Who can get access to hospice care?

Anyone that has a chronic, debilitating non-curable disease, and whose physician is prepared to certify that they have a limited life expectancy.

How can I access hospice care?

There are several ways that the process can be initiated:

• The patient or a family member can call a local Home Health agency and request an evaluation. (This is the best way to determine if the patient meets the criteria for the program.)
• The patient's physician can call in the referral (or tell the patient/family to call it in)

Who pays for hospice?

Hospice is covered by all insurance companies.

What if I have no insurance at all?

In California, admission to a hospice program will facilitate access to emergency Medi-Cal. Patients in other states would have to check their state's regulations.

How long can a patient be on hospice?

The patient is evaluated every ninety days for two ninety day periods, and then every sixty days thereafter.

As long as the patient continues to meet the criteria, they can continue to access the program.

Can I keep my own doctor?

Your primary care physician should be encouraged to continue to monitor your care and provide guidance to the hospice team. If they are unwilling or unable to do that, Haven Hospice can and will provide physician services that will include home visits.

Do I lose my Medicare benefits?

No! This is the most common misunderstanding about the hospice benefit. Medicare stays in place and only the hospice portion of that benefit is assigned to hospice. The Medicare benefit is still in place to cover hospitalizations, surgery, and doctor visits that are not related to the diagnosis that made the patient eligible for the hospice program.

Can we hear about the program before we discuss it with the MD?

Any patient can receive an evaluation for services without a physician's order. The hospice, however, cannot provide any care or service without a doctor's order.

Can I still get medical care for my other ailments?

If you have an HMO or any other insurance, you continue to be covered for the non-diagnosis-related ailments.

What if I have to go to the hospital (for example, with a broken leg)?

That hospitalization is not related to the diagnosis that made the patient eligible for the program and therefore would not interfere with the hospice care.

If hospitalization is required for something related to the diagnosis the patient has the option of withdrawing from the hospice program and being admitted to the hospital.

Hospice is only for those imminently dying.

All too often we receive referrals when the patient is days or even hours from dying. When this occurs, few of the many resources that could have made the end of life process more bearable and humanitarian can come to bear. Once it has been determined that a terminal illness has been diagnosed and aggressive treatment has been ruled out hospice should be considered.

Hospice is only for cancer patients.

While it is true that cancer patients are a large part of the hospice clientele there are many non-cancer diagnoses that qualify for the hospice benefit. One of the most significant diagnoses is end-stage dementia where, with other associated symptoms including loss of weight, bed bound, or multiple bed sores, the patient can qualify for the benefit.

Hospice means all treatment is stopped.

This is not true, particularly if you are committed to maintaining quality of life. Treatment for the primary disease will include pain control and other palliative treatment to keep the patient comfortable. We have even provided chemotherapy for cancer patients when it provides relief without the expectation of cure. There are often a number of treatments for related health problems such as urinary tract infections, bed sores and anxiety that should be treated solely to provide comfort.

In addition, there may be other secondary diagnoses that should be treated that are paid for under pre-hospice medical coverage, whether that is Medicare/MediCal or private insurance. The care of ALL the patient’s medical needs is managed by hospice regardless of payer source to insure continuity and comprehensive care management.

There is a limited number of cycles or amount of time that a patient can be on hospice or once you are on hospice, you cannot receive acute patient services.

There no longer any limits as to how many times patients can go on and off hospice. If a need arises for the patient to go to an acute facility or to have minor surgery, the patient can be discharged and readmitted to hospice upon their return home or to their facility of residence. While six months is the criteria for admission to hospice, their eligibility is reviewed every 90 days and if still appropriate they can remain on service virtually indefinitely.

Once hospice takes over, the role of the primary care physician in the patient's care management ceases to exist.

The primary care physician is as involved in the care as they wish to be. Minimally, they are sent a copy of all Plans of Care and Physician Orders for their concurrent approval. They are compensated by hospice for visits to the patient. And they are invited to attend the weekly Interdisciplinary Team meetings.

The patient must sign a Do Not Resuscitate (DNR) order before enrolling in hospice.

While a DNR would eventually be appropriate for a terminally ill patient, the federal laws on advance directives forbid an agency from requiring a patient or family representative from changing an advance directive (of which a DNR order is a type) in order to enroll in a program or receive a service. The family/patient can put one in place at any time when they feel it is appropriate and acceptable.