MyGericare

Hospice | Palliative Care

QUICK OVERVIEW: Hospice is a type of palliative care given during the final stages of a terminal illness. Known more commonly as just Hospice, care provides comfort and promote a patient's comfort by focusing on both the physical and emotional causes of any pain and suffering. Also known as end-of-life care, Hospice is designed to keep pain and suffering to a minimum, not to cure the illness, as the patient's doctor has determined the patient is terminal and can no longer benefit from regular medical treatment. Hospice care can be provided in the patient's residence, in a singular Hospice Facility, or, within either an Assisted Living or a Skilled Nursing Facility. All Hospice Agencies are Medicare certified.

 

APPROPRIATE FOR: The senior who can no longer benefit from regular medical treatment

 

SERVICES PROVIDED: Hospice agencies provide many services such as nursing, physical and occupational therapy, speech and language therapy, medical social services, medical supplies and appliances, drugs for symptom control and pain relief, physician services; psychological, spiritual, and nutritional counseling; group and bereavement counseling, caregiver support groups and grief support.

 

COST RANGE: $1,000 - $3,000/month

 

FUNDING SOURCES: Private pay, some Long-term Care Insurance (LTCI) policies, Managed Care (HMOs), Veteran's Benefits, Medicare & Medicaid.

 

 


PRIVATE PAY SOURCE:

Coverage

Conditions & Limits

-All-

-None-

 

 


LONG-TERM CARE INSURANCE (LTCI) SOURCE:

Coverage

Conditions & Limits

- Depends on your policy - read the details.

- Some policies cover Hospice in the home only

- Other policies cover both in-home & in-facility hospice care.

   - Read your policy - some policies only provide for one or the other, either in-home Hospice care, or in-facility hospice care, though usually not both.

- For information on how to determine what kind of LTCI policy is best, consult with one of our Advisors For Seniors

 

 

VETERAN'S BENEFITS SOURCE:

Coverage

Conditions & Limits

- Veterans Benefits cover hospice care at a certified facility vs. in-home.

- Veteran must meet eligibility criteria for VA benefits, and

- Demonstrate need for this type of care

 

 

 

 

MANAGED CARE (HMO) SOURCE:

Coverage

Conditions & Limits

- Managed Care policies cover everything that Medicare covers (see Medicare section below).

 

- Most policies only cover hospice care and services provided by Medicare-certified hospice agencies that are designated by the individual insurance company.

 

 

 

 

MEDICARE SOURCE:

Coverage

Conditions & Limits

 

- Usually a 210-day cap on Medicare-covered hospice care, which are split into two ninety-day periods, followed by a thirty-day period. Each period may be extended when a doctor re-certifies that the patient's condition remains terminal. In some circumstances, coverage may be extended indefinitely, as Medicare pays for most hospice services such as:

- Nursing services

- Durable medical equipment i.e., wheelchairs, walkers

- Medical supplies

- Drugs prescribed by a doctor

- Short-term hospital care, including respite care

- Home health aide and housekeeping services

- Physical, occupational and speech therapies

- Social worker services

- Nutritional counseling

- Grief counseling for patient and family

 

 

- Both a doctor and hospice medical director must verify that the patient has a terminal illness and probably has less than six months to live.

- Patient must sign a statement choosing hospice care instead of standard Medicare-covered benefits (Medicare will continue to cover health problems unrelated to terminal illness.)

- NOTE:  Hospice agencies sometimes charge more than Medicare pays. In these instances, the patient is responsible for the balance. Before providing care, the hospice must advise the patient how much of the bill Medicare will pay and inform the patient, in writing, of any items or services not covered. The bill is sent directly to Medicare.

- The patient may be charged for: Treatments designed to cure a terminal illness, Treatments or services not related to comfort care, Room and board (except respite care)

 

 

 

 

MEDICAID SOURCE:

Coverage

Conditions & Limits

 

- RN visits for pain management and symptom control

- 24-hour on-call RN

- Medical social work visits

- Certified home health aide visits

- Chaplain visits

- Trained volunteer visits for support, companionship and errands

- Bereavement support for 13 months following the death of a loved one

- Authorized medications

- Durable medical supplies and equipment

- Coordination of hospital or skilled nursing facility admissions

- Respite care (limited to a 5-day stay)

- Hospital inpatient admission for symptom control

 

 

- Before Medicaid will approve coverage for hospice care, you must:

- Receive a doctor's certification that the individual has a terminal illness and probably has less than 6 months to live

- Sign a statement choosing hospice care instead of standard Medicare-covered benefits (Medicare will continue to cover health problems unrelated to terminal illness)

NOTE: Medicaid only pays for hospice care provided by a Medicare-certified agency

-    We recommend consulting with one of our Advisors For Seniors