How do I choose a Hospice Agency? Part 2

The Centers for Medicare & Medicaid Services (CMS) has created the hospice coverage program to support patients who have a terminal illness and their families through the dying process and 13 months afterwards. The guarantee supports patients receiving care from a certified hospice agency, collaboration from two providers to certify the patient’s prognosis, and the patient election of services. While the hope is for all patients to experience the comfort and care that is provided through hospice, patients and families always have a choice.

A common misconception is that hospice is only for palliative services, i.e., pain management via morphine. This is an oversimplification of the skilled services the hospice team provides and limits the level of intervention that is actually provided. Services that can support quality of life include the medical oversight from the agency provider, the skilled nursing care, the medical equipment and supplies provided, the medications that address pain and other symptoms, the care services of the certified aide, the counseling services of the social worker, the spiritual guidance of the chaplain, and the consultative training and support of physical, occupational, speech, and dietary therapies. Finally, the ongoing service provision after the patient has died cannot be discounted.

Facilities and providers that claim “hospice-like” services will often charge for the medical consultation, charge for the medications provided, and often do not address the psycho-social-emotional-spiritual aspects of the dying process. Patients on hospice are supported with a comprehensive plan that addresses how they would like to pass away, their funeral arrangements, their household arrangements, and the collaboration with their family members for key decisions beyond their healthcare. This is included in the hospice benefit. The Medicare benefit covers all of these services.

Patients are entitled to hospice. They have paid their whole life for the service, and they deserve the full benefit.

Questions you may want to explore with a potential hospice company are:

1)How will the hospice team manage my pain or other symptoms that arise? Your nurse and medical provider will review your symptoms and implement different interventions, including medications, therapies (e.g., massage), or strategies.

2) Can I take my current medications? Some patients choose to continue existing medications. All medications are discussed with your hospice team to identify side effects and symptoms that may alleviate or contribute to your comfort.

3) What if my symptoms become uncontrollable at home? Can I go to the hospital? Hospice involves different levels of care. While our goal is to manage all of your symptoms in the comfort of your home, if we are unable to do this, we will increase your care potentially involving an inpatient stay.

4)How will the hospice team keep me and my family informed about my condition? You will have ongoing communication with your hospice team, primarily through your nurse case manager.

5) Will my family and I be involved in making care decisions? Yours and your family’s concerns for care are integral in the team dynamic. Your concerns and questions are critical to developing a care decision that meets the need.

6)How do I communicate any questions or concerns I have about my care? You have access to all of your care team members. These individuals are available to you to support issues or concerns that arise.

7)Can I still see my regular doctor if I am on hospice? If you choose the agency’s medical director, your care will be deferred to the new provider in collaboration with you and the care team. You may elect to use your primary care provider to oversee your hospice benefit if you prefer to retain your provider.

8)How will the hospice team prepare me and my family for what to expect? Your team involves trained professionals who recognize signs and phases of the dying process. Part of hospice is to provide education and support as things change. This is why you will have regular visits with the nurse who will assess and provide education and training. This visit with your nurse may introduce, or exit, members of your care team based on your individual needs.

9)Can we speak with other caregivers to learn of their experience with hospice? We can connect you with individuals who have gone through the hospice process. Many times, these individuals are volunteers with our agency who want to give the support they received back to individuals who are now going through the process.

10) What support services are offered by the hospice? One of the levels of hospice involves respite care. There are also coordinated services for caregivers to provide regular opportunities to refresh. Your case manager will work with you and the social worker to identify and coordinate the appropriate supports.

11) What if we cannot take care of our loved one at home? Your social worker is a critical member at addressing your psycho-social-emotional needs. If you find that you are unable to care for your loved one at home, your social worker will work with you to identify options for placement, increased hired help, or other supports.

12) How will the hospice team support us emotionally through the grieving process? Bereavement is offered for up to 13 months. By design, your hospice benefit is meant to support your loved ones after you pass away through important dates, such as birthdays, anniversaries, and your death. These services are part of hospice and help family members after you have transitioned.

These questions are some of the more common questions we address regularly. You may have others, and those should be talked about before you start hospice. It is a big decision, and for many family members, a decision that helps shape how someone passes.

How do I choose a Hospice Agency? Part 1

Hospice is a Medicare program designed to provide comfort and support for individuals at the end of their life. Medicare evaluates agencies that provide services by addressing issues related to how quickly comfort is provided and the level of support the hospice team is giving to a patient and their family.

