Hospice Care13 minute read

13 minute read

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Updated for December, 2018

Healthcare across the world is turning to home- and community-based care. Although “coordinated care” models today are largely evaluated through the lens of metrics like reduced hospital readmissions and decreased health complications, its real value lies in the physical and emotional benefits of both a gravely ill patient and his or her family.

old man talking to nurse

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If you reach a point in your career where there is no more that can be done for a terminal illness, or you decide to forego additional curative treatments, hospice offers a comprehensive approach to give you the best quality of life possible from that point forward.

  • 1.43 million Medicare beneficiaries were enrolled in hospice care for one day or more in 2016.
  • 48% of Medicare decedents were enrolled in hospice at the time of their deaths.
  • The average length of service for Medicare beneficiaries was 71 days, with the median length being 24 days.
  • 98% of hospice care was provided at the Routine Home Care level.
  • There are currently 4,382 Medicare-certified hospices in operation. The majority of hospices averaged less than 50 patients.
  • Compared to home health care, hospice had significant growth in 2017, with 1.3 million Medicare enrollees—a 6.5% jump from 2016. 47.5% of these enrollees were at least 85, while only 13% of admitted patients were under 70.
  • The top five hospice terminal diagnoses in 2017 were Alzheimer’s, COPD, heart failure, lung cancer, and senile degeneration of the brain.

Hospice patients may require differing intensities of care during the course of their disease.

holding hands
Hospice patients may require differing intensities of care during the course of their disease. The Medicare Hospice Benefit affords patients four levels of care to meet their clinical needs.
Most patients and families choose Routine Hospice Care. A patient can receive this at home, an assisted living residence, or at a nursing facility – wherever he or she is living.

A Medicare-certified hospital, hospice inpatient facility, or nursing home can also provide General Inpatient Care. This provides direct care with registered nursing available 24 hours a day for pain control or other acute symptom management that cannot feasibly be provided in any other setting. General Inpatient Care begins when other efforts to manage symptoms have been ineffective.

Another option for managing pain and acute symptoms is Continuous Home Care, which is offered between eight and 24 hours a day. Though it is paired with caregiver and hospice aide services, continuous home care is predominately nursing care.

A temporary option for up to five consecutive days is Inpatient Respite Care in a hospital, long term care center, or hospice facility with enough 24-hour nursing personnel present on all shifts to guarantee that patient’s needs are met. This is to offer relief to caregivers.

Medicare coverage for each care level includes all services related to medication, medical equipment, supplies, and the Interdisciplinary team’s services…anything related to his or her terminal illness.

Hospice patients may require differing intensities of care during the course of their disease. While you can enter hospice at any level of care, remember that circumstances may require a change in care levels.

Because keeping a patient comfortable and pain-free is an important component in hospice care, many programs have developed ways to measure how comfortable a patient is during the course of their stay. They work with the patient’s physician to make sure that medication, therapies, and procedures are designed to achieve whatever goals are outlined in the patient’s care plan. The care plan is reviewed frequently to make sure any changes and new goals are in the plan.

The Affordable Care Act has required hospices that accept Medicare — almost all of them — to complete surveys and provide data about several quality measures, including how well they manage patients’ pain.

older man showing hospice nurse a photo album
You will want to be sure that your hospice program is Medicare-certified if, like the vast majority of patients, you will seek Medicare coverage. You should also check to see if it is accredited. While outside accreditation isn’t required, hospices that do secure it have made a special commitment to quality care. Organizations like the Joint Commission, the National Hospice and Palliative Care Organization, and Community Health Accreditation Partner have standards of excellence for participating hospices must meet.

Your state may have an agency that certifies hospices. Find out if it has been surveyed by either a state or federal oversight organization. Up to this writing, The Affordable Care Act has required hospices that accept Medicare — almost all of them — to complete surveys and provide data about several quality measures, including how well they manage patients’ pain. Eventually the results will be publicly available online. For now, ask if a survey has been done and what the results show.

Another important, yet non-mandatory option is board certification. A medical director who is certified by a medical board as a palliative medicine specialist offers one more assurance of training, experience and overall quality.

Check to see how the agency has been open, and search for a list of any specialized services it offers to enhance the patient’s comfort. You will want a provider with a 24-7 call line. Hospice care is generally available “on-call” 24/7, regardless of whether the provider’s office is open. Most have nurses who can respond to a call for help within minutes. Some hospice chaplains and social workers are on call. If you or a loved one has Alzheimer’s, see if the workers have experience with Alzheimer’s patients.

Different hospice sizes come with different pros and cons. While providers with 100 or more patients may offer more resources, smaller ones may provide more personalized care. Ideally, a hospice nurse or nurse practitioner should manage a caseload with no more than 12 patients.

hospice nurse checking on older man
How can you know when to try hospice? This should be part of ongoing discussions with your health care team— “ongoing” because goals and needs evolve. Ideally, hospice should begin when the patient is still able to give input on choosing the provider and other important healthcare decisions. It also helps family members make sure they understand the patient’s wishes and that everyone is on the same page.

But whatever stage of illness you or a loved one is at, the best time to learn more about hospice is now. End-of-life care and medical directives are never easy subjects to broach, yet it is best for family members to share their wishes long before it becomes an issue. This can greatly reduce stress for everyone concerned when the time for hospice is needed. Good communication in advance avoids putting patients in uncomfortable situations. It helps them make an educated decision that includes the advice and input of doctors and loved ones alike. This enables both the patient and family to reap the full benefits of hospice care.

Sources:

www.nhpco.org/about-hospice-and-palliative-care/hospice-faqs
www.nhpco.org/sites/default/files/public/Statistics_Research/2017_Facts_Figures.pdf
americanhospice.org/learning-about-hospice/how-is-hospice-care-paid-for/
www.cincinnati.com/story/sponsor-story/hospice-cincinnati/2018/07/17/its-never-too-early-talk-hospice-care/792172002/
www.floridatoday.com/story/opinion/2018/07/13/hospice-health-care-works/782332002/
homehealthcarenews.com/2018/07/nahc-president-on-pre-claims-chilling-effect-end-of-the-hospice-honeymoon/
www.nytimes.com/2018/06/22/health/hospice-humana-private-equity.html
www.theherald-news.com/sponsored/articles/2018/07/16/60625056/
www.picayuneitem.com/2018/07/those-in-hospice-need-additional-care/
omaha.com/sponsored/creighton/why-hospice-patients-need-and-deserve-better-oral-health-care/article_58c2dd50-82ad-55bb-8293-5b04647a435e.html
www.aarp.org/caregiving/basics/info-2017/hospice-need-to-know.html
homehealthcarenews.com/2018/06/2017-hospice-and-home-health-medicare-utilization-trends/