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General Hospice FAQs for Healthcare Professionals

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Understanding Hospice Services

  1. What is hospice?
  2. Who is on the hospice team?
  3. Where do patients go to receive hospice services?
  4. What are hospice “levels of care?”

Making the Prognosis

  1. When exactly is the right time for hospice?
  2. How can a physician know whether a patient will die in the next six months?
  3. Are there signs that a patient might be ready for hospice services?

Hospice Services

  1. How often does the hospice nurse or doctor visit?
  2. What does “comfort care” mean?
  3. Does hospice care for the patient 24/7?
  4. What is the role of hospice at the time of death?
  5. What about grief and other emotions? Does hospice address those?

Special Concerns

  1. What if the patient has special needs?
  2. How is hospice different from home health services?
  3. Why would a nursing home resident require hospice services?
  4. Why would anyone put a child in hospice?

Understanding How Hospice is Reimbursed

  1. Who pays for hospice? Is it covered by insurance? Medicare? Medicaid?
  2. What about patients without insurance?
  3. If Medicare covers hospice services, does that preclude other Medicare coverage?
  4. How does hospice work with an HMO?
  5. Is there a fee for a consultation?

How Hospice Addresses Specific Medical Conditions

  1. Heart patients
  2. Alzheimer’s and dementia patients
  3. Why would an Alzheimer’s patient get hospice care?
  4. ALS patients
  5. Cancer patients
  6. Can a patient receive chemotherapy and hospice services at the same time?
  7. COPD patients
  8. Parkinson's patients

Understanding VITAS Healthcare

  1. Who is VITAS Healthcare?
  2. Where is VITAS located?
  3. Is VITAS a nonprofit company?
  4. How do VITAS services begin?
  5. What is Palliative Care Associates?

Understanding Hospice Services

What is hospice?

Hospice is palliative, not curative. It cares for the terminally ill by focusing on pain relief, symptom management and emotional and spiritual end-of-life issues. Hospice does not try to cure disease. 

FAQ 4

Who is on the hospice team?

Hospice patients receive services from an interdisciplinary team (IDT), including a physician, registered nurse, hospice aide, social worker, chaplain, bereavement services manager, volunteer and other healthcare professionals.

Where do patients go to receive hospice services?

Hospice services are typically brought to wherever the patient calls home—a private residence, assisted living community or nursing home. Patients can also receive hospice services while in the hospital, or in an inpatient hospice unit.

What are hospice “levels of care?”

Medicare requires all hospice providers to offer four levels of care to address different needs of patients and families:

  1. Routine hospice care in the home
  2. Shifts of acute symptom management in the home when medically necessary. VITAS calls this Intensive Comfort Care®; it is also called “continuous care.”
  3. Round-the-clock inpatient care when symptoms cannot be managed at home.
  4. Respite inpatient care for the patient when the family caregiver is away 1−5 days.

Making the Prognosis

When exactly is the right time for hospice?

Physicians, patients and families should consider hospice services when medical treatments can no longer cure their disease and/or the symptom burden outweighs the benefits of treatment. Hospice services can begin when a doctor decides the patient’s life expectancy is six months or less. Hospice services are more efficacious if provided for months rather than days or hours. There is general dissatisfaction among families who believe their loved ones were referred to hospice too late. They reported more unmet needs, greater concerns, and lower satisfaction with the overall quality of care.

How can a physician know whether a patient will die in the next six months?

The prognosis is the physician’s best estimate of how long the illness will take to run its course before the patient dies.

Are there signs that a patient might be ready for hospice services?

When the burden of treatment outweighs the benefits and/or the patient has had multiple hospitalizations over the last several months, he or she might be ready for hospice. Other indications include:

  • Repeat trips to the emergency department
  • Unrelieved pain
  • Worsening cognitive function or increased confusion
  • Frequent infections
  • Sudden or progressive decline in physical functioning and eating
  • Weight loss/difficulty swallowing
  • Shortness of breath/oxygen dependence

Hospice Services

How often does the hospice nurse or doctor visit?

The hospice nurse creates a plan of care with the patient’s and family’s input that is designed to meet the patient’s needs. This determines the frequency of visits by the doctor, nurse and others on the hospice team. VITAS patients see their nurses or doctors an average of 5.9 times per week.

What does “comfort care” mean?

Comfort care focuses on the patient’s physical, psychological, social, and spiritual well-being as well as providing support for family .  The focus shifts from “cure” given that the patient is no longer responsive to such treatments to comfort care.  The hospice team works together to ensure the care provided reflects your wishes and goals. 

