Common Questions About Hospice

"You'll Just Feel Better Knowing We Are There"

Common Questions About Hospice

WHAT ARE THE REQUIREMENTS TO BE ADMITTED TO HOSPICE?
To qualify for hospice care using the Medicare or Medicaid benefit, your doctor must certify that you have a terminal diagnosis with a life expectancy of 6 months or less if the disease process continues as it most often does. You will need someone available to assist as primary caregiver” when you are not able to care for your own daily needs. VNA HOSPICE will work with you and your family to provide for your needs at every stage of your illness.
WHEN SHOULD YOU MAKE THE DECISION TO ENTER HOSPICE?
When should the decision be made? The decision to use hospice should be made as soon as possible after curative treatments are stopped. You are the one who must make that choice. It is good to discuss hospice with family members and your doctor before coming to a decision. Information about hospice may be obtained at any time. It is never too soon to know what help is available.
CAN I CHANGED MY MIND TO RECEIVE CURATIVE TREATMENT AFTER ENTERING HOSPICE?
Absolutely… Should your condition improve or a new curative treatment become available, you can request discharge from hospice at any time to return to curative care. If you wish, you can be readmitted to hospice again at any time.
WILL I DIE SOONER IN HOSPICE?
No…VNA HOSPICE lends support and specialized knowledge to promote Comfort. Nothing is done to speed up or slow down the dying process. In fact polls show that people actually survive longer under the direction of a good hospice program.
WHAT HAPPENS DURING THE HOSPICE ADMISSION PROCESS?
The hospice nurse will first contact your physician to be sure that hospice care is appropriate for your needs. You will be given information about the hospice benefit and an opportunity to ask questions during an “information visit” by a registered nurse. The care you receive will focus on relief from pain and other symptoms and is not designed to provide a cure. Once you have decided to enter hospice, your nurse will perform a full assessment of your needs and begin actual teaching and nursing care during the first visit.
HOW DOES VNA HOPICE MANAGE THE PAIN?
VNA HOSPICE nurses and doctors use the most effective medications along with other comfort measures to aggressively control pain and provide symptom relief. Team members work with you to control physical, emotional and spiritual pain.
HOW HARD IS IT FOR A FAMILY TO CARE FOR A LOVED ONE AT HOME?
It is never easy and sometimes can be very hard. VNA HOSPICE nurses visit regularly and are available on-call 24 hours per day to answer questions, provide support and give care. Most families report a great deal of satisfaction and peace at allowing a loved one the luxury of remaining at home with the people and things dear to them.
WHAT EXACTLY DOES VNA HOSPICE PROVIDE PATIENTS AT HOME?
A team of doctors, nurses, social workers, home health aides, clergy, volunteers, homemakers and therapists provide assistance according to their areas of expertise for you and your family in the privacy of your home. Medications, supplies, and medical equipment are provided as appropriate to meet your needs.
IS THE PRIVATE HOME THE ONLY PLACE HOSPICE CARE IS PROVIDED?
No. Care may be provided in any residence, including a nursing home.
WHAT QUESTIONS SHOULD I ASK IN SELECTING A HOSPICE?
There are a number of questions to ask before deciding on a hospice program.

Certification: Is this hospice program Medicare certified? Medicare certified programs have met federal minimum requirements for patient care and management.
Licenser Is the program licensed by the state, if required by your state?

Consumer information: Does the agency have written statements outlining services, eligibility criteria, costs, and payment procedures, employee job descriptions, malpractice, and liability insurance? Is the agency in-state or out-state owned and operated? Is it for profit or a non-profit? Who makes up the agency’s Board of Directors? Are funds raised by the hospice used within this state?

References: How many years has the agency been serving the community? Can the agency provide references from professionals, such as a hospital or community social workers, who have used this agency? Ask for specific names and telephone numbers. A good agency will provide this on request. Talk with these people about their experiences. Also check with the Better Business Bureau, local Consumer Bureau, or the State Attorney General’s office.

Admissions: How flexible is this hospice in applying its policies to each patient or negotiating over differences? If the hospice imposes upfront conditions that do not feel comfortable, that may be a sign that it is not a good fit. Also, if you are not certain whether you or your loved one qualifies for hospice, or whether you even want it, is the agency willing to make an assessment to help clarify these issues?

