Medicare beneficiaries become eligible for end of life benefits such as hospice care upon receiving a diagnosis, from a medical doctor, that they have a life expectancy of six months or less.
Patients fighting a terminal illness often choose to change the focus of their care from curative efforts to palliative care measures designed to manage pain and other symptoms of their disease. This is a difficult choice for both the patient and caregivers.
Recognizing the Necessity of End of Life Care
Diseases progress differently with each individual, which can make it difficult to point out where end of life care begins. A patient’s doctor can provide information on each stage of the disease, as well as when to consider palliative care. In addition, common signs, such as repeated emergency room trips or hospital admittances, can alert both the patient and their caregivers to the potential need for end of life care.
If the patient states that he or she wishes to stop receiving treatment for the disease and prefers to undergo care at home, the time for palliative care has clearly arrived.
How to Prepare
Friends and family often resist a loved one’s decision to cease curative treatment. Clearly communicating the patient’s wishes helps bridge the gap between what the patient wants and what his or her family desires. Aside from open, honest conversations regarding the patient’s care, advance directives offer the simplest means of communicating these wishes. Advance directives are legal documents, such as a durable medical power of attorney or a living will, in which the patient details his or her wishes regarding medical care.
Medicare offers emotional support for the families of beneficiaries entering end of life care, via benefits such as grief and loss counseling and social worker services.
Patients entering end of life care typically have different care requirements than curative care patients. Often, their condition calls for round-the-clock care due to increased need for physical safety. This is especially true in patients with advanced cases of Alzheimer’s disease or dementia. The patient’s primary caregiver requires assistance in these instances; hospice or home offers viable options.
If the patient has Medicare Part A, he or she qualifies for hospice care if the patient’s doctor certifies that the patient’s life expectancy is six months or less. Additionally, the patient must accept palliative care in lieu of further attempts to cure the illness or disease and sign a statement that he or she wants to begin hospice care. In addition to covering doctor and nursing care, Medicare Part A coverage includes items such as medical equipment and supplies as well as hospice aide and homemaker services.
Choosing hospice care means that Medicare no longer covers treatments intended to cure the patient’s terminal illness, including medications prescribed to cure the illness (this does not include pain management and symptom relief prescriptions). Additionally, the patient must receive hospice care from the chosen hospice provider on record. Coverage does not include room and board unless the hospice team determines the patient requires short-term in-patient services.
Benefits of Hospice Care
Hospice care offers comprehensive comfort care to the patient while also providing support to the patient’s family. The main goal of hospice care is relieving symptoms of the patient’s illness and making the patient comfortable to help improve quality of life.
Although hospice care provides support to family and caregivers, it does not include round-the-clock care. Even so, patients who choose hospice care report feeling more satisfied with their end of life care than patients who refuse such treatment. The most popular reasons cited: better pain control and fewer instances of unnecessary testing while in hospice care.
The mission of hospice care is allowing people to enjoy their remaining days with dignity while supporting the patient’s loved ones through the process. The focus is caring, not curing, and may be provided in-home or in a hospice center, hospital, or long-term care facility such as a nursing home.
Palliative care relieves the pain, discomfort, symptoms, and stress of illness and may occur along with curative care. The focus and goal in palliative care is improving the patient’s quality of life. It is not reserved for patients in an end of life situation but applies to any patient experiencing chronic illness that may eventually cause death, including Parkinson’s disease, cystic fibrosis, and HIV/AIDS.
One of the main differences between palliative care and hospice care is that palliative care does not require the patient to reject curative treatments. Patients also receive palliative care in any setting, including clinics, hospitals, and specialized clinics.
Truly comprehensive end of life care includes emotional support to deal with the understandable anxiety and depression that patients nearing end of life experience. Common fears, beyond the fear of dying, include worries about those the patient leaves behind and dying alone. The fears and confusion of loved ones, and even medical providers, often lead to feelings of isolation, exacerbating these already growing worries.
Traditional Medicare covers mental health and counseling services for beneficiaries. Hospice care also covers counseling services. Social workers also provide guidance on comforting and supporting the patient during these final days.
Few people wish to spend their last days in a hospital or nursing home. Hospice care offers an end of life care option that supports and comforts both the patient and his or her loved ones and provides improved quality of life and greater dignity.