Does hospice care for the patient 24/7?

Except in the cases of inpatient hospice care and continuous care, no. Hospice does not take over from a primary caregiver. Hospice supplements that care, sharing the responsibility of caregiving through scheduled visits and education of loved ones.  However, hospice is available around the clock to answer questions or concerns that may arise after hours.

FAQ 2

What is the role of hospice at the time of death?

No patient should die alone. Ideally, a member of the hospice team is at the bedside at the time of death, able to explain the stages of death, make necessary phone calls, prepare the body and support the family in the first few hours. If a member of the team is not present at the death, they arrive as soon as the hospice is notified.

What about grief and other emotions? Does hospice address those?

Bereavement specialists, a member of the hospice interdisciplinary team, address all aspects of grief, including anticipatory grief and the grief process after death. According to the Medicare hospice benefit, hospices provide bereavement services for family for up to 13 months after the death. Bereavement services are provided to the patient, family members or other persons caring for the individual at home.

Special Concerns

What if the patient has special needs?

The hospice plan of care is individualized to meet each patient’s needs. If special equipment (e.g., wheelchair, lift, trapeze bar, etc.) or therapies (e.g., respiratory therapy, physical therapy, etc.) are needed, the hospice provider offers these as part of its services. The need may be for a certain religious practice or person, acceptance of a family or cultural tradition, a language other than English or another unique circumstance. Hospice providers address each patient’s unique needs through a personalized plan of care.

How is hospice different from home health services?

Hospice offers services home healthcare does not, such as prescriptions, medical equipment and visits from an interdisciplinary healthcare staff. Typically, the goal of home healthcare is to help the patient become more independent; visits decrease in frequency as the patient’s condition improves. The goal of hospice is to keep the patient comfortable as symptoms increase. Hospice services change to fit the needs of the patient.

Why would a nursing home resident require hospice services?

Nursing homes focus on routine daily care and rehabilitation. Nursing home residents who receive hospice services get customized support determined by their plan of care. The focus is the physical, emotional and spiritual end-of-life needs of the resident, the family and even the nursing home staff. 

Why would anyone put a child in hospice?

Hospice is for anyone with a terminal disease. From infants to adult through old age, hospice offers quality of life near the end of life as well as support for those who are caring for the patient. 

Understanding How Hospice is Reimbursed

Who pays for hospice? Is it covered by insurance? Medicare? Medicaid?

Part A of Medicare covers 100% of hospice services. Once you choose hospice care, your hospice benefit should cover everything the patient needs. All Medicare-covered services while in hospice care are covered under Original Medicare, even if the patient was previously in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan.

The Medicare standard daily rate includes payment for services related to the primary illness, including:

  • Management of the primary illness
  • Interdisciplinary team visits
  • Telecare® (after-hours) service
  • Care provided in the most appropriate setting
  • Medication, medical equipment and supplies related to the primary illness

Generally, most hospices also work with Medicaid, the Veterans Administration and private insurance companies.

How is hospice covered for patients without insurance?

Hospice admissions staff work with patients who are not insured to determine financial responsibility, self-payments and eligibility for other benefits that could help pay for services.

If Medicare covers hospice services, does that preclude other Medicare coverage?

No. If a hospice patient needs hospitalization for any reason unrelated to the terminal disease, traditional Medicare will cover that care. The patient’s medical insurance continues to pay for care unrelated to the terminal diagnosis. For example, if a hospice patient with cancer in involved in an accident and breaks their leg, the ED and physician charges would be paid via regular medical insurance. Hospice would continue to cover the cancer patient’s comfort care. The patient need not and should not revoke their hospice benefit in order to receive emergent care for the broken leg.

The Medicare hospice benefit can be discontinued if the patient requests treatment for the terminal illness that is different from what hospice provides. The Medicare hospice benefit can also be resumed at any time.

How does hospice work with an HMO?

Hospice provides care related to the primary diagnosis; the HMO takes care of unrelated healthcare.

Is there a fee for a consultation?

Hospices do not charge fees for eligibility consultations.

How Hospice Addresses Specific Medical Conditions

Each of the diseases listed below has unique symptoms, but all are appropriate for hospice care when the patient’s prognosis is six months or less. While every patient’s case is unique, some symptoms to look for are:

Heart patients

  • The patient has advanced congestive heart failure or advanced coronary disease with frequent episodes of angina
  • The patient has an abnormal heart due to disease and suffers from significant symptoms of fatigue, shortness of breath or functional decline
  • The patient has received optimal treatment for his/her disease and is not a candidate for further surgical or medical intervention
  • The patient has received optimal treatment for his/her disease and has chosen not to pursue advanced specialized treatment

Alzheimer’s and dementia patients

  • The patient can say only a few words
  • The patient can no longer walk and may be bed-bound
  • The patient shows signs of severe anxiety
  • The patient has been through several years of decline

Why would an Alzheimer’s patient get hospice care?

