Today’s “DRops of Wisdom,” our physician blog, Dr. Andrea Miller describes the Medicare hospice benefit.

What is the Medicare Hospice Benefit?

Second only to being asked tips on how to talk about hospice, I am often asked, “What is covered under the Medicare hospice benefit?” In the Unites States, Medicare covers 100 percent of hospice services, with no out-of-pocket expenses to the patient or family. Additionally, most private insurance companies and Medicaid cover hospice services.

At all affiliates of Chapters Health — Chapters Health Hospice, Good Shepherd Hospice, Hospice of Okeechobee, HPH Hospice and LifePath Hospice — each hospice patient has a unique plan of care that addresses their specific end-of-life needs. This plan also takes into account the needs of the caregivers.

The Medicare hospice benefit for patients and families includes the following:

• Home visits by nurses, social workers, hospice aides, chaplains, physicians, nurse practitioners and volunteers as described in the patient’s plan of care
• Medications, supplies and durable medical equipment related to the hospice diagnosis
• Assistance with advance care planning
• Support and education for caregivers
• Counseling, emotional and spiritual support
• Grief support before and after death

Who is Eligible for the Medicare Hospice Benefit?

In order for patients to access the Medicare hospice benefit, they must be eligible for Medicare Part A. They must also agree to pain/symptom management and not curative care.

Following Medicare hospice benefit regulations and rules, in order for any of the Chapters Health affiliates to provide care for patients, the community physician or hospice medical director must certify that, based on his or her clinical expertise, the patient has a prognosis of six months or less should the diagnosis runs its natural course. It is important for patients to understand and know that their physician—if chosen as the attending physician—will continue to see and care for them if that is what they desire. However, a patient’s physician can refer him or her to hospice but does not necessarily need to be the attending physician. The patient or family can also ask for a patient to be evaluated by hospice.

Under the Medicare Hospice Benefit, Are There Different Hospice Levels of Care?

Often times, patient’s symptoms can change, resulting in an adaptation of the plan of care. Under the Medicare hospice benefit, patients are able to receive four different levels of hospice care based on their situation.

Routine Care: Visits are made according to the plan of care and are provided wherever the patient calls home — private residence, assisted living community or nursing home. Day-to-day care is provided by caregivers.

Respite Care: When caregivers need a short-term relief, a hospice patient can be admitted to an inpatient facility for up to five days and still receive routine visits from the hospice team.

Inpatient Care: When a patient needs short-term, round-the-clock care due to a variety of acute medical needs, inpatient care is available in a hospice house. This level of care is strictly available for acute symptoms that cannot be managed with routine care.

Continuous Care: If a patient is experiencing acute pain and symptoms that cannot be managed with routine care, continuous care can be offered. This level of care is provided for a minimum of eight hours per day. Although not exclusively, the continuous care provided is primarily nursing care. Once reaching a state of comfort, the patient can return to routine care.

We are always available to speak with patients, families and physicians about any questions they might have about the Medicare hospice benefit and other hospice and palliative care topics.

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