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Guidelines for Hospice Care and Treatment
The following guidelines have been developed to assist in making decisions about
hospice care. It is important that patients and families understand the benefits
they are entitled to, as well as any financial responsibility they may retain.
These guidelines, though extensive, are not meant to be all-inclusive. If you
have any questions concerning coverage, please call 800-717-3811.
Often physicians will recommend comfort measures to their
patients when it becomes clear that pursuing aggressive curative treatment is no
longer beneficial to the patient. Typically a patient is referred to hospice to
receive care in this specialty.
The focus of hospice is to provide the best quality of life possible for
patients and families. Hospice specializes in pain and symptom management. Often
the symptoms are not physical, but spiritual, emotional, or social. Hospice
attempts to control pain in such a manner that patients are able to remain alert
and active to the extent possible.
Informed Consent
Electing hospice care is a personal decision that Hospice at Home, Inc. takes
seriously. It is crucial that certain information be thoroughly understood upon
entry into hospice. For example, it is understood that hospice care neither
hastens nor prolongs the natural dying process and that the patient has the
right to exercise choice with respect to services. Included in the informational
visit are discussions of the current care plan and how it may be modified in a
hospice medical plan of care.
Interdisciplinary Team and the Plan of Care
The patient and family collaborate with our team of professionals to design a
unique plan of care which will meet your needs. The hospice Medical Director and
attending physician are a part of this team and they will be involved in the
development and medical supervision of this plan of care.
Items Included with Comprehensive Hospice Coverage
Medicare, Medicaid, and most private insurance providers such as Blue Cross/Blue
Shield include a hospice benefit in their plans. Some of the treatments that are
typically covered under a hospice benefit include:
• Medication related to the primary diagnosis
• Nursing care
• Home Health Aide/personal care
• Spiritual comfort
• Social work support
• Volunteer help
• Medical equipment and supplies required for the comfort and safety
of the patient
• Oxygen therapy
• IV therapy required for the comfort of the patient
• Respite care (temporary care of the patient in a facility to provide
emotional support to the family)
• Inpatient General Care (temporary care of the patient in a facility to
better manage symptoms)
• Continuous Nursing Care (see Availability of Care)
• Physical therapy
• Speech therapy
• Nutrition counseling
Other services frequently mentioned in a plan of care are:
• Complementary therapies (such as massage, when performed
by Hospice personnel)
• Grief counseling and bereavement support
Items Excluded from Comprehensive Hospice Care
Hospice provides care that is palliative in nature: that is, care which has the
primary purpose of providing comfort to the patient. Treatments rendered with
the primary purpose of curing the illness, or treatments which extend the length
of life but compromise the quality of the time remaining, are generally not
provided for under the comprehensive hospice benefit but will be evaluated on a
case-by-care basis.
Benevolent Care Services
Hospice at Home is committed to the hospice care needs of the community,
including those who cannot pay for their care. No one is refused care due to an
inability to pay. Benevolent Care represents services provided to a person for
which Hospice at Home has no expectation of receiving full payment. In the
absence of coverage by Medicare, Medicaid, or private insurance, individuals
will still receive hospice services through our Benevolent Care fund.
Availability of Care
Hospice patients have the ability to reach Hospice by phone 24 hours a day. In
the evenings, the Phone Triage Nurse (a nurse who is an expert in making
evaluations and decisions over the phone) will work with the patient or family
to determine if or when a nurse, or other team member, should be sent to the
home. We have specially trained on-call staff who are ready to visit at any time
of the day or night, 7 days a week when that is needed or desired.
There are sometimes occasions when patients or families require Continuous Care,
that is, support that involves the Hospice staff for many hours. These extended
visits are covered under the Hospice Benefit because they are occasionally
crucial to symptom management.
Hospice does not, however; provide routine around-the-clock care. The primary
care of the patient is the responsibility of the family. Many families employ
private duty caregivers to fulfill this need if they are unable to provide this
care for the patient themselves.
IV Hydration and Tube Feedings
IV therapy for hydration, will be considered when a patient has dehydration
symptoms and other methods of relieving the discomfort (such as the use of ice
chips) have failed. Hydration is often not helpful during the last stages of
life however and may actually cause more discomfort than it relieves so these
decisions are carefully weighed.
Hospice will provide care for patients requiring tube feedings when the patient
is already receiving tube feedings upon admission to hospice. Hospice will
supply the nutritional products used for tube feedings. If a patient loses the
ability to take food and fluids by mouth while under the care of Hospice, the
patient and family will be assisted by the care team to consider whether the
placement of a feeding tube will further the goals of comfort for the patient.
Hospital Stays
Effective care planning and the availability of the Hospice oncall team
eliminates most needs for hospital ER visits or admissions. Now and then
symptoms may become too difficult to manage well in a home setting and Hospice
can then arrange for a General Inpatient Hospital admission and the patient can
retain their Hospice services under the Hospice benefit. Patients also have a
right to revoke their Hospice benefit at any time in order to pursue
hospitalization for aggressive life prolonging treatment. If the patient chooses
to revoke the Hospice Benefit when hospitalized then the Hospice philosophy of
care will be reviewed in consideration with the patient’s health goals at the
time of hospital discharge and the patient will make the decision whether or not
to reassign the Medicare benefit to the Hospice program.
Complementary and Alternative Therapies
Hospice at Home offers complementary options to relieve stress, manage symptoms,
and promote well being. Professional massage therapists may provide massages for
patients and family members. Skilled staff and trained volunteers are available
to provide gentle touch to the hands and feet for relaxation and comfort. Other
complementary options include relaxation music, aroma comfort, friendly pet
visits, and life reviews. If you are currently receiving any complementary or
alternative therapies, or have interest in receiving them, please talk about
this with your hospice team.
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