Questions you may want to consider in evaluating a hospice agency include:

  1. Are my hospice services covered by my insurance? While Medicare covers hospice at 100%, there are insurance companies that cover only a portion of the service or limit the services provided, including the number of days the patient may access the benefit. It is important to have an idea of out-of-pocket costs if you are not accessing hospice as a Medicare beneficiary.
  2. How long has this hospice agency been supporting patients in this community? Every community is different, and there may be cultural practices that agencies that have been serving an area for a long time may be aware of and are able to better support. The hospice benefit should incorporate your individual beliefs, spiritual needs and practices. Chaplains are provided as spiritual counselors. They are not proselytizing or promoting any particular religious belief system.
  3. Where does this agency provide hospice services? Agencies may choose to provide services in particular spaces, such as skilled nursing, assisted living, or in hospice houses. Elite provides services anywhere the patient calls home. It is important to check if your agency has restrictions on where they are able to provide services to support continued care even if you have to move locations.
  4. Does this hospice agency provide all of my medical equipment? Most hospice agencies will cover the cost of necessary medical equipment, such as a hospital bed, commode, and incontinence supplies. These needs are typically identified at admission and adjusted if needed during the course of hospice services.
  5. Will I have the same hospice nurse/team? While staffing may change to support on-call coverage, most hospice agencies are intentional in having the same hospice providers – nurse, chaplain, social worker, and aide – with you during the duration of your hospice service. We know that having familiar people in your home is part of providing comfort and care. Our on-call nurse is the exception to this, as we rotate our staff to support work-life balance. With that said, many of our nurses will request to be present when their patient passes and will often put the on-call nurse on alert if the call is about their particular patient.
  6. How many patients are assigned to each hospice nurse? These numbers vary by agency. At Elite, our patients serve both home health and hospice, so our numbers reflect that difference. We also support a large geographic space, so each nurse’s caseload is determined in part by the area being covered, the patient complexity, the mix of home health and hospice, the nurse’s employment status (part time or full time) and the nurse’s experience, anywhere from 8-20 patients is the average.
  7. Does the hospice agency have after hours, weekend, holidays and night support? Yes, hospice is a 24/7 service. We are available through our phone triage and in person. Simply call our main number 509-758-2568, and we will get you the right level of support.
  8. When I call with an urgent need, how long will it take someone to respond? We have a 20 minute turnaround on all phone calls. If the nurse identifies the need for a visit, there may be a delay depending on where the nurse is coming from. They will typically provide a time expectation based on the patient location and where they are coming from. If they are addressing another patient need, there may be a delay in an in-person visit. Know that we create redundancies to support if there are multiple needs at once, so a nurse can come to the home in a reasonable amount of time if needed.

We have lots more to cover. Stay tuned to next week for Part 2!

Hospice and Palliative Care

Are they different? YES

Hospice is a Medicare program. Medicare has designed and created this program.

Palliative is not a designated service. Elite has created its program, so this will look different from agency to agency.

Here is a fun way to understand how these two services are different!

Understanding Hospice Part 2

Lots of great information to better understand this unique service line. Hospice is such a great benefit that is so misunderstood. We will finish out the answers to our Hospice quiz from 2 weeks ago. As always, if there are any questions, please email us at info@elitehhh.com

Hospice provides medications, treatments, medical equipment and supplies that are related to the patient’s illness that is causing the need for services.

Hospice reviews each medication and works with the patient and family to support medications that are providing comfort. Medications that are unrelated to the diagnosis causing the need for hospice may be an out-of-pocket cost for families. This should be reviewed and discussed at the evaluation visit.

Hospice ends when the patient dies.

Grief support is provided for the family members after the patient has passed away for 13 months. Social workers and chaplains often support this service.

Hospice care is available to any individual expected to live 6 months or less.

Patients can live beyond 6 months while on hospice. The health status is regularly reviewed to determine continued eligibility. Hospice services may end due to the patient no longer having a 6-month prognosis. Patients may graduate from hospice at this point. If the patient begins to decline, they can be readmitted to the hospice program again.

People who live alone are able to receive hospice.

Most hospices will enroll a patient without a caregiver. Usually, if there is a concern for caregiver needs, this may become a focus of the hospice care plan to assure the patient has proper care and support as their disease progresses and additional help is required.

