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Choosing Home Hospice

By Barbara Barbero, R.N.

Scenario:

A cancer patient is being cared for by a hospice program in which a visiting nurse comes to his home twice a week. One day the man is feeling well enough to walk around the block. He's doing well until, unfortunately, a large dog sees a cat across the street and dashes in front on him, knocking him down and causing extreme pain in his leg. His wife is afraid the leg is broken and wants him to go to the emergency room. He is sure the hospice program won't pay for an ambulance and wants to wait until the nurse comes again in a few days.

Questions:

Does hospice insurance pay for an ambulance? What should the wife do?

Deciding To Use Home Hospice Care

Home care for a patient who is severely ill or disabled and who is expecting to die in the near future is emotionally and physically demanding for the family, caregiver and patient. Everyone involved in home hospice care needs a great deal of support to maintain an appropriate level of functioning and to prevent emotional or physical exhaustion. Home hospice care has been designed to provide that support. It has assisted many patients, families and caregivers to get through what is often the most difficult part of their lives.

Nevertheless, home hospice is not the best choice for everyone. There is no right or wrong in choosing for or against it and care cannot be forced on a patient or on a family. No one can predict the future, so you have to make the best decisions you can with as much information as you have.

In deciding whether or not to use home hospice care, it is important to know that this kind of care requires a strong partnership between the patient, family and other caregivers. This partnership is not likely to succeed, however, unless all parties are willing to work together toward a common goal. Although it is not necessary for everyone to have the same hopes, emotions or beliefs, there does have to be a common commitment to the care which will be needed. The commitment must come from within each person, so it is important to talk with one another to decide what the common commitment will be and to take as much time as is needed to resolve key issues and differences of opinion.

Qualifying For Home Hospice Support

The main requirement for qualifying to receive home hospice support is the certification of a physician that your prognosis is for living six months or less.

THIS DOES NOT MEAN THAT YOU ARE REQUIRED TO DIE WITHIN SIX MONTHS!

THIS DOES NOT MEAN THAT YOU ARE REQUIRED TO DIE AT ALL!

THIS DOES NOT MEAN THAT YOU HAVE TO WAIT FOR HOME SUPPORT UNTIL YOU ARE CERTAIN THAT YOU ARE GOING TO DIE SOON!

THIS MEANS ONLY THAT THE DOCTOR'S BEST GUESS AT THE TIME THE ORDER IS WRITTEN IS AN APPROXIMATE SIX MONTHS OR LESS PROGNOSIS.

SOME PEOPLE HAVE SURVIVED HOSPICE AND LIVED TO TELL ABOUT IT!

Another major requirement is that there is someone who is willing to commit to the role of primary caregiver, that is, a person who will assume the major responsibility for providing the needed care and who will be able to spend enough time with the patient to ensure the patient's safety at home.

How Home Hospice Insurance Plans Work

Insurance coverage for home hospice care is designed for people with end-stage illness who will continue to receive medical care for the control of symptoms (palliative care) but are no longer expecting medical care which is being administered for the purpose of achieving a cure. It is this factor—not how sick you feel or how long you might actually live—that is the defining concept and qualification for home hospice care.

Medicare first created the concept of home hospice benefits for its covered members. Since then, many, if not most, major insurance plans of all types have adopted a similar benefit package. It works very much like an HMO, even if you have PPO or total choice insurance. However, you need to make certain at the time of discharge that the hospice agency you plan to use is covered by your insurance.

The package was designed because it can be very cost-effective for insurance plans compared to the extremely high cost of last ditch or heroic medical measures. It was also designed as an alternative for patients who: do not wish for their end-stage care to use up all the family's savings, believe they are receiving more harm than good from their treatments, or may feel intimidated by health care providers who push them to accept every possible drug, surgery, or radiation treatment conceivably deliverable.

There is a great deal of misunderstanding about the acceptance of home hospice insurance, so it is important you understand the answers to three common questions:

1. Does accepting hospice care mean that you can never go to the hospital again? NO.

2. Does it mean that if a new treatment or clinical trial becomes available, one which is believed to have a possibility of curing your cancer, that you cannot receive this treatment? NO.

3. Does this mean that you can never call 911 in the case of a medical emergency? NO.

Under the stress of end-stage care, however, patients and families can feel so grateful to their care providers that they don't want to "let them down". It is important to realize that you are entitled to the very best care available, which may—or may not—include the latest medical treatment offered. Some physicians constitutionally can't let go. You are entitled to let this be their problem rather than yours. You have quite enough problems of your own. You owe your loyalty first to yourself.

What Care Are You Entitled To?

The Medicare standard home hospice plan entitles you to the following services:

Intermittent skilled nursing and rehab care as needed. (Intermittent means that live-in or 24-hour care is not provided by the hospice agency or covered by the hospice benefit.)

Intermittent, usually three to five times a week as needed, visits by a Home Health Aide to attend to the personal needs of the patient (bathing, clothing, grooming, cleaning the patient's immediate environment, doing patient laundry, etc.)

A 24-hour telephone hotline number where you can reach a registered nurse every day and night for advice

Temporary 8-hour shift coverage during a medical crisis

Home visits by a chaplain who provides non-denominational support or will help you to obtain a home visit from a religious domination or church of your choice

Home visits by a social worker, licensed social worker counselor or psychiatric nurse for emotional support for the patient and family members, to help the family plan funeral arrangements, and for assistance in resolving difficulties of various types

Consultation, as needed, with a registered dietitian to identify and resolve nutritional problems

Up to 5 days of respite hospital care (in a hospital contracted with your hospice agency), where the patient receives ongoing palliative care and support while the family or caregiver takes a rest, a vacation or attends to other family business or needs.

A trained hospice volunteer who will assist the caregiver and/or patient with various miscellaneous needs. These can include running errands or shopping, reading to the patient, sitting with the patient while a caregiver does an errand or attends to self-care. After all, the caregiver needs time for himself or herself to have hair and nails done, play a sport, exercise, get a message, visit, or go out with a friend, family member or partner.

Hospitalization to obtain control of symptoms which have been out of control at home (at a hospital contracted by your hospice agency)

Grief support, as needed, for the caregiver or family following the death of the patient

You will see that we haven't answered the question of the wife whose husband broke his leg. For that, go to Hospice Limitations.

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