Hospice Basics, Hospice Eligibility

Inpatient Hospice Guidelines for Our Patients

October 1, 2019

Variety of Hard-to-Manage Symptoms May Indicate a Patient is Eligible

Joseph Shega MD

By

When you refer your patient to hospice care with VITAS, we help to determine the best care setting. Most of the time, hospice care is provided to the patient at home. Sometimes, patients require inpatient care.

When the VITAS hospice interdisciplinary team determines a hospice patient’s symptoms and pain can no longer be managed and controlled at home, the team may move the patient to a 24-hour inpatient care facility.

The Medicare hospice benefit requires that all hospice providers offer inpatient care when medically necessary. At VITAS inpatient hospice facilities, care is provided in a home-like setting. Friends and family members are welcome to visit at any time, and overnight stays can always be arranged.

Once symptoms and pain stabilize during inpatient care, the patient can return to hospice care at home.

Which Patients Qualify for Inpatient Hospice Care?

A variety of hard-to-manage symptoms may indicate that a patient is eligible for inpatient hospice care:

  • Sudden deterioration that requires intensive nursing intervention
  • Uncontrolled pain
  • Uncontrolled nausea and vomiting
  • Pathological fractures
  • Unmanageable respiratory distress
  • Symptom relief via intravenous medications that require close monitoring
  • Wound care that requires complex and/or frequent dressing changes that cannot be managed in the patient’s residence
  • Unmanageable agitation; delirium; or acute severe anxiety
  • Uncontrolled seizures

For condition-specific qualifications, consult our hospice eligibility guidelines.

When Are Patients Discharged from Inpatient Hospice Care?

Inpatient hospice care is intended to be temporary, allowing patients to return home to familiar surroundings and loved ones as soon as possible. The following criteria indicate a patient may be ready to discharge from inpatient care:

  • Symptoms have stabilized
  • The patient has transferred to another level of care (i.e., continuous care)
  • Medication requiring skilled nursing care is no longer necessary

Who Pays for Inpatient Hospice Care?

Medicare Part A covers up to 100% of the cost of hospice care related to a hospice-eligible patient’s terminal illness, with no deductible or copayment. For patients with Medicare Advantage, hospice is covered by original Medicare. Patients with a private or employer-provided health plan should check with their insurance provider for details about hospice eligibility, coverage and out-of-pocket expenses. Medicaid provides hospice coverage, but it varies by state.

When care unrelated to a patient’s terminal illness is necessary, Medicare Parts A and B may cover expenses under normal rules.

Questions About Inpatient Hospice?

When symptoms can no longer be managed at home, inpatient hospice care from VITAS offers round-the-clock inpatient care in a warm and comforting environment. If your seriously ill patient is living with complex symptoms and serious pain, schedule a consultation with VITAS and help your patient find a better quality of life. Contact VITAS via phone, app or referral form today to determine whether hospice is right for your patient.

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