Hospice Care is available in several settings: home, inpatient hospice units, nursing homes and CBRF's.
- Acute hospice facilities generally admit patients that are not stable and have rapidly changing symptoms.
- There is 24/7 RN staffing.
- The goal is acute symptom management.
- Residential hospice facilities have 24/7 CNA staffing. They do not manage IV's.
- There is a daily room & board charge ($285/day at Fitchburg center as of 6/09).
- Some Nursing Homes contract with hospice agencies to provide hospice care for their custodial care patients. Insurance will not pay for skilled and hospice at the same time.
- Many Assisted Living facilities contract with hospice agencies. Since care is typically private pay, insurance can cover hospice services.
Clients must have a terminal condition and be certified by a physician to have a life expectancy of less than six months (at times, 12 months). Clients are not discharged from hospice and will not lose their Medicare Hospice Benefit after six months as long as their physician continues to re-certify a six-month prognosis.
Clients must seek palliative—or comfort—care over curative care.
Medicare Part A covers nursing care, social and bereavement support, medications (limited co-payment of no more than $5), laboratory tests, and other services required for the management of the terminal illness and documented as necessary in the hospice plan of care. Palliative chemotherapy and radiotherapy may also be included.
Clients must pay room and board costs when they are residential status in inpatient hospice units. They do NOT have to pay room & board for general inpatient status!
Clients on home I.V. dobutamine therapy for Congestive Heart Failure will be reviewed on a case-by-case basis for eligibility for Hospice.
Hospice Care Inc inpatient hospice can take patients in intermittent (not continuous) CPAP, can not take patients on BiPAP.
If a client is confused, and does not have a Power of Attorney for Health Care, a close family member may be assigned to make decisions in lieu of pursuing a guardianship.
What Happens if Home Hospice Patients Call 911? Is it true that if a home hospice patient calls 911, does that automatically disenroll them in home hospice?
There is no Medicare "regulation" that says agencies have to disenroll patients if they call 911 or go to a hospital. Hospices might have their own "policy" that says they will do that, but it's more in their (financial) interest than in the patient's.
If a hospice patient goes to the hospital and the reason is related the terminal diagnosis (that qualifies them for hospice), then the hospice is responsible for the bill.
If a hospice patient goes to the hospital for an unrelated reason (fell and broke a hip), then regular Medicare covers it.
Finding and Choosing a Community Based Residential Facility
UWHC Guidelines for Hospice Referrals