Four Levels of Hospice

What is Hospice Care?

Many diseases and conditions are treatable or even curable, but what happens when someone reaches the stage where they aren’t getting better? Sometimes, people do not respond to medication, or they simply do not wish to continue treatment after dealing with a terminal illness for some time. In this case, when a patient is determined by a medical professional to have six months or less to live (terminally ill), they may wish to pursue a type of treatment known as hospice care.

Hospice care focuses on helping people remain comfortable at the end of their lives instead of spending their remaining days dedicated to prolonging their lives through medical treatment. Rather than focusing on a cure, a patient’s medical team will help ease any pain or suffering the person is going through. In other words, hospice care can be considered a way to manage symptoms rather than finding a definitive end to them.

There are four levels of hospice care, but no matter which level a patient utilizes, they’ll have a robust team of experts available to assist them. In fact, a hospice care plan often focuses on not just pain alleviation, but spiritual support and social work services as well. Coupled with speech therapy and even physical therapy, a person still has plenty of support from medical professionals even though their primary treatment goal may be different than before.

Where is Care Given?

The exact location of the care depends on which level of care a person needs. In general, hospice care services can be received either at a person’s home or at the hospital. Since the program’s main purpose is designed to increase the comfort level of a senior, this type of care can be performed in a variety of locations:

• Private residence
• Assisted living facility
• Skilled nursing facility
• Hospital

Many people prefer to receive care at home if possible. Home care has benefits like familiarity with the setting and proximity to loved ones.

Who is Suited for Hospice?

Hospice care can be considered a solution for people who are near the end-of-life stage. When a person turns to hospice care, they understand that medical treatment will shift from trying to extend their lifespan and will, instead, focus on improving their quality of life.

There is no minimum or maximum age for receiving hospice benefits, which means that seniors of all ages can qualify. Younger people even receive hospice care in some situations. People with a variety of conditions join hospice when their illnesses have progressed significantly:

• Parkinson’s disease
• Alzheimer’s disease
• End-stage cancer
• Stroke
• Heart disease
• AIDS
• Other terminal illnesses

According to a recent study, about 30% of Medicare hospice patients have cancer listed as their primary diagnosis. Heart disease and circulatory issues are the next leading diagnosis, followed by dementia.

When Should You Consider Hospice?

Not everyone will consider hospice, but for those who do, there are some notable events and situations that may prompt discussions about possibly switching to hospice care. It’s important to keep in mind that determining when to transition to hospice care can be a difficult decision. No matter which decision is made, the patient should be receiving the care that they want and the way that they want it.

A senior or their family may wish to discuss hospice options with a physician if the person is experiencing a number of drastic changes in their health, such as:

• Multiple trips to the emergency room
• Difficulty with activities of daily living
• Frequent infections
• Breathing difficulties
• Unresponsiveness to treatment

A hospice program can help patients feel more comfortable while dealing with these symptoms and conditions. Family caregivers are not always available 24/7 to provide the necessary support for a loved one, so hospice aides and other staff can alleviate some of the stress that comes with caring for a patient full-time.

How Do You Enroll in a Hospice Program?

Hospice providers are located around the country. The type of health insurance you have will likely guide your decision for selecting a certain provider. If you have Medicare, you’ll want to speak with a Medicare specialist to determine where the closest hospice facility is.

To qualify for hospice, most programs require a diagnosis by a hospice doctor as well as your general physician. You may need to sign paperwork that formally declares your intent to pursue hospice care rather than aggressive medical treatment.

Which Professionals Administer Hospice Care?

During a person’s time in hospice, they will work with a network of individuals who all try to make the patient as comfortable as possible. Hospice programs involve the typical medical staff most seniors are accustomed to working with: doctors, nurses, and pharmacists. However, don’t be surprised to learn that many other people will likely be involved in a hospice stay. Other professionals that support a patient throughout their time in hospice include counselors, chaplains, physical and occupational therapists, and social workers.

What Sort of Treatments Are Included in Hospice?