Hospice is designed to treat the emotional needs of the dying individual and their family.

The hospice team is uniquely trained to provide emotional support. The unique training of social workers and chaplains aids in meeting these needs. The patient and family determine the level of support provided.

Dementia, such as Alzheimer’s disease, cannot have hospice.

Around 13% of all hospice patients have a diagnosis of one of the dementias. This is becoming the largest and fastest growing segment of hospice.

While on hospice, individuals can receive treatment such as chemotherapy, radiation, or surgery to cure the illness causing the need for services.

In many cases, these interventions are considered curative. As such, the role of hospice cannot properly be provided, and patients will often choose to discharge from hospice in pursuit of these services.

Individuals on hospice cannot be taken to the hospital.

Hospitalization is usually unnecessary while on hospice. Unrelated conditions may be treated in a hospital setting while on hospice. The important thing is to let the hospice agency know, so they can properly advise if a hospitalization is the best treatment plan based on overall goals. The hospital will also need to be informed to support the patient’s decisions for care.

Hospice care focuses on managing pain and symptoms.

The purpose of hospice is quality pain and symptom management. In fact, this is one of the key metrics that contributes to a hospice’s rating. Most patients expect hospice to address pain relief as a priority in the care plan.

Hospice is for the caregivers, family, and friends, as well as, the patient.

Hospice is a team targeting physical, emotional, psychosocial, and spiritual needs. Additional members that may be available, depending on the hospice, include massage therapists, physical therapists, occupational therapists, speech-language pathologists, pharmacists, and volunteers.

Hospice is a minimum of 12 hours of daily bedside care provided by the clinicians.

Hospice is generally provided as visits by different team members each week. The frequency and duration of visits will depend on the patient’s needs. There may be a need to supplement services with hired caregivers to meet all the needs of the patient.

Understanding Hospice

Last week, we gave a 24-question quiz to test your knowledge of hospice. What we have found is that there are many misconceptions of hospice, what it is, what it is designed to do, and when to pursue it. So, let’s dig into the questions together. As always, feel free to send follow-up questions to info@elitehhh.com

Hospice is a 24/7 service.

Hospice is provided on a 24/7 basis. That means patients and families on hospice can call at any time of day to speak with a nurse or have the nurse come out to the home to do a visit. Our goal is comfort. These issues do not always occur during a regular business day. That is why these are services designed to meet your needs…whenever that may happen.

Hospice is only for 6 months even if you continue to live beyond that time frame.

Hospice is a service designed to be initiated during the last 6 months of life. BUT, this is not an exact science, and patients are not beholden to the 6 months. Medicare guidelines dictate that hospice services are only to be stopped if the patient’s condition improves beyond a brief or temporary period that the life expectancy is now beyond 6 months. Hospice benefits do not expire, and patients can access these benefits if conditions change again, and they now qualify for hospice again.

Hospice is only for cancer patients.

Hospice is not contingent on a particular disease process, like cancer. In fact, many hospice patients have conditions related to heart and lung disease, dementia, kidney failure, neurological disease, and many other conditions. Hospice is not a cancer-specific service.

Hospice services are paid for by health insurance.

Hospice is covered by nearly all insurance plans. Medicare and Medicaid cover these services in nearly all 50 states. Coverage may vary state by state. Some things are not covered based on state benefits such as nutritional supplements and disposable supplies. Room and board at a nursing home and over the counter medications are typically not covered and are often paid out of pocket by the family or through a long-term care insurance plan.

Hospice services include comfort and grief support for families after the patient dies.

Hospice includes bereavement services. These services are provided for 13 months after the passing of a loved one. This may be one-on-one counseling, group sessions, or periodic phone calls. Bereavement is often extended to members of the public who interacted with the individual who passed as well.

Hospice can be provided in nursing homes.

Hospice can be provided in a residential setting. That means traditional homes/apartments/condominiums, nursing homes, and assisted living communities – including memory care facilities may all serve as locations for hospice.

Hospice is only appropriate if the person only has a few days to live.

Hospice is designed to be a gradual progression of increased care and support as symptoms change and the body changes. Most people find hospice is beneficial when the full range of skilled medical, emotional, and spiritual support services for provided for at least a month or longer.

Patients on hospice cannot receive care from spouses, partners, children or other loved ones.

