Hospice and End of Life Resources for Palliative Care
 
Welcome Medicare Nation!  Today we continue with Part 2 of our Death Series, as we talk about end of life resources that Hospice provides.  Most people are familiar with Hospice and the services they provide, but I wanted us to take a closer look at Hospice as it relates to Medicare.  Hospice provides several different levels of care, but the focus of our conversation today is routine care and respite care.
 
My guest for today is Judy Lund Person. Judy is with the National Hospice and Palliative Care Association.  She has worked in the national office since 2002 and is considered an expert in Compliance and Regulatory Leadership for Palliative Care. 
 
 
We discuss some very important aspects of Hospice care and Medicare, so for more details on each of these questions below, please listen to the full episode here.
 
 
Who qualifies for Hospice services?
 
Hospice is for patients who have a life expectancy of 6 months or less. Hospice is covered under Part A of Medicare.  The key is that the person would be nearing the end of their life, regardless of their age.  In Judy’s experience, she has seen patients from 2 days old to 100 years old.
 
 
Routine Care:
 
When should hospice be called in?
 
Many families feel that hospice should have been called in sooner.  Judy encourages you to have a conversation with the physician and begin asking when hospice services should begin.  Many times they see patients in the 3-6 months prior to their end of life.  
 
Where can hospice provide care?
 
95% of the care they provide is in a patient’s home, or where they call home.  Hospice does have facilities, but the majority of their patients are in their own homes.
 
What kinds of services are provided?
 

Nurse - initial assessment is done
Social Worker
Chaplain
Aide
Therapy including art or other
Hospice Physician who consults with the attending Physician
Patient chooses who they want to be their attending physician, and do as much or as little as the patient wants.

 
It is very much a team approach to providing services.
 
 
How does Medicare work with Hospice?
 
Medicare covers hospice at 100% under Part A. Medications may need to be paid for out of pocket if hospice doesn’t feel a medication is necessary.  Hospice benefits are paid on a daily rate, so it does not matter the amount of services that are provided on a single day, because the rate is the same.
 
The Hospice team provides intermittent visits, depending on the need. Each patient has an individual care plan.
 
Medicare pays for two 90 day periods and then there is an extension of 30 days.  Physicians can re-certify the patient for coverage to continue.  Many patients have hospice for much longer, depending on their need.  Length of coverage is on a case by case basis.  If you are beyond the score of time set forth, all that needs to be done is for your Physician to re-certify that Hospice service is still needed and it will continue to be provided.  There is no need to worry that you will be cut off from services if you outlive the timeframes set forth in the coverage plan.
 
 
Respite Care
 
What is respite care?
 
If you have a short term period where you as a care provider need a break, hospice will provide respite care in a facility, while the family and caregivers get a break.  This service is covered under Medicare Part A.  This is different than routine care, but it is still a covered level of care.
 
 
 
Hospice care is considered palliative care, for the comfort of the patient, not to provide a cure for the disease.
 
Palliative care is comfort care.  Maybe it is pain, shortness of breath or other conditions that are difficult to tolerate.  Hospice specializes in pain management and pain control, while still keeping the patient alert.  They also deal with anxiety and depression that can go along with the terminal condition.
 
Hospice can help with any sort of distressing symptoms.  However, if another issue aris