Frequently asked questions about Hospice Care
How and when does hospice care start?
Anyone can inquire about hospice services. You or your loved one may call a local hospice and request services. The hospice staff will then contact your physician to determine if a referral to hospice is appropriate. Another way to inquire about hospice is to talk with your physician, and he or she can make a referral.
Hospice services can begin as soon as a referral is made by your doctor. The hospice staff will contact you and set up an initial meeting. The staff will review the services that hospice will offer and you can sign the necessary consent forms for care to begin. Usually, care can begin within a day or two of a referral. However, in urgent situations, service may begin sooner.
Paying for hospice care
Hospice is paid for through the Medicare hospice benefit, Medicaid hospice benefit and most private insurers. If you do not have coverage through Medicare, Medicaid or a private insurance company, hospice will work with you and your family to ensure that needed services can be provided.
Medicare hospice benefits
Who is eligible for Medicare hospice benefits
- You are eligible for Medicare part A (Hospital Insurance);
- Your doctor and the hospice medical director certify that you have a life-limiting illness and if the disease runs its normal course, death may be expected in six months or less to live;
- You sign a statement choosing hospice care instead of routine Medicare-covered benefits for you illness*;
- You receive care from a Medicare-approved hospice program.
The Medicare hospice benefit, initiated in 1983, is covered under Medicare part A (hospital insurance). Medicare beneficiaries who choose hospice care receive a full scope of medical and support services for their life-limiting illness. Through a variety of services, hospice care supports you and your family.
More than 90 percent of hospices in the United States are certified by Medicare. Eighty percent of people who use hospice care are older than 65 and are thus entitled to the services offered by the Medicare hospice benefit. This benefit covers virtually all aspects of hospice care with little out-of-pocket expense to people or their families. In addition, most private health plans and Medicaid in 47 states and the District of Columbia cover hospice services.
Sometimes your health improves or your illness goes into remission. If that happens, your doctor may feel that you no longer need hospice care. Also, you always have the right for any reason to stop getting hospice care. If you stop hospice care, then you will receive the type of Medicare coverage that you had before choosing hospice. If you are eligible, you can go back to hospice care at any time.
You are eligible for Medicare hospice benefits when you meet all of the following conditions:
* Medicare will still pay for covered benefits for any health needs that aren't related to your life-limiting illness.
What does Medicare cover?
- Doctor services
- Nursing care
- Medical equipment (such as wheelchairs or walkers)
- Medical supplies (such as bandages and catheters)
- Drugs for symptom control and pain relief
- Short-term care in the hospital, including respite and inpatient for pain and symptom management
- home health aide and homemaker services
- Physical and occupational therapy
- Speech therapy
- Social work services
- Dietary counseling
- Grief support to help you and your family
Medicare defines a set of hospice core services, which means that hospices are required to provide these sets of services to every person they serve, regardless of the person's insurance policy.
Medicare covers these hospice services and pays nearly all of their costs:
You will have to pay part of the cost of outpatient drugs and inpatient respite care.
Will I have my own hospice team and how often will it visit?
Every person receiving hospice has access to an interdisciplinary team made up of a hospice volunteer, registered nurse, social worker, home aide and chaplain. The team writes a care plan to make sure that you and your family are getting the care you need. Typically, full-time registered nurses provide care to about a dozen different families. Social workers usually work with about twice that number. If needed, home health aides, who provide personal care, will visit most frequently.
All visits, however, are based on your condition during the course of the illness and your needs and your family's needs as described in the care plan. The frequency of volunteer visits and spiritual care services often depends upon what you request and the availability of these services. Travel requirements and other factors may cause some variation in how many individuals the hospice staff serves.
Is hospice available 24 hours a day, 7 days a week?
Hospice care is available on call after the administrative office has closed. Most hospices have nurses available to respond to calls for help within minutes, if necessary. Some hospice programs have chaplains and social workers on call as well.
What do hospice volunteers do?
Hospice volunteers are generally available to provide different types of support, including running errands, preparing light meals, staying with a person to give loved ones a break, and lending emotional support and companionship.
Because hospice volunteers spend time in homes, every hospice program generally has some type of application and interview process to ensure the person is right for this type of volunteer work. In addition, hospice programs have an organized training program for volunteers. Topics covered by these training programs often include understanding hospice, confidentially, working with families, listening skills, signs and symptoms of approaching death, loss and grief, and bereavement support.
What happens if I can't be cared for at home?
A growing number of hospice programs have their own hospice facilities or have arrangements with nursing homes, hospitals or inpatient residential centers to care for people who cannot be cared for at home. However, the cost to live in these settings may not be covered by your insurance. So it's best to find out if insurance covers this type of care before you call hospice.
Can I be cared for by hospice if I live in a nursing facility or other type of long-term care facility?
Hospice services can be provided to a person who has a life-limiting illness wherever they live. This means a person living in a nursing facility or long-term care facility can receive specialized visits from hospice nurses, home health aides, chaplains, social workers and volunteers, in addition to other care and services provided by the nursing facility. The hospice and nursing home will have a written agreement in place in order for the hospice to serve residents of the facility.
Do state and federal reviewers inspect and evaluate hospices?
Yes. There are state licensure requirements that must be met by hospice programs in order for them to deliver care. In addition, hospices must comply with federal regulations in order to be approved for reimbursement under Medicare. Hospices must periodically undergo inspection: (1) To be sure they are meeting regulatory standards; (2) To maintain their license to operate; (3) To maintain the certification that permits Medicare reimbursement.
How can I find out if a hospice provides excellent care?
Many hospices use tools to help them see how well they are meeting quality standards for hospice care. The National Hospice and Palliative Care Organization recommends standards of practice for hospice programs as one way of ensuring quality. NHPCO also offers hospices a tool to do a self-evaluation of their program so they can draw comparisons with the NHPCO Standards. You may ask the hospice when it last completed a self-assessment using the NHPCO standards.
In addition, most programs use family satisfaction surveys to get feedback on their services and to make improvements. You may ask the hospice to share a summary of their family satisfaction scores for the last several months. You can also ask if they participate in the national Family Evaluation of Hospice Care. If they do, they should be able to provide you with a summary that compares their scores with the national average.
This material is from the National Hospice and Palliative Care Organization website