Hospice supports the family and caregivers of the patient through education and partnership. Support for stress and identifying resources are often key elements of the hospice care plan. In most cases, family members provide the day-to-day patient care.

Hospice helps by speeding up the dying process.

Hospice does not speed up the dying process. At this point of the illness, no medical intervention can prolong or cure the terminal illness. Hospice is designed to support the quality of life by addressing symptoms and discomfort. Some studies suggest patients actually live longer on hospice than without the service.

Hospice cannot be provided in the home.

Over 66% of all hospice is provided in the home setting!

Only persons older than 65 can receive hospice.

Hospice is not constrained to age. Any person with a terminal diagnosis and expected to pass in 6 months is eligible for hospice, regardless of age.

Anyone can make a referral to hospice.

Anyone can initiate the process for a hospice review. Often, patients, family members, or caregivers reach out to hospice and ask if the service is appropriate. This usually starts a conversation with the patient’s provider (doctor, nurse practitioner, or physician assistant) to better understand the patient’s prognosis and goals. If hospice makes sense, the provider writes an order, and the hospice assessment occurs.

Lots of great information here. If there are questions, let us know. We are happy to answer any questions you may have. Email us at info@elitehhh.com

Hospice Quiz

November is National Hospice and Palliative Care Month!

Let’s test our knowledge and learn together!

True or False:

  1. Hospice is a 24/7 service.
  2. Hospice is only for 6 months even if you continue to live beyond that time frame.
  3. Hospice is only for cancer patients.
  4. Hospice services are paid for by health insurance.
  5. Hospice services include comfort and grief support for families after the patient dies.
  6. Hospice can be provided in nursing homes.
  7. Hospice is only appropriate if the person only has a few days to live.
  8. Patients on hospice cannot receive care from spouses, partners, children or other loved ones.
  9. Hospice helps by speeding up the dying process.
  10. Hospice cannot be provided in the home.
  11. Only persons older than 65 can receive hospice.
  12. Anyone can make a referral to hospice.
  13. Hospice provides medications, treatments, medical equipment and supplies that are related to the patient’s illness that is causing the need for services.
  14. Hospice ends when the patient dies.
  15. Hospice care is available to any individual expected to live 6 months or less.
  16. People who live alone are able to receive hospice.
  17. Hospice is designed to treat the emotional needs of the dying individual and their family.
  18. Dementia, such as Alzheimer’s disease, cannot have hospice.
  19. While on hospice, individuals can receive treatment such as chemotherapy, radiation, or surgery to cure the illness causing the need for services.
  20. Individuals on hospice cannot be taken to the hospital.
  21. Hospice care focuses on managing pain and symptoms.
  22. Hospice is for the caregivers, family, and friends, as well as, the patient.
  23. The Hospice team is a physician, nurses, social workers, and chaplains.
  24. Hospice is a minimum of 12 hours of daily bedside care provided by the clinicians.

Here are the answers:

  1. True
  2. False
  3. False
  4. True
  5. True
  6. True
  7. False
  8. False
  9. False
  10. False
  11. False
  12. True
  13. True
  14. False
  15. True
  16. True
  17. True
  18. False
  19. False
  20. False
  21. True
  22. True
  23. True
  24. False

Explanations will be in next week’s blog…stay tuned!

Hospice and Palliative Care Month

November is the month where we get the privilege to highlight the unique realm of healthcare that is focused strictly on quality of life.

The Hospice Foundation of America provides resources to assist in selecting the best hospice provider for you.

Here are some key ideas to consider when selecting a hospice provider

https://hospicefoundation.org/Videos/video-player?id=85

What does a day on hospice look like? According to the Hospice Foundation of America, hospice is…

  • Medical care for people with an anticipated life expectancy of 6 months or less, when cure isn’t an option, and the focus shifts to symptom management and quality of life. 
  • An interdisciplinary team of professionals trained to address physical, psychosocial, and spiritual needs of the person; the team also supports family members and other intimate unpaid caregivers.  
  • Specialty care that is person-centered, stressing coordination of care, clarification of goals of care, and communication.
  • Provided primarily where a person lives, whether that is a private residence, nursing home, or community living arrangement, allowing the patient to be with important objects, memories, and family.
  • Care that includes periodic visits to the patient and family caregivers by hospice team members. Hospice providers are available 24 hours a day, 7 days a week to respond if patient or caregiver concerns arise.
  • The only medical care that includes bereavement care, which is available during the illness and for more than a year after the death for the family/intimate network.

