Last week we began our discussion on the truths surrounding hospice care. Advance planning is key to making sure a loved one’s final days are as comfortable and organized as possible.
My hope is this platform will get the information you need to help you make smart decisions you can feel good about. Among the most difficult aspects of hospice care are the preconceived ideas about the end of life. There are many myths surrounding hospice. There’s also fear. Facing the truth head on and taking action could be the best course for you and your family.
Last week we began with Myths 1 and 2, so today we will continue with Myths 3-6 in this three-part series followed by the third week’s conclusion of The Truth About Hospice.
• Myth No. 3 – You can’t keep your own doctor if you enter hospice: Hospice physicians work closely with the doctor of choice to determine a plan of care. Someone on hospice need never lose a personal physician. However, that individual will typically gain a hospice provider as part of the care team. Sometimes family physicians prefer that patients work with hospice physicians.
• Myth No. 4 – Hospice care is more expensive: Studies have shown hospice care to be less expensive than conventional care during the last six months of life. Less high-cost technology is used, and family, friends and volunteers provide an estimated 90 percent of the day-to-day patient care at home. Additionally, patients eligible for Medicare or Medicaid generally pay fewer out-of-pocket expenses related to their hospice care. Many private insurers also cover some or most hospice-related expenses. According to Medicare.gov, people who meet all of the following conditions are eligible to receive hospice care benefits if:
• The person is eligible for Medicare Part A (Hospital Insurance).
• The person’s doctor certifies he or she is terminally ill and expected to have six months or less to live (recertification is required every six months).
• The person accepts palliative care (for comfort) instead of care to cure his or her illness.
• The person signs a statement choosing hospice care
instead of routine Medicare-covered benefits for his or her illness.
Medicare hospice benefit
According to Medicare.gov, hospice benefits can include:
• Doctor services;
• Nursing care;
• Medical equipment (like wheelchairs or walkers);
• Medical supplies (like bandages and catheters);
• Drugs for symptom control or pain relief (may need to pay a small copayment);
• Hospice aide;
• Physical and occupational therapy; speech-language pathology services;
• Social worker services;
• Dietary counseling;
• Grief and loss counseling for the hospice patient and their family;
• Short-term inpatient care (for pain and symptom management);
• Short-term respite care;
What Medicare doesn’t cover when hospice care is chosen:
• Treatment intended to cure a terminal illness.
• Prescription drugs to cure illness (rather than for symptom control or pain relief).
• Care from any hospice provider that wasn’t set up by the hospice medical team.
• Room and board. (Medicare doesn’t cover room and board if hospice care is provided in the home, in a nursing home, or in a hospice inpatient facility.)
• Care in an emergency room, inpatient facility care, or ambulance transportation, unless it’s either arranged by a hospice team or is unrelated to a terminal illness.
• Myth No. 5 – Hospice means death is imminent: Hospice care is a process that can be as unique as the individual. Hospice care is generally for a person with a prognosis of six months or less to live. With Medicare, hospice care is given in benefit periods. Eligible persons can get hospice care for two 90-day periods, followed by an unlimited number of 60-day periods. At the start of each period, the hospice medical doctor or other hospice doctor must certify the person is terminally ill so he or she can continue the hospice care. At any time, a person can stop his or her hospice care.
• Myth No. 6 – We shouldn’t tell Mom she is dying or has exhausted all treatment options: It’s important to be honest with a loved one and to remember that people with a life-limiting illness do have a choice. They can continue treatment to try and combat their illness or they can discontinue treatment and seek comfort care. When they discontinue treatment, they may choose to enter into hospice care, which is designed to help control the pain and manage the symptoms associated with the illness. This often means they move from a hospital to a home setting or from a hospital to a long-term care facility or hospice facility. They must weigh several factors when they make their decision. Deciding what to do can be a process.
Hospice care can make someone feel as though others have given up hope on him or her. Reassure a family member or friend that is not the case. Hospice care is not about giving up hope, but changing the focus from continued treatment to comfort and quality. In fact, some individuals do improve on hospice care for a time. When it is time to go, though, hospice can help someone die with dignity.
Here are some conversation starters that could help you and your family member work through these issues:
• “Mom, I wish we had a treatment that could take all this away, but we don’t. I think we should focus on the things that will enable you to have the best quality of life for the longest period of time.”
• “What do you think? Do you feel like you’re on your final journey?”
• “Did you understand what the doctor said? Can I go over that with you?”
• “Do you have questions about what this means?”
• “The doctor has suggested hospice care. I think this sounds like a great way to make you more comfortable. Would you like to learn more? I think I would.
• “After we learn more, you can decide what you’d like to do.”
• “I’ll be with you every step of the way, Mom. We’ll face this together.”
Julie Ann Soukoulis is the owner of Home Instead Senior care office in Rohnert Park, mother of two and passionate about healthy living at all ages. Having cared for her parents, she understands your struggles and aims, through her website, www.homeinstead.com/sonoma to educate and encourage seniors and caregivers. Have a caregiving or aging concern? She’s love to hear from you at 586-1516 anytime.