A person’s specific hospice plan will depend on their unique condition, health needs, and care preferences. Some options that may be available to a patient include:

• Nursing care
• Counseling (including spiritual, dietary, and grief)
• Therapy (physical and occupational)
• Speech-language pathology
• Drug treatment to minimize pain

Four Levels of Hospice

Depending on a person’s needs, they will be considered for one of four types of hospice care. People can progress from one type of care to another depending on their overall state of health. Additionally, a person can choose to discontinue (“revoke”) their hospice care if they wish. People may choose to do so for a number of reasons, such as:

• The person decides to participate in a clinical study
• The person decides to start (or resume) treatment like chemotherapy
• The person decides to go to the hospital for treatment

Most people remain in hospice until the end of life, but some people do discontinue it for one of the reasons above.

However, while someone remains in hospice care, they will be receiving one of four types of care:

1. Continuous Home Care

Despite this type of hospice care’s name, continuous home care doesn’t necessarily mean “continuous” in the sense that it is ongoing indefinitely. Continuous home hospice care can occur in short periods when a person is experiencing a severe medical event, or, alternatively, it can be used as continuing care management for someone who needs primarily nursing care.

2. General Hospice Inpatient Care

Inpatient hospice care is performed in a medical setting that is not the person’s home. For example, general hospice inpatient care can occur in a hospital, hospice inpatient unit, or a nursing home facility. General care denotes support for pain issues or management of chronic conditions.

3. Inpatient Respite Care

A person on hospice may need care 24 hours a day. When a person’s typical caregiver (or caregiver team) isn’t able to attend to their needs for a period of time, the person may undergo what is called inpatient respite care. During this time, the person will be cared for at an inpatient facility for a few days.

4. Routine Home Care

Routine home care is an intermittent form of hospice care that is provided when a patient isn’t experiencing any severe medical issues but still needs periodic care maintenance. In this regard, the definition of “home” typically extends to the patient’s traditional home or even an assisted living facility.

For Medicare patients, routine home care typically accounts for the majority of hospice services, just over 98%.

Paying for Hospice

Like with many medical treatments, hospice can be expensive. Fortunately, many programs exist that make affording hospice care easier for patients and their families. Keep in mind that you’ll want to check thoroughly into your coverage options, since electing for hospice care coverage may mean other medical treatment that was previously covered may no longer be.

Medicare

Medicare may cover most or all a senior’s hospice services. In order for Medicaid to cover the cost of your hospice care, patients need to sign an official document acknowledging their transition to hospice. Some of the costs that Medicare typically covers include:

• Hospice aide costs
• Spiritual and grief counseling
• Medical equipment
• Medication
• Nursing and medical services

Tricare

If you have Tricare services, you may be eligible for hospice coverage if you are seeking a hospice program in the U.S. As with Medicare, you’ll need to sign an official statement that declares your intentions to undergo hospice care rather than traditional treatment.

Tricare will usually cover services like:

• Home health aide assistance
• Items intended to increase your comfort
• Counseling
• Pain management

How Long Are People in Hospice?

This question is, understandably, a common one. The length of time a person spends in hospice depends on many factors, including the person’s overall health status. In 2018, Medicare patients were in hospice for an average of 89.6 days, while the median length of stay was 18 days. How long a senior can expect to stay in hospice is a difficult one to predict, as the answer depends on many factors.

Conclusion

There are a number of reasons that a person may be referred to hospice care. Choosing to pursue this type of care is a personal decision that should be discussed with a doctor and one’s family. If you decide to change your treatment to hospice care, it’s important to understand how your medical care will shift. Taking advantage of some, or even all, the resources provided by a hospice program can improve your quality of life and help you and your family come to terms with this end-stage of your life.

Sources:

1. Covered Services, Tricare, tricare.mil
2. What Are Palliative Care and Hospice Care?, U.S. Department of Health and Human Services, www.nia.nih.gov
3. Hospice Care, Medicare, www.medicare.gov
4. Hospice, Center for Medicare & Medicaid Services, www.cms.gov
5. FAQ: What Type of Terminal Illnesses Does Hospice Treat?, American Hospice Foundation, americanhospice.org
6. How Do You Become Eligible for Hospice?, Pathways Health, pathwayshealth.org
7. NHPCO Releases New Facts and Figures Report on Hospice Care in America, National Hospice and Palliative Care Organization, www.nhpco.org
8. 5 Signs Your Loved One is Ready for Hospice, Hospice Red River Valley, www.hrrv.org