Medicare Hospice Benefit brochure
Medicare Hospice Benefit brochure (Large print edition)
Medicare Hospice Benefit brochure (Spanish edition)
People with a terminal illness have special concerns. Often, they say:
- "I don't want pain."
- "I don't want to die alone or hooked up to machines."
- "I don't want to be a burden to my family."
- "I want to spend my last months at home."
For over a quarter-century, choosing hospice care has been a helpful way to address those concerns and many others.
Hospice is a set of services that help the patient and family cope with the effects of terminal illness. The goal of hospice care is to enhance the quality of life for patient and family and allow patients to spend their remaining time in their home. Hospice provides comfort when cure is no longer possible or curative treatment is no longer desired.
Services are provided through a hospice agency by a team of hospice professionals and volunteers. These professionals provide direct care during their visits and also teach the family how to care for the patient in-between visits. With simple training, almost every family can care for a hospice patient.
The unit of care in hospice is the patient and family. A customized plan of care is developed to meet their needs. The plan of care includes basic services that every hospice must offer patients and families -- these are called "core services":
- Medical services
- Nursing services
- Medical social services
In addition to services, the hospice plan of care specifies what the hospice will provide in terms of:
- Medical equipment
- Medications (the patient will be responsible for a co-pay on all medications related to the terminal illness of up to $5 per prescription).
Based on the hospice's assessment of patient/family needs, the hospice's plan of care may offer other services as well:
- Home health aide services, to assist in housekeeping and other chores related to the patient
- Volunteers, to provide the companionship to the patient and support to the family
- Various types of therapy to enhance the quality of the patient's life, such as speech therapy, occupational therapy and physical therapy
For at least a year after the patient dies, the hospice will offer bereavement counseling to help family members deal with their grief.
Eligibility for Hospice Care
For a patient to elect hospice care:
- two physicians must certify that the patient has a terminal illness and is expected to live six months or less
- the hospice must determine that care can be provided in safe surroundings
- the patient must give "informed consent" -- that is, be informed about the goals and purposes of hospice care
Hospice care is available regardless of race, ethnicity, nationality, gender, marital status, sexual orientation, religious belief, diagnosis or disability.
Paying for Hospice
- Medicare Part A includes the Medicare Hospice Benefit, which pays for all hospice services included in the hospice's plan of care for the patient (except for the small co-pay on prescriptions specified above)
- New Jersey Medicaid offers a Medicaid Hospice Benefit
- Many private insurers and managed care companies provide a hospice benefit
- Patients and families without adequate insurance coverage should talk to their hospice about a "sliding" payment schedule or charity care. This will require an assessment of family finances.
Clearing Up Misconceptions
Let us clear up some misunderstandings you may have about hospice:
- Hospice is not just for the last few days or the last two weeks. Hospice is designed to care for the patient and family during the last months of life. Hospice is not a "crisis" service. Patients and families should ask their doctor whether curative treatment will work and what burden it will place on the patient. An early hospice admission helps the patient and family get the full benefit of hospice services, including the emotional support and family services.
- Hospice is not a "place" -- it is a kind of care and a set of services. Hospice care is typically delivered in the patient's own home, a nursing home or in assisted living. Other locations can include a hospital or a "hospice house."
- You do not have to be "ready to die" to receive hospice care. Rather, you should be seeking comfort and an improved quality of life. Hospice is ready to help you and your family make the most of the time that's left.
- Under normal circumstances, hospice does not provide services in the home around the clock or for "shifts" that allow family members to go to work. Hospice team members provide services during visits that may last a half-hour, an hour or two.
- You may continue to see your own doctors, whether for your terminal illness or other illnesses.
- You need not be home-bound to receive hospice care. Many patients are out-and-about at times, and some make trips while under hospice care.
- You may leave hospice care at any time. If you would like to return to curative treatment, discuss it with your hospice team. You will be eligible to re-enter hospice at any time without penalty.
- Hospice does not conflict with the beliefs of any major religion. All faiths recognize the value of spiritual support, pain relief, symptom management and counseling during the final phase of life.
- Hospice is not just for the elderly or just for Medicare patients. Hospice serves patients of all ages, from infants to centenarians.
- Hospice is not a financial burden. Hospice services are covered by Medicare Part A, Medicaid and many private insurers. Most hospices have a sliding scale for poor patients and some provide charity care for the truly destitute. The vast majority of patients and families never receive a bill from hospice.
- You may decline specific hospice services such as volunteers and housekeeping support.
- Hospice will neither hasten nor delay death. Hospice seeks to improve the patient's quality of life and allow dying to take place naturally. It will not extend life through artificial or mechanical means. Nor will it shorten life through assisted suicide.
- There is no limitation on how long you can receive hospice care. True, your physician must certify that you are expected to live six months or less, but hospice services need not end at six months. Hospice care can extend well beyond the original six-month life expectancy.
To identify a hospice serving your county in New Jersey, please click here.