At the end of their lives, Alzheimer’s patients can present challenges to caregivers. In the last six months, hospice can relieve some of the burden—physically, emotionally and spiritually—for caregivers and help the patient’s end-of-life experience be comfortable and dignified.

ALS patients

  • Progression* from independent ambulation to wheelchair or bed-bound
  • Progression* from normal to barely intelligible or unintelligible speech
  • Progression* from normal to pureed diet
  • Progression* from independence in most or all activities of daily living (e.g., toileting, feeding, dressing, etc.) to needing major assistance with these tasks
  • Choice to forego feeding tubes for hydration and nutrition and supportive ventilation for breathing

*Progression is defined as the development of severe neurologic disability over a 12-month period.

Cancer patients

  • The patient is rapidly weakening and the cancer is progressing
  • If a cancer patients spends half of their time in a bed or chair, hospice care may be more helpful than other therapies  
  • The treatment intervention is not fully effective
  • The burden of treatment on the patient and family outweighs the benefits

Can a patient receive chemotherapy and hospice services at the same time?

If chemotherapy were an attempt to cure the cancer, hospice would be inappropriate. However, a patient receiving hospice services may receive chemo for reasons of comfort and quality of life—for example, to shrink a tumor that is pressing on an organ.

COPD patients

  • The patient has made one or more trips to the emergency department every three months due to infection or respiratory failure
  • The patient spends most of his/her days at home
  • The patient has endured repeated hospitalizations (i.e., one or more in three months) and wants to remain out of the hospital
  • The patient no longer wishes to be intubated

Parkinson’s patients

  • Continuous decline in function
  • Coma
  • Persistent vegetative state
  • Severely reduced level of consciousness
  • A significant compromise in breathing and/or swallowing
  • Any of the progressions under “ALS,” question 4 above

Understanding VITAS Healthcare

Who is VITAS Healthcare?

VITAS® (pronounced VEE-tahss) Healthcare is the nation’s leading provider of end-of-life care.

Where is VITAS located?

VITAS cares for patients and families in 15 states (Alabama, California, Connecticut, Delaware, Florida, Georgia, Illinois, Kansas, Missouri, New Jersey, Ohio, Pennsylvania, Texas, Virginia and Wisconsin) and the District of Columbia. The company is headquartered in Miami, Florida.

Is VITAS a nonprofit company?

Medicare requires all hospices to provide the same basic care, regardless of tax status. As a for-profit hospice, VITAS cares for all patients regardless of their ability to pay. Our for-profit status also allows us to finance projects that enhance care for the terminally ill.

VITAS has a not-for-profit component, VITAS Community Connection, which helps hospice patients and their families in need meet both routine and unexpected expenses beyond their care needs (i.e., rent, utilities, groceries and more) and contributes to other community nonprofit organizations.

What services does VITAS provide?

  • An interdisciplinary team of hospice experts (physician, nurse, hospice aide, social worker, chaplain and volunteer)
  • An individualized plan of care
  • Four levels of care, including routine care in the home, shifts of acute symptom management in the home when medically necessary (Intensive Comfort Care®), round-the-clock inpatient care when symptoms can’t be managed at home, respite inpatient care
  • Telecare®—24/7 support for patients and family and team members ready to be dispatched to the patient’s home after hours if needed
  • Prescription drugs, over-the-counter medications, medical equipment and supplies
  • Holistic therapies, such as music therapy and pet visits for hospice patients
  • Bereavement specialist for 13 months of grief support after a loved one’s death

How do VITAS services begin?

Evaluating the patient is the first step in starting VITAS services. There is no need for a doctor’s referral in order to request an evaluation. A VITAS representative speaks directly with the patient and the family. If they choose to begin hospice services, the doctor’s referral is obtained. The patient, family, physician and VITAS team create a plan of care, which includes everything related to the terminal diagnosis.

What is Palliative Care Associates?

The word palliative means comfort. Palliative care is comfort care, intended to treat pain and other symptoms causing discomfort. Palliative Care Associates is a division of VITAS Healthcare that offers consultation and expertise in aggressive symptom management and support to patients and families, whether or not the patient is hospice appropriate.