Understanding the Medicare hospice benefit
by Terre Mirsch
While attending a national hospice conference a few years back, I recall listening to Mary Labyak, one of the earliest pioneers of hospice care in our country. I’d heard Mary speak previously and, although I never had the honor of knowing her, she was a mentor for me throughout my career. Mary stated, “When you’ve seen one hospice, you’ve seen one hospice.” I was puzzled for a moment but quickly understood—and she was certainly correct in her declaration. Hospices across the country were continuing to find new and innovative ways to deliver services, developing programs that meet the unique needs of their communities. One is as different as the next. Some hospices are small, focused on providing care within a small geographic area, while others are large with a nationwide reach. Some service urban environments while others meet the challenges of servicing rural communities. Some are not-for-profit providers, some are for-profit, and others are government sponsored. It can be a challenge to navigate through the array of programs that may be available to you, and for this I refer you to my prior blog “Choosing a hospice: Finding the right program for you and your loved one.”
But caregivers can also take comfort in knowing that there are some things that are certain and consistent across all hospice programs. The Medicare Hospice Benefit was made permanent by Congress in 1986, defining hospice standards and required services in order for a program to obtain federal certification. Additional licensure requirements exist in most states. Accreditation organizations also have standards that define standards for service and quality. All recognize that as illness progresses, a variety of support services are necessary in order to adequately support patients and families who are facing life limiting illness. All recognize the need for bereavement support following loss. These services provide advantages that other types of care may not in the face of serious illness.
Where can care be provided?
Hospice services are typically provided in the home, or home-like setting with “home” being wherever the person lives—whether a house or apartment, a long term care facility, personal care or assisted living facility, boarding home, or a homeless shelter. Some hospices have residential hospice units or houses that provide 24 hour care, for which there may be room and board charges. If acute medical problems requiring frequent skilled care and intervention, inpatient care can be provided in a hospice inpatient unit for a short period of time.
Does my loved one need to be homebound?
No. Unlike the home care benefit, there is no requirement that those receiving hospice care be homebound, nor is here a requirement for skilled care. Hospice is about living each day to its fullest, and we encourage people to engage in activities outside of the home when possible.
What services will be provided?
Hospice care is designed to support caregivers through the provision of holistic, intermittent services and assistance. At the heart of hospice care is the interdisciplinary team that provides, or arranges for, needed care and services. Which care and services are provided is determined by a plan of care that is developed by the patient, family, physician, and hospice team.
Hospice team members include:
- Your loved one’s physician
- Hospice Medical Director or physician
- Social workers
- Counselors, including pastoral, dietary, and bereavement counselors
- Hospice aide or homemaker services
- Physical, Speech, and Occupational Therapists
Other services that are provided by Medicare certified hospices include:
- 24 hour/7 day a week on-call availability
- Medical Equipment and supplies related to the management of the life limiting illness
- Medications and biologicals related to the life limiting illness, as necessary for symptom control
- Bereavement services for family members
Some hospices offer additional services, not required by state or federal regulations. Additional supports may include complementary or integrative therapies such as bodywork therapies (massage, reflexology, energy therapies, or acupressure to name a few) or healing art therapies (such as music, art, pet, or horticultural therapies). Those providing these services are integral members of the hospice interdisciplinary team. Holy Redeemer Hospice is especially well-known for these complementary therapies.
What options are available if I need a break from caregiving? What if my loved one’s symptoms cannot be managed in the home setting?
Hospice care is provided at one of four levels of care based on criteria established under the Medicare Hospice Benefit. Other insurance providers may have provisions for similar care options. While most hospice care is provided at the ‘routine’ level of care, caregivers often take comfort in knowing that there are other options available if their loved ones condition requires a higher level of care or if they need a break from caregiving.
Routine Home Care includes intermittent visits by members of the hospice team in your home.
Inpatient Respite Care is provided in a hospice-contracted facility to provide relief for caregivers for a maximum of five consecutive days on an occasional basis.
General Inpatient Care is short-term care in a free standing or hospice-contracted facility for management of pain and symptoms that cannot be controlled in the home setting. Eligibility for inpatient care is determined daily, based on the continued presence of unmanaged symptoms and frequent changes to your loved one’s treatment plan.
Continuous Home Care can be provided during periods of medical crisis in your home. Continuous Home Care can be provided for 8-to-24 hours a day, but must require the skills of a licensed nurse for more than fifty percent of the time. Continuous Home Care cannot be utilized to provide routine custodial care.
Throughout our life span our care needs change, with care at end of life care being no exception. Understanding the benefits that are available to you and your loved one is essential for ensuring the necessary support and guidance throughout the caregiving journey. For more information regarding the Medicare Hospice Benefit, you can also refer to the official Centers for Medicare and Medicaid Services booklet Medicare Hospice Benefits.