What is Hospice?
Hospice is a special way of caring for individuals who are in the final stage of their lives due to a terminal illness. The hospice approach to care focuses on palliation and symptom management as opposed to curative care. Hospice services help patients, who are no longer seeking aggressive treatment or a medical cure, manage their terminal illness at home or in a home like environment. Hospice care addresses the physical, psychosocial, and spiritual needs of the patient and his or her family.
Where may Hospice Care be Provided?
Although some hospice services may be provided in a facility (hospital, skilled nursing facility (SNF), or inpatient hospice facility) most services are provided in the patient's home.
Who Pays for Hospice Services?
Generally, home hospice care costs less than care in hospitals, nursing homes, or other institutional settings because less high-cost technology is used and because family and friends provide much of the care at home.
Hospice care is financed by a variety of sources: Medicare; Medicaid in most states; the Department of Veterans Affairs; and by most private insurance plans, HMOs, and other managed care organizations. In addition, through community contributions, memorial donations, and foundation gifts, many hospices are able to provide free services to patients who can't afford payment. Other programs charge patients according to their ability to pay. To receive payment from Medicare, the agency must be approved by Medicare to provide hospice services.
To qualify for the Medicare hospice benefit, a physician and the hospice medical director must certify that the patient has less than 6 months to live if the disease runs its normal course. The physician must re-certify the individual at the beginning of each benefit period (2 periods of 90 days each, then an unlimited number of 60-day periods). The patient signs a statement indicating that he or she understands the nature of the illness and of hospice care, and that he or she is willing to be admitted to hospice. By signing the statement, the patient declines Medicare Part A and chooses instead the Medicare hospice benefit for all care related to his or her cancer. The patient can still receive Medicare benefits for other illnesses. A family member may sign the statement if the patient is unable to do so.
In 1986, legislation was passed allowing the states to develop coverage for hospice programs. Most states have implemented the Medicaid hospice benefit, which is patterned after the Medicare hospice benefit.
Most private insurance companies include hospice care as a benefit. Be sure to inquire about your insurance coverage, not only for hospice, but also for home care.
If insurance coverage is not available or is insufficient, the patient and the family can engage hospice providers and pay for services out of pocket. Most hospices provide services without charge if patients have limited or no financial resources.
How Do I Determine the Quality of Hospice Care?
2. Medicare Certification
Hospice agencies that wish to provide services and receive reimbursement under the Medicare or Medicaid hospice programs must be certified and meet federally mandated requirements, referred to as Conditions of Participation (COPs). Certified hospice agencies are subject to State surveys to ensure the agency continues to be in compliance with all of these requirements.
Accreditation is a voluntary process in which a non-profit professional organization conducts a survey of the hospice agency. If the hospice agency meets the standards established by the organization, then the agency is granted "accreditation". A hospice agency may seek voluntary accreditation from one or more of the three accreditation organizations: JCAHO, ACHA, and CHAP.