Hospice FAQs
There’s a lot to know about the hospice process, but you’re not in it alone. We’re here to help you understand the hospice process and make the best decision for you and your family. Below are a few common questions families have about hospice care.
We’d love to talk to you about your specific situation. Feel free to reach out to us any time.
FAQs
Hospice care covers all medication, treatment, and care related to the patient’s terminal illness and related conditions. That includes:
- Physician services (MD, DO, NP, PA)
- Nursing care
- Social worker services
- Spiritual counseling
- Hospice aide and homemaker services
- Bereavement counseling for the family for over a year after death
- Medical equipment like hospital beds, oxygen, wheelchairs, and more
- Medical supplies like diapers, underpads, wound supplies, catheters, and more
- Prescription drugs and pharmacy services
- Dietary counseling
- Physical and occupational therapy
- Speech-language pathology services
- Short-term inpatient care for managing pain and symptoms
- Short-term respite care when you or your caregivers need a break
- Any other Medicare-covered services needed to manage symptoms that your hospice team recommends
Note that when a patient begins hospice care, they are no longer pursuing curative treatments for their condition. In other words, they are not trying to get better. As such, these services are not included in hospice care, and are not covered once the patient enters hospice.
- Treatments aimed at curing the patient’s terminal illness and/or related conditions.
- Prescriptions that do not treat the patient’s terminal illness and/or related conditions.
- Care from providers that wasn’t arranged by the hospice medical team. The hospice team must give or arrange all the care the patient receives for their terminal illness or related conditions. Though the patient can still see their regular doctor, nurse practitioner, or physician’s assistant if they’ve chosen him or her as their attending medical professional.
- Room and board outside of short-term inpatient or respite care services arranged by the hospice team — unless the patient is a Medi-Cal beneficiary.
- Care received as a hospital outpatient or inpatient, unless this care is arranged by the hospice team or the care is unrelated to the terminal illness and related conditions.
No. A patient can refer themselves or be referred by a family member. In that case, we’ll conduct a pre-evaluation to build a baseline and assess whether the patient is ready for hospice or not.
To make a referral, reach out to us. We’ll schedule a time to meet with you and talk about the hospice process and the services we provide.
For most patients, hospice is paid for through Medicare, though some use private insurance or Medi-Cal.
When hospice care is paid for through Medicare, no deductible is required. Once hospice care begins, Medicare’s hospice benefit should cover everything related to the patient’s terminal illness, even if you remain in a Medicare Advantage plan or other Medicare health plan.
For illnesses and conditions not related to the terminal illness, the patient can still get covered through Original Medicare or through a Medicare Advantage plan.
Medi-Cal’s hospice benefit mirrors Medicare’s hospice benefit in design and scope. A patient may be covered for hospice by Medicare or Medi-Cal. A patient may receive hospice benefits through Fee-For-Service (Regular) Medi-Cal or more commonly a Medi-Cal Managed Care Plan. To see which one would be your primary payer, contact one of our family care coordinators.
If the patient uses private insurance to cover hospice care, most private health plans mirror Medicare’s requirements for hospice. However, details around coverage and out-of-pocket costs may differ from that of Medicare, and the patient should consult their health plan directly to understand these differences.
Not every illness or disease has the same trajectory, and it can be tough to know when it’s the right time to consider hospice care. No matter the case, you don’t have to make any decisions on your own, or on the spot.
A patient qualifies for hospice care when:
- They have been diagnosed with a terminal illness.
- They have received a prognosis of six months or less to live.
- They have chosen not to pursue curative treatment. This can be because the patient’s doctor has determined that curative efforts are not working, or the patient can choose to discontinue treatment because that treatment is debilitating or ineffective.
When the patient or a loved one reaches this stage, the next step is to start the conversation with your family and physicians about whether hospice care is the right next step.
Let us help. Contact us for a complimentary pre-evaluation screening.
It can be hard to admit and accept that you or your loved one has reached a point where hospice care has become appropriate. Aside from the qualification factors listed above, these signs may indicate you or your loved one has reached the beginning of their end-of-life process.
- They are no longer able to care for themselves and perform routine daily activities like bathing, preparing food, and taking medication as instructed.
- They have suffered frequent periods of hospitalization or visits to the ER.
- You notice significant mental decline like decreased alertness, withdrawal, or sleeping far more often.
- They show signs of physical decline like a diminished appetite or rapid loss in weight.
- Symptoms of their terminal illness become more acute, like severe pain, trouble breathing, nausea or vomiting, and frequent infections.
- They have started to prioritize quality of life over continuing aggressive curative treatments.
It’s a common misconception that hospice is a facility that houses hospice patients. Hospice care is administered wherever the patient calls home — it is a service, not a place. Hospice facilities are not as common in California as they are in other parts of the country.
Hospice comes to the patient, whether they live in a private residence, skilled nursing facility, assisted living facility, board and care, or some other setting.
Medi-Cal covers room and board for long-term care in a skilled nursing facility if care at home or in any of these settings is not feasible. For Medi-Cal patients who live in nursing homes, both the cost of living there (room and board) and hospice are fully covered.
Probably not.
When a patient enters hospice, all care, medications, and services related to the patient’s terminal illness or related conditions are provided by the patient’s hospice team.
