conditions improve their quality of life. Palliative care works to deal with the symptoms and daily stresses that come with a chronic illness. It focuses on both a patient and their family’s needs. Palliative care may be used to deal with end-of-life care, but this is not always the case. It can also be used to treat patients who have chronic, long-term medical conditions.
Palliative care is completed by medical providers with specialized training in working with patients with chronic diseases. It can be a part of a patient’s plan at any point in their condition, not just for end-of-life care. While both types of care aim to improve the patient’s qualify of life, the biggest difference is that those on hospice care have less than six months to live.
Both hospice and palliative care can be useful, but each offers its own advantages. Discuss the unique needs of your loved one with their medical care team to decide which is right for you.
Where Can You Receive Hospice Care?
In most cases, hospice occurs at home. While there are hospice facilities, these are rarely covered by Medicare or other types of insurance. Many patients may also prefer to receive care in their homes, where they’re most comfortable. When receiving hospice care at home, patients can also be surrounded by their family, who can sometimes assist with the care.
Medicare may approve patients to spend minimal periods of time in a hospice inpatient environment. This is referred to as general inpatient care, and unlike with a traditional inpatient environment, the goal isn’t to make the patient better. Instead, it’s to reduce their symptoms to a place where they can be treated at their home.
Is In-Home Hospice Care Right For My Loved One?
You might be wondering if in-home hospice care is right for your loved one. Deciding to move them to hospice care is a big decision. It’s important to consider your loved one’s condition, the prognosis as discussed by their medical team, and how well they manage current activities of daily living.
Hospice care can be a huge relief for the patient and their caregivers. Caring for a loved one 24 hours a day and seven days a week can be stressful and overwhelming, and hospice helps with that. Hospice may be right for your loved one if:
- They are in a lot of pain with a condition that won’t improve.
- They are unable to move around themselves.
- They have many symptoms to deal with daily.
- The family is concerned about their safety.
Hospice may be right for your loved one if they have been diagnosed with a terminal illness and are unable to care for themselves at home. While a family member may take over some of the caregiving duties, it can often be too much for a single family member to handle. Your loved one may also require skilled nursing care.
Using in-home hospice can also make your loved one more comfortable. Most seniors claim that they prefer to receive care in their homes, whether it’s for hospice or other care. As the hospice departments further their training, they are able to offer more advanced healthcare medical services at home while keeping your loved one safe and happy. It’s always a good idea to find out what your loved one’s care preferences are though.
When Is the Right Time for Hospice?
It is up to you and your loved one’s medical provider to decide when the right time for hospice is, as it is a big decision. In order to be eligible for hospice, it’s usually required that the patient has less than six months to live and is unable to perform activities of daily living. Most insurance providers will only allow members to use hospice benefits if they have less than six months to live.
However, even if the patient makes it longer, or decides to try another treatment later, they can always exit and reenter the program if needed. The insurance company won’t cover hospice care for longer than six months at one time. If you have a senior loved one with chronic medical conditions, it can also be useful to discuss their wants early on. This can help you feel better about your decisions and decide when it’s the right time to move them to upgraded care. Find out early on what their preferences are, and where they w
How Do I Pay for Hospice?
Figuring out how you can pay for hospice is an important concern for many. You want to provide your loved one with the best care possible, but hospice can be expensive. Some families may be worried about the six-month time limit that comes with hospice care. If a patient’s condition improves, they may be discharged from hospice care. If the condition worsens again at a later time, they can be readmitted into the hospice program.
Most people who are put on hospice are also eligible for Medicare. Medicare Part B can cover many of the costs related to hospice care. While Medicare members may have a co-payment, there typically isn’t a deductible. Even if you opted for a Medicare Advantage Plan instead of Original Medicare, it should still cover many of the costs of hospice care.
If you’re a military family, you may also have hospice benefits through Tricare. The cost of hospice is usually categorized into benefit periods. The available benefits depend on your provider. In most cases, you are eligible for two 90-day hospice care periods, then followed by an unlimited number of 60-day periods.
It’s also important to note that no one is penalized if the patient makes it beyond the six months required for hospice care.
It’s important to always ask how much hospice care will cost, so you can prepare for any out-of-pocket costs that you may experience. When choosing a hospice care team, make sure they accept Medicare and ask for an estimate of costs. If Medicare denies your claim, you may be able to appeal the decision.
What is Original Medicare?
It can also be helpful to review what is included with the Original Medicare program, and what parts may help to cover hospice costs.
Many people use Original Medicare to pay for hospice benefits. If you are 65 years or older, you should be eligible for Original Medicare. Original Medicare is made up of Parts A and B. Part A is hospitalization insurance that covers the costs of a hospital stay. This may include the cost of a hospital room and any treatments you receive while hospitalized.
Part B is medical insurance. This covers the cost of physician visits. If you have to receive medical care from a specialist, Part B also covers that. Part B may cover costs like doctor’s visits, tests, lab work, or even preventative services. Part B also covers the cost of hospice care if you need it, and are eligible for receiving benefits.
It’s best to enroll in Original Medicare as soon as you’re eligible, which is three months before you turn 65 years and ends three months after you turn 65 years. If you miss your enrollment period, you may have to wait to enroll until later and you could experience a permanent penalty that you pay monthly.
What is the Hospice Medicare Benefit?
The Hospice Medicare Benefit is a benefit available through Original Medicare. This benefit covers the cost of hospice care for eligible patients. Even if you have Part C, and regardless of whether you have a PPO or HMO, you should be eligible for the hospice benefit. If you’re not sure if you have this benefit, or you have questions about it, reach out to a Medicare consultant.
Dealing With Grief
Having a loved one moved to a hospice department can be difficult, both financially and emotionally. If you have Medicare, you may have benefits available to help deal with grief. Medicare benefits may cover the cost of counseling. The program may also provide grief counseling to your loved one.
Medicare benefits may not cover the cost of hospice counseling services for family members, depending on the coverage. Other ways to deal with your grief include:
- Acknowledge your pain.
- Take care of yourself during this difficult time.
- Be open with your feelings.
- Recognize the difference between grief and depression.
- Take care of yourself physically.
- Avoid coping with drugs or alcohol.
- Know when to reach out to a professional.
- Be honest with your loved one.
It can also be beneficial to have some of these tough conversations before your loved one may need to move to hospice care. Many people consider hospice a time to begin their goodbyes to their loved ones. While it may never seem like enough time, it can give you the opportunity to talk through your feelings. You can have conversations with your loved one that you haven’t been able to do yet. You can also use this time to work through your own grief.
It’s especially important to know how to determine the difference between grief versus depression. Depression and grief can have many of the same symptoms, and grief can turn into depression. Grief is something that occurs after losing a loved one. It’s a general feeling of sadness and may include feelings of anger. Grief is an expected response to loss.
Depression is a medical condition that must meet certain requirements to be diagnosed. If you find that you’re having a hard time eating, sleeping, or finding joy in the things you once did, it may be worth it to reach out to a licensed counselor. If you’re unsure if the symptoms you’re feeling are normal, a counselor can also help you work through them.
Making the decision to move a loved one to hospice care is difficult. Learning everything you can about the difference between hospice and palliative care and when to choose this type of care can help you with this important decision. If your loved one is already enrolled in Medicare, you may find that some types and services of hospice are included.