For more information, check out Hospice Foundation Of America – What is Hospice?

This is an unbiased website about what to look for and consider when selecting a hospice provider.

As a local provider, we hope you will choose us to support you and your loved ones in this critical decision. We know every story is different and every experience is unique. Our goal is to tailor your experience to you and your wishes. If you have questions, you can always call or email us.

Are all hospice agencies the same?

Hospice is a Medicare program, so agencies that pursue Medicare certification must offer the same basic services. However, the “same basic services” does not necessarily mean these services are equal. Hospice providers have choices in how they design and carryout a treatment plan. These differences can provide a very different hospice experience across agencies.

If you have a choice, selecting a hospice agency should be a carefully considered decision. For example, an agency can be certified only by Medicare which is managed by the state the agency is in. However, agencies can choose to pursue stricter and more stringent standards. This may involve accreditation with the National Hospice and Palliative Care Organization or review by an outside organization, such as the Community Health Accreditation. Agencies that pursue these higher standards show that while the minimum requirements to provide “hospice” are met, these agencies are choosing the next level of care and are measured on their performance across other aspects of the hospice service.

Hospice is a medical service, but not all of hospice has to be medically focused. Some hospice agencies embrace alternative interventions such as massage therapy, energy work, therapeutic music, and palliative therapies, such as physical, occupational or speech. Also, some hospice agencies support specific populations, such as geriatrics, veterans, or pediatric patients. Some hospice agencies foster building in cultural considerations into the care, such as language used during service, religious beliefs and practices supported through spiritual care, and intentional inclusion of the diversity in the community. If these are important to you, make sure the hospice agency you select is open to alternative medicine options, such as naturopathic or Eastern approaches.

Finally, hospice is a 24/7 service, but that means different things for different providers. A monitored voicemail is different than a live answering service or a scheduled nurse visit the next day versus a middle of the night nurse phone call versus a middle of the night in-person nurse house call. Knowing what you need and want can help aid in differentiating what is available.

Choosing the right provider can demonstrate the unique value of hospice or tarnish a perspective of what the hospice benefit actually is. Take your time and start early. Schedule a meeting with a potential provider to better understand how they do hospice!

What does it mean to age well?

When we think about aging, we may find there are conflicting views about the freedom of retirement and the challenges of one’s body becoming older. But, when it comes to the word itself, “aging” can mean lifestyle choices and living one’s best life. Sometimes, it is taking an intentional first step to plan out what aging will be for you.

According to Johns Hopkins Medicine, aging well involves intentionality and active participation in your health and lifestyle. Being aware of your physical needs and changes may involve having conversations with friends and families about your goals and plans for your health, your living abilities, and how you intend to change these areas over time. Aging well also involves plans for your financial health, supportive resources to continue living your best life, and having a plan for your needs as you change. Aging well also involves a plan for your mental and emotional health, supportive friendships and community outside of your immediate family, as well as engaging in activities that create meaning for your life. Finally, healthy aging involves a balanced diet and some form of physical activity to support your overall health goals.

Aging is more that numbers rising, another calendar year gone by, or physical change. Aging is something you can plan for and work with. At least, that’s what we believe!

Resources:

www.hopkinsmedicine.org/health/wellness-and-prevention/aging-well

https://www.nia.nih.gov/health/what-do-we-know-about-healthy-aging

https://www.pbs.org/newshour/show/a-neuroscientist-lays-out-the-keys-to-aging-well

What is Hospice?

Hospice is not a place. Hospice is not a death sentence.

Hospice is the specific service that is provided when you are no longer seeking curative treatments. The goal of hospice is your comfort to support you in living your life. Hospice is flexible in where it can be provided.

Hospice does not require that you stop all medications. The goal of hospice is to make sure the medications you are taking serve you. If you are uncomfortable, because of side effects of your medications, these might be removed, because the goal of hospice is comfort.

In hospice, you do not have to be a DNR (do not resuscitate). The goal of hospice is to help you understand these decisions and honor what you have requested.

Hospice is prescribed by your provider and can support individuals with various forms of cancer, dementia, cardiac disease, pulmonary disease, renal disease, liver disease, HIV/AIDS, neurological disease, and stroke or coma.

At Elite, we do hospice differently. Our team designs your program based on your needs where your voice has a say in your visits, your care goals, and your family’s needs.