Hospice – Care When It's Needed Most

November is National Hospice Month.  The first White House proclamation honoring hospice month was signed by President Jimmy Carter in 1978. Access to care has improved significantly in the three decades since November has been celebrated as National Hospice Month. At that time, hospices in the US served several thousand individuals and their family members each year.  Data from National Hospice and Palliative Care Organization showed that a record 41.5 percent of people who died in the US – 1.56 million patients with life-limiting illness – were served by hospices in 2009.

As November 2011 approaches, we should, as President Obama said in his declaration of National Hospice Month last year "take comfort in the important work of hospice care, which enables individuals to carry on their lives, in spite of a terminal illness."

What is Hospice Care?

Hospice care is compassionate end-of-life care that includes medical and supportive services intended to provide comfort to individuals who are terminally ill. Care is provided by a team of appropriate professionals. Care received under hospice is often referred to as "palliative care," because hospice care aims to manage the patient's illness and pain, but does not treat the underlying terminal illness. Hospice care may include spiritual and emotional services for the patient, and respite care for the family. While many hospitals and skilled nursing facilities have hospice units, most hospice care is provided at home.
Hospice care goals include ensuring that the patient will:

• Be as comfortable and pain-free as possible.
• Be independent for as long as possible.
• Receive care from family and friends.
• Receive support through the stages of dying.
• Die with dignity.

Hospice and palliative care programs also serve as valuable community resources about care options. And, most importantly to the Center for Medicare Advocacy's clientele, hospice care is a Medicare-covered benefit.

What Kinds of Care Does Medicare Hospice Care Include?

Generally, hospice care includes services which are reasonable and necessary for the comfort and management of a terminal illness. These services may include:

• Physician services.
• Nursing care.
• Physical therapy, occupational therapy, and speech-language pathology services.
• Medical social services.
• Hospice aide services.
• Homemaker services.
• Medical supplies, including drugs and biologicals and medical appliances.
• Counseling, including dietary counseling, counseling about care of the terminally ill patient, and bereavement counseling.
• Short term inpatient care for respite care, pain control, and symptom management.

When Will Medicare Cover Hospice Care?

• The beneficiary or his/her representative must elect the Medicare hospice benefit by signing and filing a hospice benefit election form with the hospice of choice.
• A physician must certify that the beneficiary is terminally ill. This means that in the physician’s judgment the individual has 6 months or less to live if the illness runs its normal course.
• The beneficiary’s attending physician and the hospice physician must certify the beneficiary for the initial period. For subsequent periods the hospice physician recertifies the beneficiary.
• The care must be provided by, or under arrangements with, a Medicare certified hospice.
• All hospice care and services furnished to patients and their families must follow an individualized written plan of care established by the hospice interdisciplinary group in collaboration with the attending physician (if any), the patient or representative, and the primary caregiver, in accordance with the patient's needs.

How Long Does Hospice Coverage Last?
Hospice coverage is not time limited. Initially the beneficiary must be certified as hospice eligible for a ninety day period. When this period is exhausted, the beneficiary must be certified for a second ninety day period, there are then an unlimited number of sixty day certification periods.
Beneficiaries who elect hospice coverage give up their right to regular Medicare benefits for services related to their terminal illness during the hospice election period, but hospice beneficiaries may revoke the benefit. Upon doing this, they are immediately eligible for their traditional Medicare benefits once again. After revocation, the beneficiary may also re-elect the hospice benefit at any time. Upon re-election, the beneficiary begins the next certification period. Use of the hospice benefit also does not preclude getting regular Medicare services for a condition that is not related to the terminal illness. For example, someone with a diagnosis of atrial fibrillation who develops terminal liver cancer could elect hospice and receive Medicare coverage for that care without forfeiting continued Medicare coverage for care related to the cardiac condition. 
Within a certification period, the beneficiary may change his or her designated hospice program one time without the need for revocation.

How Does Medicare Hospice Coverage Differ from Regular Medicare?

• Medicare hospice coverage is limited to beneficiaries who are terminally ill.
• Hospice coverage is for pain and symptom management and comfort, not for curative treatment of the underlying terminal illness.
• Hospice coverage is holistic. Not only is medical care covered, but so are social work services, chaplain services, bereavement services and homemaker services.

See http://www.medicareadvocacy.org/medicare-info/medicare-hospice-benefit/#Comparison for a chart comparing Medicare home health coverage and the Medicare hospice benefit.

Conclusion

During this National Hospice Month, we recognize those who allow the terminally ill to receive comfortable and dignified care. Hospice care gives medical services, emotional support, and spiritual resources to people facing life-limiting illnesses. It can also help families and caregivers manage the details and emotional challenges of caring for a dying loved one. The decision to enter a hospice program can be difficult, but Americans can have peace of mind knowing the doctors and professionals involved with these services are trained to administer high-quality and comprehensive care for terminally ill individuals.
The Medicare hospice benefit is valuable; it is also underutilized. The Center for Medicare Advocacy encourages advocates to help families understand and access Medicare's important hospice benefit.

For more information on Medicare and hospice care, contact attorney Terry Berthelot (tberthel@medicareadvocacy.org) in the Center for Medicare Advocacy's Connecticut office at (860) 456-7790