Hospice – or “comfort” – care helps patients and their families navigate the complex issues associated with a prolonged illness, including medical care, financial concerns and living arrangements.
Hospice can be offered in a person’s home or a care facility. It is designed to provide emotional support to patients and families, and to educate caregivers so that they are able to provide physical care to their loved one.
Hospice team members can include a registered nurse, a medical director, a home health aide, a social worker, a spiritual care coordinator, a volunteer and your attending physician, if they remain involved in the person’s care. Other team members may include a music therapist, physical therapist, speech therapist or occupational therapist.
Transitioning to hospice
Unlike other medical care, hospice focuses on treating symptoms, such as respiratory distress and pain, rather than trying to cure the illness.
For heart and stroke patients, a hospice referral may come from the cardiologist or neurologist.
A person being moved into hospice care must have a life threatening or terminal illness with a prognosis of 6 months or less to live.
For heart patients, additional symptoms may include recurrent congestive heart failure, an inability for the heart to adequately move blood out of its chambers, chest pain at rest, history of cardiac arrest and/or resuscitation, history of unexplained fainting due to loss of blood to the brain (syncope), and irregular heart rhythms that are resistant to therapy (arrhythmias). Stroke survivors referred to hospice may have severe lack of consciousness or coma greater than three days duration, difficulty chewing or swallowing (dysphagia) leaving them unable to eat enough to sustain life and post-stroke dementia.
Levels of care
There are four levels of care in hospice.
- Routine: The person is cared for at home or a care facility. Reimbursement to hospice is at a daily rate and all of the members of the team are available to the patient and family as needed.
- Respite: The patient goes to a facility for short-term care to provide relief to the caregiver. The patient is seen by hospice team members just as they were at their home.
- Continuous care: This type of care is used when the patient is in crisis, with pain or other symptom(s) out of control, and needs to be monitored closely by a nurse. The hours of the nurse and home health aide are counted toward the continuous care hours for reimbursement.
- Inpatient contract: The patient is placed into a hospice-contracted facility that has a registered nurse on site for 24 hours a day. For this level of care, the patient must be in crisis, with pain or other symptoms out of control, and unable to remain at home.
Hospice is covered by Medicare, Medicaid and most insurance companies, and will cover medications related to the primary hospice diagnosis, and all equipment and supplies related to the disease needed to care for the patient. Medicare Part A and Medicaid cover 100% of hospice care; however, payment levels vary for private insurance companies.
References: National Hospice and Palliative Organization