This is for our readers who treat terminal pain patients.
Author: Alicia Sparks Akers
Hospice care is a multilevel end-of-life care system that aims to manage symptoms and improve the quality of life for someone with a terminal illness. There are four levels of hospice care, each focusing on the specific needs of the person receiving care.
Hospice care focuses on caring for someone with an illness who is approaching the end of their life.
Discussing the possibility of hospice care is, or will be, a reality for many people. The Centers for Disease Control and Prevention (CDC) estimate that in 2018 alone, 1.6 million people received hospice care.
There are four levels of hospice care:
- general inpatient
This article outlines the four levels of hospice care, what makes a person eligible for hospice, and ways to pay for hospice care.
Hospice care at home, or routine hospice care, is the most common level of care in hospice. A person may choose this level of care when they do not require continuous hospice care.
Usually, this means they are not in crisis — they are stable and can control their symptoms.
People may receive routine hospice care in their home and not in an inpatient facility.
General inpatient hospice care occurs in an inpatient facility, such as a hospital or nursing facility.
This level of care focuses on pain control and symptom management that is unmanageable in home settings.
Continuous hospice care focuses mainly on continuous nursing care, though a person also may receive homemaker services, hospice aide, or both.
A patient may receive continuous hospice care in their home and not an inpatient facility.
Typically, continuous hospice care is available only during short periods of crisis and only as necessary to keep the person at home.
Someone may require continuous hospice care if their pain or symptoms become uncontrollable.
Hospice care professionals provide care so the terminally-ill person’s caregiver can rest. Typically, respite care is on a short-term basis for up to 5 days.
Respite hospice care takes place in an approved inpatient facility.
People with Medicare Part A can receive all four levels of hospice coverage as long as:
- they choose a Medicare-certified hospice
- a doctor certifies they have a terminal illness with a medical prognosis of 6 months or less
- they elect the hospice benefit and waive their rights to Medicare payments
However, they may be responsible for a coinsurance payment, such as:
- Medication: The coinsurance for each prescription approximates 5% of the drug’s cost, but it will not exceed $5 per prescription. This includes palliative drugs and biological prescriptions.
- Respite care: The coinsurance for each respite care day is equal to 5% of what Medicare pays hospice for that day. It will not exceed the inpatient hospital deductible.
What services and items does Medicare include?
The Medicare hospice benefit includes:
- nursing care
- medical equipment
- services from physicians, such as hospice-employed doctors and nurse practitioners
- medical supplies
- physical therapy
- medication to manage pain and symptoms
- occupational therapy
- dietary counseling
- spiritual counseling
- speech-language services
- hospice aids
- homemaker services
- short-term inpatient pain control
- individual and family grief counseling before and after the person’s death
Additional ways to pay for hospice include:
- Medicaid: Most, if not all, states offer hospice coverage similar to that of Medicare coverage. Medicaid provides an optional state plan service that covers all four levels of hospice care.
- TRICARE: This government-provided health insurance covers uniformed service members, retirees, and their families.
- Private health insurance: Some insurance policies may automatically offer hospice coverage, while others may provide the option to add it.
- Self-pay: Paying out-of-pocket is always an option, though this is not always feasible.
- Charity care: Many hospice facilities have a system that allows them to provide care to people who are medically eligible for hospice but have no way to cover the costs.
Typically, a hospice facility has someone on staff who can explain the type of coverage a person has or help arrange charity care, if available.
Generally, a person qualifies for hospice care if:
- two doctors — typically the hospice doctor and the person’s attending doctor — certify the person has a terminal illness with a life expectancy of 6 months or less
- the person accepts palliative care, or comfort care, over curative care
- the person or a surrogate, such as their medical power of attorney, signs a formal hospice benefit election
A person seriously considering hospice care has decided to forego or cease treatments to cure or halt their life threatening illness. Typically, this is because the treatments have been either unsuccessful or too physically debilitating.
Furthermore, people may decide it is time to consider hospice care when, despite those treatments, there is a significant decline in their physical or cognitive state.
- increased or uncontrolled pain
- considerable weight loss
- difficulty breathing or shortness of breath
- extreme fatigue or weakness
- a decreased ability to perform everyday tasks
Both hospice care and palliative care focus on improving a person’s quality of life during serious illness.
However, hospice care focuses on providing care and comfort to someone approaching the end of their life. Palliative care, on the other hand, focuses on treating the discomfort, symptoms, and stress of serious illness while the person continues treatment for the illness.
Palliative care is an option for anyone living with a serious illness. It is available at any stage of illness, even as soon as someone receives a diagnosis. A person’s doctor may refer them to a palliative care specialist. Otherwise, they may ask for a referral.
A person’s palliative care team may consist of specialist doctors and nurses, nutritionists, social workers, mental health professionals, and chaplains. Often, members of the palliative care team also work with the person’s family.
Typically, a person can receive palliative care at their home, an assisted living facility, or a hospital, much like hospice care.
Medicaid and Medicare may provide palliative care coverage. Otherwise, coverage depends on the person’s health insurance policy.
Palliative care may refocus on comfort care or transition to hospice care altogether if a person’s doctor believes they are likely to die within 6 months.
The four levels of hospice care — routine, continuous, general inpatient, and respite — aim to help manage a terminally ill person’s symptoms and improve their quality of life.
Unlike palliative care, hospice care does not provide curative treatments, such as treatments to help cure an illness or prolong a person’s life.
Many people who are eligible for hospice are also eligible for Medicare, which covers hospice costs. However, other payment options exist, including Medicaid, personal health insurance, and charity care.