Who needs Hospice Care?
Although 70% of patients admitted to hospice programs have cancer related illnesses, other frequent admission diagnoses included: Congestive Heart Failure, Cardiomyopathy, Chronic Obstructive Pulmonary Disease, Human Immunodeficiency Virus, Alzheimer's, Parkinson's and Cerebral Vascular Accidents.
Patients always have the right to withdraw from the McLaren Hospice program to obtain treatment, which is not available within the context of the hospice philosophy.
Who can use Hospice Services?
- Acceptance for care is based on mutual agreement among those concerned (the individual, the family, the physician, and hospice) that such help is timely and desirable.
- Most insurances (BCBS, Medicare, Medicaid) pay for hospice care. However, ability to pay is NOT a criterion.
Misconceptions of Hospice
Hospice is a philosophy, an interdisciplinary approach to end of life care, and a program of services available to the patient and her/his loved ones where ever the patient may be.
- Hospice requires the patient to forego a continuing relationship with her/his primary care physician; it also requires the primary care physician to forego her/his relationship with the patient.
Hospice programs encourage an on-going relationship between the primary care physician and the patient in most cases; the primary care physician becomes part of the team and actively contributes to the hospice plan of care.
- The patient must have a primary caregiver to be eligible for hospice
In the past, some hospices required a primary caregiver. This is not now the case for most hospice programs in Michigan.
Unfortunately, many physicians and other potential referral sources believe a primary caregiver is a pre-requisite and fail to make referrals for patients without such an individual present.
- The patient must have a do-not-resuscitate (DNR) order to elect the hospice benefit.
In the past, most patients who enrolled in hospice were cancer patients. Recent statistics, however, demonstrate an increasing number of patients with diagnoses other than cancer are choosing hospice. The National Hospice Organization has issued standards to help in defining hospice appropriate prognostic indicators for non-cancer patients.
In Michigan in 1996, 64 percent of hospice had a primary diagnosis of cancer. The other 35 percent represent a wide variety of endstage diseases, cardiovascular, neurological, renal, Alzheimer’s, AIDS, etc.
- Hospice provides good psychosocial supports, but because the patient is limited to the terminally ill, clinicians are not skilled health care practitioners.
Hospice clinicians demonstrate expert pain management, symptom control, and supportive care; perhaps the best combinations in the health care industry. Clinicians are not only experienced with these interventions; in addition, they are also uniquely well qualified to address personal end-of-life issues with patient and their loved ones, and to work as members of an interdisciplinary team.
- Only older people (Medicare-eligibles) enroll in hospice.
In the early days, hospice cared primarily for older patients. As hospice utilization has grown, more patients of all ages are electing the benefit. We are seeing an increasing number of families of terminally ill children choosing hospice for them.
- Hospice patients in nursing homes are ineligible for hospice.
Both Federal and Michigan state government regulations provide for nursing home patients to receive hospice care. A patient in a nursing home is considered to be "at home" for hospice purposes.
Under current definitions, hospice-appropriate patients must have a specified and limited life expectancy. However, the hospice philosophy emphasizes the creative and positive outcomes to be realized by defining and achieving personal goals and by living life as fully as possible. Death is inevitable, dying well takes work. Hospice workers handle that job very well and help hospice patients and their families to have some of the most memorable moments of their lives.
It is not uncommon for patients entering hospice to experience an improved sense of well being and comfort. This sometimes happens because pain management and symptom control issues are openly discussed and effectively resolved. Sometimes, the sense of well being is a reflection of the patient’s
Sense of control gained from defining her/his goals and from active participation in developing the plan of care.
- Once a patient revokes the hospice benefit, she/he cannot receive hospice care again.
This was once true. However, as of August 5, 1997, there is unlimited, lifetime access to hospice care under the Medicare and Medicaid hospice benefits. This means that as long as a patient meets the criteria for hospice care, that care will be available to her/him. This is true for Medicare, Medicaid, and most private insurances.
- Managed care companies don’t pay hospice.
Each managed care company makes a decision about the services covered by its basic and supplemental premiums. There is a substantial variation in the services covered and the length of time a patient is eligible to receive hospice care. In Michigan, Medicaid HMO’s are required to provide hospice coverage if the patient requests hospice care. Private insurers and self-insured businesses are not required to offer hospice care, but many do.
- Hospice services are not readily available in Michigan.
Hospice programs are located throughout the state, in rural and urban areas. In Michigan, in 1997, MHO listed over 120 hospice locations, with six in the developing process. Michigan hospices served over 21,000 patients and their families in 1996. However, many hospice-appropriate patients never experience the goodness of hospice care, mainly because people do not understand hospice care.
- After six months on the hospice benefit, the patient is no longer eligible for hospice care.
In reality, a patient is eligible for hospice as long as he/she has a life limiting illness with a prognosis of six months or less to live if the disease process proceeds on its expected course. There is no absolute time limit. An unfortunate recent trend is very late referrals to hospice. As a result, the median length of stay for some patients is too short to allow them and their loved ones to gain the full benefits of hospice care.
- Hospice patients are denied treatments because they are terminally ill.
If the purpose of any treatment is to manage pain and/or control symptoms and is consistent with the patient’s wishes, it may be included in the plan of care. All hospice programs protect the patient’s right to choose care, and readily discuss the benefits and limitations of all treatments with the patient.
- When a patient is admitted to an acute care hospital, hospice services cease.
When a hospital admission is part of the hospice plan of care, the hospice continues to care for the hospitalized patient and to provide case management services including coordination of care and discharge planning.
- Hospice ends when the patient dies.
All hospice programs must provide bereavement services for loved ones for up to one year following the death of the patient. In most cases, bereavement support continues beyond that time frame. Most hospice programs also offer bereavement support to those in need even if their loss is unrelated to a patient who received hospice care. This is a common community service of most Michigan hospice programs.
- The hospice benefit is inflexible by definition and is therefore limited in the services it can offer patients at the end of life.
The Medicare and Medicaid hospice benefit has considerable flexibility. While Medicare-certified and state of Michigan licensed programs must comply with federally defined Conditions of Participation, many offer extended services. Most Michigan hospices also provide free care in their communities to patients who meet financial need criteria. In 1966, Michigan hospices provided nearly 35,000 days of free care to Michigan citizens. This care is funded via donations and fund-raising activities on a local and state basis.
- When is it time for Hospice Care?
If you or someon in your family has a life expectance of months rather than years, an informational meeting with a McLaren HomeCare Team member would be useful. A full explanation of the benefits available under this service will help you decide if Hospice care would meet your needs.