As required by Medicare, the hospice provider prescribes, obtains, and delivers the medications their patients need. Usually, hospices work with one or a few preferred pharmacies that have a hospice focus. These pharmacies are operational seven days per week and remain on call 24/7 in case of an emergency or crisis.
When a patient enters hospice, you’ll call your hospice team instead of 911. Your hospice team is familiar with the patient and are best equipped to triage an emergency.
In the hospice setting, “emergency” can mean many things. Whether the patient is suffering a mental or emotional crisis, a serious injury, or elevated symptoms and pain, the multi-disciplinary hospice team is always on call.
Upon taking on a patient, In the Arms of Grace Hospice performs an anticipatory needs assessment of the patient’s illness and condition, in order to create a plan for emergencies that may possibly arise. This can mean emergency medication, oxygen, and other measures to ensure the team is prepared to respond immediately.
Additionally, one major advantage of hospice is that the team can catch nascent symptoms and treat them before they can ever become an emergency.
We personally educate family members on how and when to provide care and administer treatments or medication. Your hospice team will work with you as you become comfortable caring for your loved one and will remain on standby 24/7 to address any questions or emergencies that arise.
We closely evaluate the patient and, based on their disease and condition, assemble “comfort packs” which consist of emergency medications that address the most common symptoms that arise at the end of life. This can include pain, dyspnea, anxiety, agitation, nausea and vomiting, constipation, fever, secretions, and others.
Do Not Resuscitate (DNR) directives instruct emergency medical personnel regarding a patient’s decision to forgo resuscitative measures in the event of cardiopulmonary arrest. With a DNR, emergency medical services personnel will withhold resuscitative measures like chest compressions (CPR), assisted ventilation, endotracheal intubation, defibrillation, and cardiotonic drugs.
DNRs are specific to heart issues. EMS personnel will still treat symptoms for pain, bleeding, and other issues.
The DNR must be signed by a physician and the patient or the patient’s legally recognized healthcare decision-maker.
A Physician Order for Life-Sustaining Treatment (POLST) is a directive in case the patient is found without a pulse. The POLST form specifies the type of medical treatment a patient wishes to receive at end of life.
The POLST form must be signed and dated by a physician, a nurse practitioner, or physician assistant acting under the supervision of the physician, and the patient or the patient’s legally recognized healthcare decision-maker.
POLST forms are kept near the patient, usually on bright pink paper so it can be easily found.
Yes, just not treatments aimed at curing the terminal illness.
Even though the patient has decided to stop pursuing a cure, the hospice and medical teams will evaluate medication, interventions, and treatments that manage symptoms and improve the quality of life for the patient and the family.
Even regarding illnesses and conditions not related to their terminal disease, the hospice team will coordinate treatment.
It’s important to note that hospice is a different type of care with a different approach and different goals. While we don’t discontinue routine medication on day one, we do conduct a thorough medication review and reconciliation to determine what is necessary and effective based on the patient’s condition and the extent of their illness.
If the patient develops acute issues, even unrelated to their terminal illness, we will continue to treat it and provide care so long as it promotes comfort and quality of life.
Patients have the right to designate their attending physician, whether it be their own family doctor or the hospice team physician. The attending physician may also be a physician assistant or nurse practitioner.
There are some technicalities that come along with using your regular doctor.
- Only one MD or DO can administer care related to the patient’s terminal illness and still be covered by Medicare. This can be the patient’s regular doctor. However, great care must be taken to keep their regular doctor on the same page with the hospice team and plan of care. The hospice care team and the physician will work closely to coordinate care. Remember, once a patient enters hospice, they are no longer trying to cure their disease. Any efforts made to do so won’t be covered by the hospice benefit.
- The patient can use their regular doctor to receive care for conditions unrelated to the terminal diagnosis, but it won’t be covered by hospice. However, these treatments will still be covered by Original Medicare or a Medicare Advantage Plan.
- Often, patients use physicians provided by the hospice. Hospice physicians are more equipped to make house calls and administer care in line with the hospice mission. As part of the multi-disciplinary hospice team, they can ensure treatments coordinate with other efforts beyond the physical.
Yes. Labs and diagnostics such as x-rays, ultrasounds, urinalysis, and blood tests may be useful in determining more targeted and precise treatments and interventions. They are commonly performed by our hospice when seen fit or necessary to develop the course of treatment. However, bear in mind that these diagnostics are not aimed at curing the terminal illness but for addressing acute issues that may arise and for palliative reasons. In other words, we don’t perform diagnostics to assess the progression of the disease.
In hospice, we have a saying that “we don’t chase numbers, we treat symptoms.” If a patient has entered hospice, the metrics provided by these diagnostics don’t matter much. Waiting for the results of these assessments to provide treatment prolongs the discomfort of the patient. Oftentimes our care team will administer treatment based on symptoms they observe by assessing the patient.
No.
Entering hospice care is not the end of care. It’s the start of a new type of care — often more care than a patient is used to. It is by no means “giving up,” nor is it a “last resort.” Even though hospice’s goal is not to cure the terminal disease, it certainly does not cause death faster. In fact, a lot of research shows that patients live longer when they receive hospice care.
Why In the Arms of Grace Hospice?
IAGH is a family-owned and operated boutique hospice serving the communities of Los Angeles and its surrounding counties. We believe that while hospice may be a difficult time in one’s life, it certainly doesn’t have to be the worst. Our team goes above and beyond to help patients and families gain dignity, peace, and resolution in the face of loss.