Hospice: A Special Kind of Caring

Surveys over the past few years found that most Americans would prefer to spend their last days at home, close to loved ones, free of pain and other uncomfortable symptoms. However, caring for a loved one who is dying is never easy, and families often need professional help to do it. Hospice care provides that help.

Hospice is a philosophy of caring for people who are dying and their families. It focuses on helping the patient have the best quality of life possible in the time that is left. It views death as a natural part of life and neither postpones nor hastens it.

Hospice services are tailored to each patient's situation and are delivered by a team that includes a physician, nurse, social worker, spiritual caregiver, home health aide, other professionals as needed, and volunteers.

Today, 73 hospice programs in Minnesota, with 15 in the metro area, provide care to more than 11,000 persons a year. Of these programs, 63 are Medicare certified.

Can hospice care be provided at home?

Yes. Most hospice care is provided to people in their homes, where they are close to friends and family. Hospice can also be in other care settings including nursing homes, assisted living facilities, adult foster care residences or hospice homes.

Who is eligible for hospice services?

Hospice is for individuals with a life-limiting illness such as cancer, heart or pulmonary disease, Alzheimer's disease, or AIDS, who have a life expectancy of six months or less.

How does hospice help caregivers?

Hospice team members teach family and friends how to care for their loved one. A nurse is on-call to answer questions and provide support to caregivers 24-hours a day. Specially trained volunteers provide companionship, run errands, and help caregivers in a variety of ways. In addition, inpatient respite care is available for family members. Other services may include grief counseling, support groups, and help finding other needed services.

How are hospice services paid for?

Medicare pays for hospice services for individuals who have Medicare Part A. Medical Assistance, most private insurance companies and HMOs also pay for hospice. To be eligible for the Medicare Hospice Benefit, a person must also:

• be certified by a physician to have a life expectancy of six months or less;
• sign a Medicare Hospice Benefit election form saying that all treatment related to the terminal illness will be provided through hospice (Medicare Part A is still available for treatment unrelated to the terminal illness);
• choose a Medicare certified hospice program.

What hospice services are under Medicare?

The Medicare Hospice Benefit covers the entire cost of hospice services, which may include: physician and nursing services; medical social services; home health aide and homemaker services; medical equipment and supplies; medications to control pain and symptoms; short-term inpatient and respite care; physical, occupational, and speech therapy; and dietary and other counseling. (Note: a hospice provider may charge a $5 co-pay for prescription drugs and 5 percent of the cost of inpatient respite care.) 

Medical Assistance and many of the other insurance companies and HMOs that pay for hospice services follow Medicare eligibility and service guidelines. Because insurance policies differ in their coverage, it is very important to check the policy for specifics.

Do I have to change doctors to receive hospice care?

No. The person's physician may continue to direct care and bill in the usual manner.

How do I choose a hospice?

Hospice programs can be independent agencies, or may be part of a health system, hospital, or home health agency. A physician, insurance company, or other health care professional can provide information about area hospice programs. Information is also available from the Minnesota Department of Health, which licenses hospice programs and conducts on-site surveys to ensure quality. Visit http://www.health.state.mn.us/divs/fpc/
directory/providerselect.cfm. "Questions to Ask When You're Choosing a Hospice Provider" and additional information about hospice are available online at http://www.mnhospicemn.org or by calling Hospice Minnesota at (651) 659-0423 or toll free (800) 214-9597.

This article was prepared by Fran Conklin, Hospice Minnesota, a non-profit organization dedicated to promoting quality care for people who are dying and their families, educating the public about compassionate and competent end-of-life care, and advocating for increased access to hospice care in Minnesota.