Plan of care: Does the agency create a plan of care for each new patient? Is the plan carefully and professionally developed with you and your family? Is the plan of care written out and copies given to all involved? Check to see if it lists specific duties, work hours/days, and the name and telephone number of the supervisor in charge. Is the care plan updated as the patient’s needs change? Ask if you can review a sample care plan.

Family caregiver: Does the hospice require a designated family primary caregiver as a condition of admission? How much responsibility is expected of the family caregiver? What help can the hospice offer in coordinating and supplementing the family’s efforts or filling in around job schedules, travel plans, or other responsibilities? If the patient lives alone, what alternatives can the hospice suggest?

Preliminary evaluation: Does a nurse, social worker or therapist conduct a preliminary evaluation of the types of services needed in the patient’s home? Is it conducted in the home, not on the telephone? Does it highlight what the patient can do for him or herself? Does it include consultation with family physicians and/or other professionals already providing the patient with health and social services? Are other members of the family consulted?

Personnel: If you are dealing with an agency, are there references on file? Ask how many references the agency requires (two or more should be required.) Does the agency train, supervise, and monitor its caregivers? Ask how often the agency sends a supervisor to the patient’s home to review the care being given to the patient. Ask whether the caregivers are licensed and bonded.

Questions: Who can you call with questions or complaints? What is the procedure for resolving issues?

Costs: How does the agency handle payment and billing? Get all financial arrangements—costs, payment procedures, and billing—in writing. Read the agreement carefully before signing. Be sure to keep a copy. What resources does the agency provide to help you find financial assistance if it is needed? Are standard payment plan options available?

Telephone response: Does the agency have a 24-hour telephone number you can call when you have questions? How does the hospice respond to the very first call? Does telephone staff convey an attitude of caring, patience, and competence from the first contact, even if they need to return the patient’s call? Do they speak in plain, understandable language, or do they use a lot of jargon about the requirements that patients must meet? What is the procedure for receiving and resolving complaints? How a hospice responds to that first call for help may be a good indicator of the kind of care to expect.

Services: How quickly can the hospice initiate services? What are its geographic service boundaries? Does the hospice offer specialized services such as rehabilitation therapists, pharmacists, dietitians, or family counselors when these could improve the patient’s comfort? Does the hospice provide medical equipment or other items that might enhance the patient’s quality of life?

Inpatient care: What are the program’s policies regarding inpatient care? Where is such care provided? What are the requirements for an inpatient admission? How long can patients stay? What happens if the patient no longer needs inpatient care but cannot return home? Can you tour the inpatient unit or residential facility? What hospitals contract with the hospice for inpatient care? What kind of follow-up does the hospice provide for those patients? Do nursing homes contract with the hospice? Does the hospice provide as much nursing, social work, and aide care for each patient in the nursing home as it does in the home setting?

Patient’s rights and responsibilities: Does the agency explain these? Ask to see a copy of the agency’s patient’s rights and responsibilities information.
WHEN IS THE BEST TIME TO LEARN ABOUT HOSPICE?
Experts agree that the time to learn about hospice is before a life-threatening illness occurs. This greatly reduces stress, should the time come when hospice services may be needed.

Because it can take some time for hospice professionals to tailor palliative care and pain management to each person, it is best to begin some level of professional care before a crisis exists. Families often feel it is "too soon" to begin hospice care and wait until death is very near. Bringing hospice professionals in at the last minute limits their effectiveness. A better approach is to arrange introductory home meetings or hospice visits well in advance of need and obtain counseling from a hospice professional who can provide helpful suggestions on care arrangements. Put the support network in place before you need it.

Recent studies show that accessing hospice services at least 2 months before death is likely to occur, not only improves the quality of those last months of life, but also increases the amount of time the patient has with family by about a month ~ depending on the type of illness.

