Hospice care offers a holistic and comprehensive support system for individuals facing terminal illnesses and their families. Unlike treatments focused on curing illness, hospice emphasizes comfort, managing pain, and alleviating symptoms—known as palliative care—to enhance the patient’s quality of life in their remaining time.
For patients enrolled in Medicare Part A, hospice care benefits are accessible under specific conditions:
- Care must be provided by a Medicare-certified hospice agency.
- Both the patient’s attending physician (if applicable) and the hospice physician must certify the patient as terminally ill, with a prognosis of six months or less if the illness progresses naturally.
- The patient must sign an election statement to formally choose the hospice benefit, thereby waiving Medicare payments for curative treatments related to their terminal condition.
Upon meeting these criteria, patients can elect hospice benefits for:
- Initial coverage for two 90-day periods.
- Followed by an unlimited number of subsequent 60-day periods.
- For the third and all subsequent benefit periods, Medicare requires documentation of a face-to-face (FTF) encounter between a hospice physician or nurse practitioner and the patient. This encounter must confirm clinical findings supporting a life expectancy of six months or less.
A cornerstone of hospice care is the individualized written plan of care (POC). This plan is crucial, as it tailors all hospice services to meet the specific needs of each patient and is developed collaboratively by an interdisciplinary group. This group includes the patient’s attending physician (if they have one), the hospice team, the patient or their representative, and the primary caregiver.
Essential Services Included in a Hospice Plan of Care
The Medicare hospice benefit is designed to provide a wide array of services aimed at minimizing pain, managing disease symptoms, and supporting patients and families through the terminal illness journey. These essential services, all integral parts of the plan of care, include:
- Physician and Nursing Services: Access to hospice-employed physicians, nurse practitioners (NPs), and the patient’s chosen physicians ensures comprehensive medical oversight. Skilled nursing care is central to managing symptoms and providing direct patient care.
- Medical Equipment and Supplies: The plan of care includes all necessary medical equipment (like hospital beds, wheelchairs) and medical supplies (bandages, catheters) related to the hospice diagnosis, delivered to the patient’s location of care.
- Medications for Pain and Symptom Management: Crucial to palliative care, the hospice benefit covers drugs specifically for managing pain and other distressing symptoms associated with the terminal illness, as outlined in the plan of care.
- Hospice Aide and Homemaker Services: Personal care services provided by hospice aides, along with homemaker services, assist patients with daily living activities, offering both comfort and practical support as part of the plan of care.
- Therapeutic Services: Physical therapy, occupational therapy, and speech-language pathology services are available to help patients maintain function and independence for as long as possible, integrated within the plan of care to address specific patient needs.
- Medical Social Services: Social workers provide emotional support, counseling, and resource assistance to patients and families, helping navigate the psychosocial aspects of terminal illness, all within the framework of the plan of care.
- Dietary and Spiritual Counseling: Nutritional support through dietary counseling and spiritual care services are offered to address the holistic needs of patients and families, respecting their preferences and beliefs as part of a comprehensive plan of care.
- Grief and Loss Counseling: Bereavement support is provided to individuals and families both before and after the patient’s death, acknowledging the emotional journey of loss and grief, and is considered an essential component of holistic hospice care.
- Short-term Inpatient Care: The plan of care can include short-term inpatient care for pain control and symptom management that cannot be effectively managed at home, as well as respite care to provide temporary relief for caregivers.
The hospice program is responsible for offering and arranging all services deemed reasonable and necessary within the patient’s plan of care, ensuring a comprehensive and supportive approach.
Levels of Hospice Care and the Care Plan
Medicare compensates hospice agencies at a daily rate for each day a patient is enrolled in hospice, regardless of the intensity of services provided on any given day. These daily rates are structured around four distinct levels of hospice care, each influencing how the plan of care is delivered:
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Routine Home Care: This is the most common level, provided when a patient chooses to receive hospice care at home, which can include their personal residence, a skilled nursing facility (SNF), or an assisted living facility. The plan of care under routine home care is for patients whose symptoms are relatively stable and who are not in acute crisis.
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Continuous Home Care: This intensive level of care is for patients experiencing a brief crisis and requires continuous nursing care at home. The plan of care here is designed for short-term crisis management to keep the patient safely at home, avoiding hospitalization. It includes predominantly nursing care, potentially supplemented by hospice aide and homemaker services on a continuous basis.
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Inpatient Respite Care: This level offers temporary care in an approved inpatient facility, for up to 5 consecutive days, to provide respite for the patient’s primary caregiver. The plan of care during respite care focuses on maintaining patient comfort and safety while giving caregivers a necessary break.
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General Inpatient Care: Provided in an inpatient facility, this level is for managing severe pain or acute symptoms that cannot be controlled in other settings. The plan of care for general inpatient care is more intensive, aiming to stabilize the patient’s condition so they can return to a lower level of care setting if possible.
Understanding Hospice Coinsurance and Costs
While Medicare hospice benefits cover a vast range of services outlined in the plan of care, there are specific coinsurance aspects patients should be aware of:
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Drugs and Biologicals Coinsurance: For medications and biologicals prescribed to manage pain and symptoms related to the terminal illness during routine or continuous home care, patients may have a coinsurance of 5% of the drug cost to the hospice, with a maximum of $5 per prescription. No coinsurance applies during general inpatient or respite care.
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Respite Care Coinsurance: For inpatient respite care, patients are responsible for a daily coinsurance of 5% of the Medicare payment for respite care days. This coinsurance cannot exceed the current inpatient hospital deductible for the year. This level of care includes costs for room and board.
Hospice Quality Reporting and Patient Care
To ensure high-quality care, the Hospice Quality Reporting Program collects and reports data on hospice performance. This program underscores the importance of effective plans of care and their impact on patient outcomes and experiences. For further details on quality measures and reporting requirements, resources are available on the [Current Measures]([invalid URL removed]) and [Hospice Quality Reporting]([invalid URL removed]) webpages.
This comprehensive guide highlights the critical role of a well-developed plan of care in hospice services, ensuring that patients receive personalized, compassionate, and effective care tailored to their unique needs and circumstances.
