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What is Hospice?

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Hospice offers medical care toward a different goal: Maintaining or improving the quality of life for someone whose illness, disease or condition is unlikely to be cured. Each patient’s individualized care plan is updated as needed to address the physical, emotional and spiritual pain that often accompanies terminal illness. Hospice care also offers practical support for the caregiver(s) during the illness and grief support after the death. Hospice is something more that is available to the patient and the entire family when curative measures have been exhausted and life prognosis is 6 months or less.


​History of Hospice

In Western society, the concept of hospice has been evolving in Europe since the 11th century. Hospice were places of hospitality for the sick, wounded or dying, as well as those for travelers and pilgrims. The modern concept of hospice, includes palliative care for the incurably ill given in such institutions as hospitals or nursing homes, but also care provided to those who would rather spend their last months and days of life in their own homes.
It began to emerge in the 17th century, but many of the foundational principles by which modern hospice services operate were pioneered in the 1950s by Dame Cicely Saunders, when she opened St. Christopher’s Hospice in 1967. St. Christopher’s Hospice in London emphasized the multi-disciplinary approach to caring for the dying, the regular use of opioids to control physical pain and careful attention to social, spiritual and psychological suffering in patients and families.
Within the United States, the term is largely defined by the practices of the Medicare system and other health insurance providers, which make hospice care available, either in an inpatient facility or at the patient's home, to patients with a terminal prognosis who are medically certified at hospice onset to have less than six months to live.
Hospice care also involves assistance for patients’ families to help them cope with what is happening and provide care and support to keep the patient at home.
In 1969, Elisabeth wrote On Death and Dying, coining the 5 stages of death: Shock/Denial, Anger, Bargaining, Depression and Acceptance.
Emotional Response graph
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Dame Dr. Cicely Saunders
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St. Christopher’s Hospice
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Elisabeth Kübler-Ross


​How does hospice work?

1

Assessment by Patient's Doctor
assessment by doctor

2

Local Coverage Determination
local coverage determination

3

Certificate of Terminal Illness
certificate of terminal illness

4

Election of
​Hospice
election of hospice

"We'll walk with you along the way ..."

5

Initial
​Assessment
initial assessment

6

Comprehensive
​Assessment
comprehensive assessment

7

Interdisciplinary
​Team Meeting
interdisciplinary team meeting

8

Plan
​of Care
hospice plan of care


​Who pays for hospice?

Hospice care is paid for by Medicare, Medicaid in most states, the Department of Veterans Affairs, most private insurance plans, HMOs and other managed care organizations. Also, community contributions, memorial donations and foundation gifts allow many hospices to give free services to patients who can’t afford payment. Some programs charge patients according to their ability to pay.

Medicare

Medicare
The most common option to pay for hospice care because nearly all hospice patients qualify for Medicare. In most cases, you pay nothing for hospice care, but you may have co-pays for prescriptions. You also have to pay a percentage of the bill for inpatient respite care.

Medicaid

Medicaid
Converts into Medicare for Hospice coverage. However, Medicaid may cover some expenses like respite and GIP not related to Hospice care to ensure the patient has no out-of-pocket expenses.

Veteran’s Administration
Veterans can receive hospice care through the Veteran’s Administration. The VA can purchase hospice services from community providers, including hospice care provided at home or in an institution as an inpatient.

Private Insurance

private insurance
Most private health insurance companies, include hospice care as a benefit. Be sure to ask about your insurance coverage, not only for hospice, but also for home care.

Private Pay

If insurance coverage is not available or does not cover all costs, the patient and the family can hire hospice providers and pay for services out of pocket. Some hospices are able to provide services without charge if a patient has limited or no financial resources.


​Admission Process/Notice of Election

Assessment by Patient's Doctor or Referral to our Physicians/MD
  • Patient must remain under the supervision of a physician either by their current doctor or elect to have our medical director and associate physicians be their attending physician.​
assessment by doctor
physician referral
Local Coverage Determination (LCD)
  • LCD helps Medicare determine whether a patient is appropriate for hospice care
local coverage determination (LCD)
Certificate of Terminal Illness (COTI)
  • COTI is needed to qualify for the Medicare hospice benefit. 

Difference between
Prognosis and Diagnosis:

  • Diagnosis- Identification of a disease/illness
  • Prognosis- Expected outcome of a disease

Prognosis must be less than 6 months to qualify for hospice.
Election of Hospice

election of hospice
  • DNR Order
  • Advance Directives
  • Power of Attorney (POA) if applicable
  • Patient Medical Records
  • Admission Consent
  • Payer worksheet
  • Consent for Election of Medicare Hospice Benefit
  • Patient Emergency Management Plan
  • Consent for Primary Caregiver
  • Special Instructions by Patient/Family i.e. funeral and burial wishes and disposition of property.

"We'll walk with you along the way ..."

Patient's Rights

Your Rights


  • You can ask any questions that you want to know about this hospice and our staff.
  • Voice your concerns about your treatment by our staff or any one providing services.
  • Receive anything in writing about services we offer and any pre-arranged agreements
  • Treated with respect and love

Privacy and Security


HIPPA Laws
  • Your personal information is kept secure and confidential
  • You must consent to recording (audio or visual)  and any access other than our staff
  • You must consent to any use of your personal information and data outside of giving care

Quality of Care


"We'll walk with you along the way ..."

You Decide


You chose your:
  • Attending physician, it doesn’t have to be the MD at the hospice
  • Hospice Provider, we would like to be your hospice, but that decision is yours.
  • If the patient cannot make decisions, they must appoint who will make those decisions

Financial Information


  • You will be advised about any changes to billing and any charges that you might have to pay
  • Access to the list of charges paid by Medicare or other insurance for the cost of your care by us or other entity
  • Your financial information is kept safe and secure

Your Responsibilities


  • Provide accurate information about your medical history
  • Tell us about all your needs (whatever they may be); spiritual, dietary, financial, family counseling and psychosocial
  • Report and discuss pain with every staff member that visits
  • Family concerns must be voiced to our staff

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