Hospice Benefits

Article Author:
Harrison Wermuth
Article Editor:
Prasanna Tadi
Updated:
5/26/2020 12:17:21 PM
PubMed Link:
Hospice Benefits

Definition/Introduction

The underlying premise behind Hospice care is to focus on the quality of care to patients who present with a life-limiting illness who are not expected to live more than six months instead of seeking treatment the prolong the illness or seek a medical cure. Hospice focuses on the entire person, as well as supporting the family by combining all elements of physical, psychological, and spiritual needs. The provision of hospice care can take place in an acute care setting; however, generally, the patients are cared for in a private residence or another residential living facility.[1]

Issues of Concern

Candidates of Hospice:

The ideal candidates for hospice are patients who are nearing their final weeks to months of their life and want to focus on comfort measures rather than life-prolonging treatments. Physicians should give strong consideration in making a hospice referral when patients who are chronically ill present with a decreased functional status, spend more than half their time in bed or a chair, and exhibit physical and psychological distress. A referral is paramount when there is a progressive decline in the patient's condition; their highest priority is to feel more in control and remain at home with support to keep comfortable.

Qualifying for Hospice Benefits:

Patients over 65 years of age or individuals younger than 65 years with a long-term disability will receive coverage through Medicare Part A benefits. If a patient is ineligible for Medicare hospice, benefit coverage will vary depending on the individual's health insurance coverage.

Currently, Medicare has four major qualification criteria to cover hospice services:

  1. Eligible for Medicare Part A
    1. United States citizen/legal resident eligible for Social Security benefits
    2. Over 65 years of age or eligible for Medicare services due to long-term disability for greater than two years or having end-stage kidney disease
  2. Certification by Medicare as a recognized hospice facility
  3. Patient verification choosing hospice services instead of utilizing regular Medicare coverage
  4. Certification from both a physician and hospice medical director verifying the patient has received a diagnosis of a terminal illness, and in typical circumstances, without treatment to prolong the patient's disease they are expected not to live more than six months[2]

Hospice Coverage:

When a patient has a terminal condition, Medicare will provide hospice care, which includes comprehensive services related to a terminal condition. The array of benefits may include:

  1. Medical equipment
  2. Medical supplies
  3. Skilled nursing care
  4. Medications to aid in the terminal illness to provide comfort
  5. Social Workers & chaplains
  6. Home health care aids
  7. Bereavement support
  8. Short term inpatient and respite care[2]

Clinical Significance

Hospice provides patients with many benefits. Some of the benefits of hospice our: a 24-hour on-call nurse, increased availability to health care professionals, and reduce to no cost for durable medical equipment and medications to increase comfort. Additionally, patients who choose to die at home with hospice care exhibited the improved quality of life for both the patients and their family members. Once a patient and their family have acknowledged the seriousness and life-limiting nature of the underlying disease, discussions of hospice as a care option should commence. Patients who have a prognosis of six months or less should be urged to enroll in hospice care so the family and patient can focus on improving their symptoms and increasing their comfort.

Unfortunately, acceding to hospice care is a difficult choice; once the patient and their family members accept the condition is a terminal illness, hospice care may be the best option. Hospice care provides the necessary support and cares to optimize the overall end of life patient and family experience when medications and treatments will no longer improve the patient’s condition.[3]


References

[1] Blinderman CD,Billings JA, Comfort Care for Patients Dying in the Hospital. The New England journal of medicine. 2015 Dec 24;     [PubMed PMID: 26699170]
[2] Dyess SM,Prestia AS,Levene R,Gonzalez F, An Interdisciplinary Framework for Palliative and Hospice Education and Practice. Journal of holistic nursing : official journal of the American Holistic Nurses' Association. 2020 Jan 20;     [PubMed PMID: 31955648]
[3] Wallston KA,Burger C,Smith RA,Baugher RJ, Comparing the quality of death for hospice and non-hospice cancer patients. Medical care. 1988 Feb;     [PubMed PMID: 3339915]