All About Hospice

Medicare Covers Hospice Care


Many hospice organizations are now adding the word "palliative" to their names. Palliative care seeks to address not only physical pain but also emotional, social, and spiritual pain to achieve the best quality of life for patients and their families.

Many people don't realize it but Medicare offers a hospice benefit that will cover almost all of the costs of caring for a dying person during his or her last six months of life. To qualify for the Medicare hospice benefit ...

  • Your parent must have Medicare Part A.
  • Your doctor and the medical director of the hospice must confirm that your parent has a life expectancy of less than six months.
  • Your parent must agree in writing that he or she will not pursue any treatments to cure his or her illness.

As a Medicare beneficiary, your parent can choose any Medicare-certified hospice in your area. Even if your parent belongs to a Medicare managed care plan, your parent has this benefit. You do not have to be pre-certified nor do you have to use a hospice in the HMO's network. Nor does your parent need to get out of the managed care plan. If your parent needs services from the managed care plan, beyond hospice care, it will be covered as long as your parent remains enrolled.

The Medicare hospice benefit covers the following:

  • Skilled nursing services
  • Volunteer services
  • Physician visits
  • Skilled therapy
  • Medical social services
  • Spiritual counseling
  • Nutrition counseling
  • Bereavement support for the family

The benefit also covers 95 percent of the cost of prescription drugs for symptom control and pain relief, short-term inpatient respite care to relieve family members from caregiving, and home care. Most hospices cover the remaining 5 percent of the cost. Equipment is also covered. The Medicare hospice benefit does not cover 24-hour care in the home; however, in a medical crisis, continuous nursing and short-term inpatient services are available.

If no one can take care of your parent at home, hospice care is available in some nursing homes and hospitals. And there are also some programs available that can help place home health care workers in the home. Be aware, however, that Medicare does not pay for full-time home health care.

The hospice team is available 24 hours a day to those patients being cared for at home to respond to any possible emergencies. They'll provide medications, home visits, and arrange for other care as needed and reimbursed by Medicare. The day-to-day, 'round-the-clock care, however, is provided by a complement of family, friends, and home health aides covered by insurance or private pay.

Finding a Hospice

Whatever hospice you decide upon, be sure that it is a Medicare-certified facility. These are the only hospice programs that are eligible to receive your parent's Medicare Hospice Benefit. There are over 2,400 hospice programs throughout the country. Three good sources of information regarding hospice programs available in your community are the local area agency on aging, your local hospital's department of social services, and your regional home health intermediary (RHHI). And of course, there's always the trusted Yellow Pages of your phone book.

Questions to Ask a Hospice Provider

Your parent's primary physician should be a good resource in referring you to a hospice. Ask the doctor if he or she has a working relationship with any particular hospice and if it is positive. Here are some questions to ask when inquiring about a hospice:

  • Is the hospice Medicare-certified?
  • Is the hospice a member of any professional organization or has it been accredited?
  • Are there certain conditions that patients and families have to meet to enter the hospice program?
  • Would the hospice be willing to come to the home and conduct an assessment to help you and your parent decide that this is the best option?
  • What specialized services does the hospice offer (rehabilitation therapists, family counselors, pharmacists, used equipment)?
  • What are the hospice's policies regarding inpatient care? What hospitals does it have contractual relationships with in the event your parent would need to go to the hospital?
  • Does the hospice require a primary family caregiver as a condition of admission? What are the caregiver's responsibilities as related to the hospice?
  • What kind of emergency coverage does it offer? Who is on call? Will a nurse come quickly to the home, if needed?
  • What out-of-pocket expenses can we expect?
  • Will the hospice handle all of the paperwork and billing?
  • What are the hospice's policies on the use of antibiotics, ventilators, dialysis, enteral or parenteral nutrition (nutrients given intravenously)? What treatments does it consider outside its purview?

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Excerpted from The Complete Idiot's Guide to Caring for Aging Parents © 2001 by Linda Colvin Rhodes, Ed.D. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Alpha Books, a member of Penguin Group (USA) Inc.

To order this book visit the Idiot's Guide web site or call 1-800-253-6476.


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