Hospice Care: What Happens in the First 24 Hours

Understanding Hospice Care

When considering hospice care, it's essential to understand the admission requirements and the benefits of early contact with hospice services.

Admission Requirements

For a patient to become eligible for hospice care, certain admission requirements must be met as per federal regulations. The primary criterion is that the physician must estimate a life expectancy of six months or less, assuming the disease progresses naturally. This estimation of life expectancy is crucial in determining the medical appropriateness for hospice care.

To officially enter the hospice care program, the patient or their representative must sign a consent form electing to receive hospice care. This formal step marks the beginning of the patient's journey within the hospice care system.

Benefits of Early Contact with Hospice

Early contact with hospice services can provide numerous advantages for patients and their families. Understanding the different levels of care available under the Medicare hospice benefit is crucial. These levels include Routine Home Care, Continuous Home Care, General Inpatient Care (GIP), and Respite Care. Each level of care serves distinct purposes and has different reimbursement structures under Medicare [2].

Patients and families are strongly encouraged to reach out to Hospice & Palliative Care as soon as possible to gather comprehensive information about the services offered. This early contact facilitates informed decision-making regarding future choices related to hospice care. By being proactive in seeking information, patients and families can better understand the available services and make decisions that align with their preferences and needs [1].

Understanding the admission requirements and the benefits of early contact with hospice services are crucial steps in ensuring a smooth transition into hospice care. By meeting the necessary criteria and taking advantage of early communication with hospice providers, patients and families can access the support and services they need during challenging times.

Overview of Hospice Care Services

When considering hospice care services, it is essential to understand the availability and coverage, the various levels of care provided, and the core hospice team that plays a crucial role in patient care.

Availability and Coverage

Since 1983, hospice services have been available through Medicare, Medicaid, and nearly all US insurance plans. In 2016, there were 4382 Medicare-certified hospices in operation, with an estimated 1.4 million people receiving hospice care in the US. More than 50% of patients were cared for at home.

Hospice care is a fully covered Medicare benefit, encompassing nurses, caregivers, medicines, supplies, equipment, and support. There are generally no out-of-pocket expenses for the hospice diagnosis.

Levels of Care

The Medicare hospice benefit includes four levels of care: Routine Home Care, Continuous Home Care, General Inpatient Care (GIP), and Respite Care. Each level of care serves different purposes and is reimbursed differently by Medicare.

To understand these levels of care in detail, refer to the following table:

Level of CareDescriptionRoutine Home CareProvided at home or in a nursing facility for pain management and other symptom control.Continuous Home CareIntensive care provided at home during a crisis to manage acute medical symptoms requiring continuous nursing care.General Inpatient CareCare provided in a facility for symptoms that cannot be managed at home or for short-term needs such as pain control or respite for family members.Respite CareShort-term care provided in a facility to give a break to the family caregiver; usually up to 5 consecutive days.

Core Hospice Team

The core hospice team consists of professionals who play essential roles in providing comprehensive end-of-life care. This team typically includes a hospice nurse, a social worker, and a chaplain. They collectively manage pain and other symptoms, address psychosocial and spiritual aspects of dying, provide medications and medical equipment, and offer grief support and counseling to patients and families.

Understanding the availability and coverage of hospice care services, the different levels of care offered, and the roles of the core hospice team members is essential for individuals and families considering hospice care for their loved ones. Each aspect contributes to a holistic approach to end-of-life care that focuses on comfort, support, and dignity for both patients and their families.

Emotional and Spiritual Support

In hospice care, emotional and spiritual support play pivotal roles in providing comfort and solace to individuals facing terminal illnesses and their families. These components are integral in aiding patients to navigate their final months with serenity and assisting their loved ones in coping with the hospice journey and the subsequent grieving process.

Importance of Emotional Support

Emotional support is a cornerstone of hospice care, offering individuals a safe space to process their emotions and uncertainties. At VNS Health, emotional support is administered through the expertise of social workers and spiritual care counselors. These professionals aid individuals in managing their emotions, making critical decisions, and finding hope and meaning in their circumstances. Furthermore, emotional support also extends to caregivers and family members, acknowledging the emotional and physical challenges that come with transitioning to hospice care.

Spiritual Care in Hospice

The holistic care approach in hospice includes addressing not only the physical symptoms but also the psychosocial and spiritual needs of patients. The core hospice team typically comprises a nurse, social worker, and chaplain, each contributing to the overall well-being of the patient and their family members. At VNS Health, social workers and spiritual care counselors are instrumental in providing specialized emotional and spiritual care to patients nearing the end of life and their families. These professionals are well-versed in offering support that caters to the unique emotional and spiritual needs of individuals during their hospice journey.

Grief Support Services

In the aftermath of a loss, grief support services become invaluable for families navigating their bereavement. VNS Health extends grief support for up to 13 months after the passing of a loved one who received hospice care. Specialized grief support groups are tailored to specific relationships, such as those with parents, spouses or partners, siblings, and adult children. Additionally, workshops focusing on stress relief and strategies for navigating holidays without the presence of a loved one offer practical assistance to individuals coping with grief [4].

As individuals journey through hospice care, emotional and spiritual support remains a constant source of comfort and guidance, recognizing the multifaceted nature of end-of-life experiences and the importance of addressing emotional and spiritual well-being alongside physical care.

