Medicare provides in-home services to patients who have been diagnosed with a terminal illness and have a life expectancy of less than 6 months. The benefits include a wide variety of services that are more comprehensive than those provided by Medicare for patients who are ill but are expected to recover. Medicare hospice services include coverage for drug expenses related to the terminal diagnosis and hospital quality in-home equipment, such as a hospital bed, wheelchair and bathroom aids. In addition, hospices may provide chaplains, social workers, nursing and some alternative therapies. Hospices are designed to help terminally ill patients make the most out of their lives. Hospice care can produce a highly satisfying, even joyful, experience for most patients and their loved ones.
What to Look for
You can choose your hospice provider. Most hospice agencies are small and have an average of less than 150 patients on service at any given time. When you're researching to discover what agencies serve your area, here are some important questions to ask:
1. Does your hospice have an inpatient unit? There may be times when your caregiver needs a break. Many hospice patients can move into a small inpatient facility for 2 to 3 days. You may need to have the patient's medications adjusted. This can be easier when you have 24-hour surveillance. If the hospice does not have an inpatient facility, they probably will contract for rooms in a nursing home or small hospital. In any case, visit the location to see if you like the atmosphere and the staff.
2. Ask who manages after-hour calls and find out where the on-call nurse lives. Hospice service areas can be large. You will want to know how long it will take someone to get to your house if you need something after hours. Find out whether the on-call nurses work full time with the agency and whether they are specialists in hospice. Get the name of the medical director and find out where he lives. House calls are sometimes needed.
3. Ask an administrator to describe the type of technology the hospice uses. A hospice that uses an electronic medical record can offer quicker and more precise clinician communication. This may not seem important, but making sure the visiting staff knows which clinical services are effective for you will enhance your comfort and will eliminate the need for you to take charge of your own clinical care and communications.
4. Inquire about access to a pharmacist who is experienced in hospice care. A hospice will use many drugs for "off label" purposes. An experienced pharmacy consultant can make you more comfortable if serious problems arise.
Common Pitfalls
Probably the saddest thing about hospice is that people wait too long to take advantage of it. Hospice is a specialty service staffed by people who know how to manage pain, family dynamics, spiritual needs and have typically dedicated their professional lives to helping people live their lives as fully as possible. To sign up for hospice, you must have a recommendation from your primary physician. Some physicians are reluctant to make hospice referrals. They believe that doing so removes hope as a life-giving force. While this can be true, have a frank discussion with your physician well before you become a candidate for hospice. Express your interest in availing yourself of the combined benefits most of these facilities offer.
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