When Is the Right Time for Hospice Care
Some time ago an excellent on-line publication, Next Avenue, dedicated to providing information for seniors, caregivers and those on their way to some day becoming seniors, published an article titled “When Is the Right Time for Hospice Care?” by John F. Wasik. The author had personal experience in that his father had been admitted and then readmitted to the hospital following bouts with pneumonia. His father’s physician recommended hospice and the author, as many others do, was reluctant both with accepting that his father was declining and acting as a result of the author’s imperfect understanding of what hospice entailed. It might be a good time to note here that there are, by the way, many individuals who have shown progress even after hospice and have “graduated” from the benefit and returned to regular Medicare after improvement so it is important to recognize that hospice does not necessarily mean moving to the end of life although for many it does.
First things first in knowing the benefit. Hospice is a regular Medicare benefit covered through the individual’s own health insurance. This might be Medicare combined with a Medicare Supplement or a Medicare Advantage plan such as an HMO or PPO. Unlike Medicaid, hospice under Medicare does not require a spenddown of assets which is a distinct advantage for hard-pressed families concerned about the cost of care especially when finding care through providers coming into the home. One of my clients some time ago called and expressed the thought that prior to hospice she was severely stressed and unable to cope with her husband’s physical and mental condition. Her husband had severe dementia. After signing up for the program and welcoming caregivers into her home she felt this stress had been lifted considerably.
Hospice requires a written sign-off both by the physician, typically the family physician, and a hospice physician. The certification made is that the individual has a life expectancy of six months or less. However, if the insured individual continues to need the care beyond this time hospice can be recertified. One of the biggest concerns is that overwhelmingly family members wait too long before requesting the benefit, many times doing this only within a few days or weeks before death. Application can be made and benefits started much earlier.
The first step in acquiring the benefit under hospice is typically to go to your family member’s physician and initiate a discussion regarding care. It is very helpful if you have a healthcare power of attorney. If you do not have one this can be drafted by an elder law or estates attorney or sometimes found on line. You should be a healthcare agent (power of attorney or surrogate) to deal with HIPAA requirements. Your parent or family member, if competent, can sign.
Once you have discussed the issue with the physician and he/she agrees with the decision there are several quality hospice providers and you want to consider the individual benefits of each. These can include availability of services and experiences of other clients in dealing with that agency. Also note that there are typically hospice volunteers who come to the home and help. The benefit is not just physical or in providing pain management but emotional also and hospice volunteers often help family members to deal with potential loss. This can continue through the grieving process. It can be helpful to know you have a team of individuals on your side to help in dealing with your family member.
One of the primary benefits of hospice is its concentration on relieving pain. One trade off is that it does not focus on curing the illness or providing treatment for it. However, this does not mean it does not offer any medical intervention. For instance, for cancer patients who opt not to continue treatment it can mean discontinuance of chemotherapy. However, oxygen can continue to be provided for someone who has difficulty breathing. There would not be surgery also to cure the underlying condition but hospice has a team of professionals who monitor and deal with pain including recommending medications.
For stressed family members at a very difficult time in their lives, both for the patient and their loved ones, hospice is a benefit that can be worth considering.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.