Most people do not want to die alone in a sterile, impersonal surrounding, hooked up by tubes to machines and cut off from their family and friends and everything that’s familiar. Nor do they want to die in pain. They would prefer, if possible, to spend their last days at home . . . alert and free of pain . . . among the people and things they love. Hospice is dedicated to making this possible.
HOW HOSPICE DIFFERS FROM OTHER TYPES OF HEALTH CARE?
1. The focus in HOSPICE is on palliative rather than curative treatment:
  • Pain control
  • Comfort measures
  • Treatment of symptoms rather than the disease
2. The team approach is used in HOSPICE to treat the patient rather than the disease. The team addresses medical, emotional, psychological and spiritual needs of the patient AND their family.
3. Emphasis is on quality of life rather than length of life in HOSPICE.
  • Hospice neither hastens nor postpones death.
  • Hospice affirms life and regards dying a normal process of life.
  • Hospice stresses human values that go beyond physical needs of the patient
4. Hospice Considers the entire family, not just the patient, to be the “unit of care” 
  • Patient and Family are included in the decision-making
  • Patient and Family are involved in bereavement counseling
5. Help and support are available 24 hours per day, 7 days per week
  • Nurses are available “on-call” 24 hours per day for either phone or home visit assistance
  • Patient routinely receives periodic in-home services of a nurse, aide, social worker, chaplain, volunteer, etc.
LEGAL DEFINITIONS
Terminal Condition ~ the condition cannot be cured and death is expected to occur within a short time, regardless of the medical treatment.

Death Prolonging Procedures ~ medical treatments that will only lengthen the dying process. (Food and water are not death prolonging procedures and can never be with held without explicit written directives to do so.
WHAT IS MEDICARE HOSPICE CARE?
Under Medicare, hospice is primarily a program of care delivered in a person’s home (which may be a nursing home) by a Medicare - approved hospice. Reasonable and necessary medical and support services for the management of a terminal illness are furnished under a plan-of-care established by the beneficiary’s attending physician and the hospice team.
Medicare covers:
  • Physicians’ services,
  • Nursing care (intermittent with 24-hour on call),
  • Medical social services, and
  • Counseling, including dietary and spiritual counseling.
  • Medical appliances and supplies related to the terminal illness,
  • Outpatient drugs for symptom management and pain relief,
  • Home health aide and homemaker services,
  • Physical therapy, occupational therapy and speech/language pathology services,
  • Short-term acute inpatient care, including respite care, usually 3 days or less
  • Continuous home care is 8 or more hours of continuous nursing care provided in a day, with at least 50% of that nursing care being provided directly by an LPN or an RN in the home.
WHO CAN PROVIDE HOSPICE CARE?
  • Hospice care can be provided by an agency or organization that is primarily engaged in furnishing services to terminally ill individuals and their families. To receive Medicare payment, the agency or organization must be approved by Medicare to provide hospice services.
  • Approval for hospice is required even if the agency or organization is already approved by Medicare to provide other kinds of health services. Patients can find out whether a hospice program is approved by Medicare by asking their physician or checking with the agency or organization offering the program. This information also is available from local Social Security offices.
  • Hospice uses a team approach that includes the patient and family, nurses, social workers, physicians, clergy and volunteers, all working together to plan and coordinate care. Family or friends (serving as primary caregivers) in the home can call for the help of a hospice team member 24 hours a day, 7 days a week. The team member will come to the patient’s home whenever needed and appropriate. The hospice team can arrange for a transfer to another setting when necessary.
HOW LONG CAN HOSPICE CARE CONTINUE?
  • Special benefit periods apply to hospice care. A Medicare beneficiary may elect to receive hospice care for two 90-day periods, followed by an unlimited number of 60-day periods. The benefit periods may be used consecutively or at intervals. Regardless of whether they are used one right after the other or at different times, the patient must be certified as terminally ill at the beginning of each period.
  • A patient who chooses hospice care may change hospice programs once each benefit period. A patient also has the right to cancel hospice care at any time and return to standard Medicare coverage, then later reelect the hospice benefit in the next benefit period. If a patient cancels during one of the first three benefit periods, any days left in that period are lost.
Call Visiting Nurse Association of Southeast Missouri today and learn how you can receive convenient home medical care from a team with 40 years of experience.

Share by: