Learning Center
On this page we have provided more in depth information about hospice services gathered from The Centers for Medicare & Medicaid Services website. We understand that thinking about starting hospice services can be difficult for you and your family. If you have any questions or if you would prefer to speak with one of our knowledgeable team members, please go to our Contact Page
What is hospice?
C E N T E R S f o r M E D I C A R E & M E D I C A I D S E R V I C E S define Hospice as a program of care and support for people who are terminally ill (with a life expectancy of 6 months or less, if the illness runs its normal course) and their families. Here are some important facts about hospice:
■ Hospice helps people who are terminally ill live comfortably.
■ Hospice isn’t only for people with cancer.
■ The focus is on comfort (palliative care), not on curing an illness.
■ A specially trained team of professionals and caregivers provide care for the “whole person,” including physical, emotional, social, and spiritual needs.
■ Services typically include physical care, counseling, drugs, equipment, and supplies for the terminal illness and related conditions.
■ Care is generally given in the home.
■ Family caregivers can get support. Palliative care Palliative care is the part of hospice care that
How does the hospice benefit work?
If you qualify and agree to hospice services, you and your family will work alongside your hospice provider to set up a plan of care that meets your needs. Hospice care is provided by a team of professionals and you and your family members are the most important part of a that team. that may also include:
■ Doctors
■ Nurses or nurse practitioners
■ Spiritual Counselors
■ Medical Social workers
■ Pharmacists
■ Physical and occupational therapists ( provided on a limited and as needed basis for safety concerns)
■ Registered Dietitian
■ Hospice aides
■ Volunteers
In addition, a hospice nurse and doctor are on-call 24 hours a day, 7 days a week, to give you and your family support and care when you need it. Even though a hospice doctor is part of your medical team, your regular doctor can continue to participate in your care. The hospice benefit allows you and your family to stay together in the comfort of your home, unless you need care in an inpatient facility. If your hospice provider decides you need inpatient hospice care, your hospice provider will make the arrangements for your stay.
What is covered under the Medicare hospice benefit?
Once your hospice benefit starts, Original Medicare will cover everything you need related to your terminal illness, but the care you get must be from a Medicare-approved hospice provider. Hospice care is usually given in your home, but it also may be covered in a hospice inpatient facility. Depending on your terminal illness and related conditions, the plan of care your hospice team creates can include any or all of these services:
■ Doctor services
■ Nursing care
■ Medical equipment (i.e. a medical bed, wheelchair or walker)
■ Medical supplies (i.e. gloves, incontinence briefs, bandages and catheters)
■ Prescription drugs (related to the hospice diagnosis, for symptoms management & comfort)
■ Hospice aide and homemaker services
■ Physical and occupational therapy
■ Speech-language pathology services
■ Social worker services
■ Dietary counseling
■ Grief and loss counseling for you and your family
■ Short-term inpatient care (for pain and symptom management)
■ Short-term respite care
■ Any other Medicare-covered services needed to manage your terminal illness and related conditions, as recommended by your hospice team
What is not covered by the Medicare hospice benefit?
Once you have elected to start hospice care, you have decided that you no longer want curative care for your terminal illness and related conditions, and/or your doctor has determined that efforts to cure your illness aren’t working. Medicare hospice benefit does not cover any of the following once your hospice benefit starts:
■ Treatment intended to cure your terminal illness and/or related conditions. Talk with your doctor if you’re thinking about getting treatment to cure your illness. You always have the right to stop hospice care at any time.
■ Prescription drugs (except for symptom control or pain relief).
■ Care from any provider that wasn’t set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness and related conditions must be given by or arranged by the hospice team. You can’t get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care.
■ Room and board: Medicare doesn’t cover room and board. However, if the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility for no more than five (5) days.
■ Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it’s either arranged by your hospice team or is unrelated to your terminal illness and related conditions.
**Contact your hospice team before you get any of these services, or you might have to pay the entire cost.
What about care for a condition other than your terminal illness?
Under The Centers for Medicare & Medicaid Services, the hospice benefit covers care for your terminal illness and related conditions. Once you start getting hospice care, your hospice benefit should cover everything you need related to your terminal illness, even if you remain in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan. After your hospice benefit starts, you can still get covered services for conditions not related to your terminal illness. Original Medicare will pay for covered services for any health problems that aren’t part of your terminal illness and related conditions. However, you must pay the deductible and coinsurance amounts for all Medicare-covered services you get to treat health problems that aren’t part of your terminal illness and related conditions.
How long you can get hospice care?
Hospice care is for people with a life expectancy of 6 months or less (if the illness runs its normal course). If you live longer than 6 months, you can still get hospice care, as long as the hospice medical director or other hospice doctor re-certifies that you’re terminally ill. Hospice care is given in benefit periods. You can get hospice care for two 90-day benefit periods followed by an unlimited number of 60-day benefit periods. At the start of the first 90-day benefit period, your hospice doctor and your regular doctor (if you have one) must certify that you’re terminally ill (with a life expectancy of 6 months or less). At the start of each benefit period after the first 90-day benefit period, the hospice medical director or other hospice doctor must re-certify that you’re terminally ill, so you can continue to get hospice care. A benefit period starts the day you begin to get hospice care and it ends when your 90-day or 60-day benefit period ends.
When do hospice services end?
If your health improves or your illness goes into remission, you may no longer need hospice care. You always have the right to stop hospice care at any time. If you choose to stop hospice care, you’ll be asked to sign a form that includes the date your care will end. You shouldn’t be asked to sign any forms about stopping your hospice care at the time you start hospice. Stopping hospice care is a choice only you can make, and you shouldn’t sign or date any forms until the actual date that you want your hospice care to stop.
Because hospice is a choice, you also have the right to switch hospice providers once every benefit period.
What is the difference between Hospice and Palliative Care?
Palliative care is focused on symptom management support to individuals who are receiving active treatment for their terminal illness but generally services are limited compared to hospice services.
Hospice care is comfort focused, helping people who are terminally ill and their families maintain their quality of life. If you’re terminally ill or have an illness that has no further therapy available, hospice care can address your physical, intellectual, emotional, social, and spiritual needs. Hospice care supports your independence, access to information, and ability to make choices about your health care.
What is a POLST form?
Physician Orders for Life-Sustaining Treatment (POLST) is a form that gives seriously-ill patients more control over their end-of-life care, including medical treatment, extraordinary measures (such as a ventilator or feeding tube) and CPR. Printed on bright pink paper, and signed by both a patient and physician, nurse practitioner or physician assistant, POLST can prevent unwanted or ineffective treatments, reduce patient and family suffering, and ensure that a patient's wishes are honored.