Admission Process and Care Timeline

Upon entering hospice care, the admission process and care timeline play a crucial role in ensuring that individuals and their families receive the necessary support and services. This section highlights the consultation and care plan process, coverage and benefits available, and how to navigate and respond to loss during the initial stages of hospice care.

Consultation and Care Plan

The first step in the hospice care journey typically involves a consultation with the hospice team. During this consultation, the hospice team, including medical professionals and support staff, will assess the individual's medical condition, evaluate their needs, and collaborate with the patient and family to create a personalized care plan.

The care plan outlines the goals of care, treatment options, symptom management strategies, and the services that will be provided to ensure the comfort and well-being of the patient. It is essential for the care plan to be regularly reviewed and updated to reflect any changes in the patient's condition and needs.

Coverage and Benefits

Understanding the coverage and benefits of hospice care is essential for individuals and families to make informed decisions regarding their care. Hospice care is typically covered by Medicare, Medicaid, and most private insurance plans. These coverages include a range of services such as medical care, medications related to the terminal illness, medical equipment, and emotional and spiritual support.

It is important to familiarize yourself with the coverage details, limitations, and any out-of-pocket expenses that may arise during the hospice care journey. Understanding the financial aspects of hospice care can help alleviate stress and allow families to focus on the well-being of their loved one.

Responding to Loss

The loss of a loved one is a challenging and emotional experience for families involved in hospice care. Following the passing of a patient, the hospice care team will provide immediate support and guidance to help families navigate this difficult time.

During the initial stages of loss, families may experience a range of emotions, including grief, denial, anger, and sadness. The hospice team is trained to provide compassionate care and emotional support to help families cope with their feelings and process their emotions.

Anticipatory grief, which occurs before the death of a loved one, is also common in hospice care. The hospice team anticipates the needs of the caregiver during this challenging time, offering support and resources to help them through the grieving process.

By acknowledging and addressing the emotional and spiritual needs of individuals and families, hospice care providers like VNS Health offer a holistic approach to end-of-life care, ensuring that both the physical and emotional aspects of the patient's journey are supported with compassion and understanding.

Family Involvement and Decision Making

Amid the complexities of hospice care, involving families in the decision-making process plays a pivotal role in ensuring holistic and compassionate end-of-life care. Empowering families with information and the opportunity for active participation in care are essential components in this sensitive journey.

Empowering Families

Families are key stakeholders in the hospice care admissions process and are encouraged to take an active role in decision-making, guided by the patient's preferences and needs. According to Compassus, families are empowered to collaborate with the hospice care team to navigate the challenges of end-of-life care. This collaborative approach fosters trust, communication, and a shared commitment to providing the best possible care for the patient.

To become a patient of hospice care, the family plays a vital role in signing a consent form electing hospice care. This formalizes the official entry into the hospice care program, marking the beginning of a supportive and compassionate journey [1].

Active Participation in Care

In the hospice care setting, emotional and spiritual support are fundamental aspects that provide comfort and assistance to both patients and their families. At VNS Health, emotional support is offered through social workers and spiritual care counselors who help individuals cope with emotions, make decisions, and find hope and meaning during this challenging time.

Within the hospice care team at VNS Health, social workers and spiritual care counselors are equipped to address the emotional and spiritual needs of patients and their families as they navigate the end-of-life journey. Recognizing the emotional and physical strain that comes with transitioning to hospice care, VNS Health tailors emotional support and spiritual care to meet the unique needs of both the patient and their caregivers.

By actively involving families in the decision-making process and providing them with emotional and spiritual support, hospice care aims to create a supportive environment that honors the dignity and wishes of the patient while assisting families in coping with the profound emotions that come with end-of-life care.

Appeals Process for Hospice Care Denials

When facing a denial of hospice care, beneficiaries have specific rights and options to appeal such decisions. Understanding the methods of appeal, beneficiary rights, and provider liabilities is crucial in navigating through this challenging process.

Methods of Appeal

Under Medicare, beneficiaries have two methods of appeal available for denials of hospice care - expedited appeals and standard appeals. The right to an expedited appeal was implemented to address situations where the provider decides to discontinue hospice care because it believes the patient no longer has a life expectancy of six months or less [5].

An expedited appeal allows beneficiaries to challenge the discontinuation of hospice care quickly and efficiently. The decision regarding the appropriateness of the hospice program's discharge must be made within 72 hours after the beneficiary's request. During this process, the burden of proof rests with the provider to justify their decision.

Beneficiary Rights

Beneficiaries have certain rights when facing a denial of hospice care. The hospice provider must provide the beneficiary with a standardized "valid written notice" at least two days before the cessation of care. This notice should include essential information such as the end date of coverage services, the start date of the beneficiary's financial liability, and details regarding the right to an expedited determination [5].

Additionally, if the Quality Improvement Organization (QIO) reverses the provider's discharge decision, coverage of hospice care will continue until the specified termination date on the notice. If the QIO determines that the beneficiary did not receive valid notice, coverage of provider services will continue until two days after valid notice is received.

Provider Liabilities

Providers are financially responsible for continued services until two days after the beneficiary receives a valid notice or until the service termination date specified on the notice, whichever is later. This ensures that beneficiaries have the necessary support during the appeals process and are not left without essential care prematurely.

Understanding the appeals process for hospice care empowers beneficiaries to advocate for their rights and access the care they deserve. By being aware of the methods of appeal, beneficiary rights, and provider liabilities, individuals can navigate through challenges in the hospice care journey with confidence and clarity.

References

[2]:

[3]:

[4]:

[5]: