Hospice is designed to bring comfort and support to people with terminal illness, and their families. When a patient elects to receive hospice care it means that she, or he, has decided to forgo any further aggressive, curative treatments and, instead, focus on comfort care and quality of life. We want to keep our patients out of the hospital and at home where things are familiar and life is more comfortable.
Hospice care is provided by a team of professionals, led by the nurse case manager, in conjunction with the patient's PCP and the hospice Medical Director. The team also includes nurse's aides, medical social workers, and bereavement counselors. Physical therapists, occupational therapists, speech therapists, certified dieticians/nutritionists and volunteers are also available, as needed.
How is hospice care paid for?
For the vast majority of patients, hospice care (including medications and equipment related to the terminal illness) is 100% paid for by Medicare. In other situations the VA, Medicaid or private insurance may pay. Aside from co-pays (in a case where private insurance pays), it is very unusual for patients to have any out-of-pocket costs for hospice care.
The 4 levels of hospice care
The Medicare hospice benefit provides for four levels of hospice care: Routine Home Care, General Inpatient Care, Continuous Care, and Respite care. Patients may be admitted at any level of care. These levels of care are designed specifically to meet the changing needs of hospice patients as symptoms and circumstances necessitate.
Routine Care: Provides patients with regularly scheduled visits from their hospice team. Support includes visits from nurses, medical social workers, home health aides, a hospice chaplain/counselor, and sometimes volunteers. Patients also have access to home medical equipment, medications, personal supplies, therapy and 24/7 on-call nursing support. Routine Care is the most common level of hospice care.
Continuous Care: Provides more intense nursing and support services when the patient is going through a medical crisis or experiencing severe symptoms, such as unrelieved pain. Continuous care is defined as a minimum of 8 hours of care in a 24 hour period. At least half of those 8 care hours must be provided by a by a Registered Nurse.
General Inpatient Care: A short term level of care designed to manage symptoms that cannot be managed in the patient's home. Typically used for only a few days, General Inpatient Care is provided in a nursing home, hospital or hospice inpatient unit. Once the situation improves and the symptoms are managed, the patient typically returns to his or her home with routine home hospice support.
Respite Care: A short term level of care (up to 5 days) intended to give caregivers, (often the spouse, children or other family members), the opportunity to take some time away from their responsibilities. This respite period allows everyone to emotionally recharge, physically refresh and better prepare to manage the day-to-day challenges of caregiving in the face of a chronic life-threatening illness.
What else does hospice provide?
In addition to nursing, aide, social work, counseling, and other services, hospice also provides medications and equipment related to the patient's terminal illness. Medications that are unrelated to the terminal illness are not covered by hospice. These medications continue to be covered in whatever manner they were covered prior to the patient coming on hospice (Medicare, Medicaid, or private insurance, for example).
Frequently Asked Questions
How do we know if we're ready for hospice?
This can be a difficult question to answer, because it is a deeply personal one and we naturally to want to continue to pursue every available option for treatment for ourselves or our loved ones. It's helpful to discuss treatment options/benefits with your Primary Care Physician or Specialists to see if hospice is right for you. Some common indications hospice may be appropriate include:
Increased frequency of hospitalizations/ER visits
Frequent or recurrent infections
Uncontrolled pain, shortness of breath, nausea or vomiting
Increased dependence for assistance with activities of daily living
Changes in mental capacity/increased sleeping
Reduced desire to eat resulting in weight loss
Is Hospice 24/7 Care?
Hospice is a supplemental care provider, which is not the same as a primary caregiver. Hospice patients should have a primary caregiver, such as a family member or be in the care of a facility that offers ongoing caregiver services. However, hospice care is available in an ‘on-call’ capacity 24 hours a day, seven days a week, with the ability to make visits for patients who have had an emergency or change in condition any time of the day or night.
Do you offer emergency services?
Commonwealth Hospice is available to respond to patient emergencies 24 hours a day, 7 days a week. We offer dedicated on-call nursing for changes in condition that occur outside of normal business hours. Commonwealth also partners with numerous skilled nursing and personal care facilities in the Pittsburgh area that can assist in providing emergency care, if caregivers are unable to meet a patient's changing needs.
Can I receive hospice care if I reside in a nursing facility or other type of long-term care facility?
Yes. Hospice services can be provided to a person who has a life-limiting illness wherever that person lives. 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 the care and services provided by the nursing facility. The hospice and the nursing home will have a written agreement in place in order for the hospice to serve residents of the facility. The Medicare Hospice Benefit will cover the care related to your terminal illness, but it will not cover any charges related to the facility (room and board, laundry and housekeeping fees, etc.).