Hospice and Medicare

OCTOBER 3, 1994 VOLUME 2, NUMBER 13

When a terminally ill patient needs care at the end of life, hospice programs are often the best choice available. Family members may gain as much (or more) from the hospice experience as that patient himself. Most providers know the value of hospice, but the availability of hospice programs, the variety of programs and the possibilities for Medicare funding are widely unknown or misunderstood.

A number of common myths about hospice care prevail in the medical and nursing community. With thanks to Dasa Colsman of Hospice Family Care, Inc., a few of those myths can be exploded.

Medicare does not limit its coverage to six months of hospice care. Medicare coverage for hospice care is not available until the prognosis is for less than six months of life. Unfortunately, many practitioners misunderstand this benefit limitation and delay referral to hospice programs until the last hours or days of life.

Hospice provides a great deal more than traditional nursing services. Although nurses are trained to deal with dying patients, the special training and orientation of hospice workers is of great benefit to patients and family members. More importantly, Medicare coverage for hospice patients does not include a co-payment and all prescriptions, disposable and necessary medical equipment is covered. For that matter, so are individual and family counselling, caregiver assistance and grief support. Consequently, terminally ill Medicare patients actually get much more service through the hospice program than traditional nursing services, even when provided in the nursing home.

Hospice services can be delivered in the nursing home. Non-Medicare patients can receive hospice services in the nursing home. Provision of hospice services must be coordinated with the nursing facility.

HMO members can receive hospice care. The Medicare hospice benefit is available to those who subscribe to one of the growing number of Medicare HMO programs. The primary physician remains responsible and directs the medical care component.

Hospice care is appropriate for people who are not suffering from AIDS or cancer.Although those two illnesses are the ones most commonly thought about in relationship to hospice programs (in 1992, 78% of US hospice patients had a diagnosis of cancer), any terminally ill patient, regardless of diagnosis, can be admitted to many hospice programs.

Hospice patients do not have to “give up” on all forms of treatment. Although curative treatment is not provided in hospice programs (since the very nature of the programs is to deal with the inevitability of death in the near future), “palliative” care is provided. Radiation, chemotherapy, intravenous administration of medications and other therapies may sometimes be aimed at relieving pain or making the process easier, and many hospice programs will permit continued administration of such therapies.

Hospice services can be provided in the home on a part-time basis. Not all hospice programs are based in institutions, nor do they all require 24-hour attendants. Different programs are intended to deal with different patient needs.

According to statistics provided by Hospice Family Care, Inc., 12,000 Arizonans died from terminal or irreversible illnesses in 1990. Only 4,500 (or about 37%) had hospice care.

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