Hospice Care

Hospice Care

A hospice is a facility or program designed to provide a caring environment for meeting the physical and emotional needs of those with life-threatening illnesses. It is typically the end-of-life care provided by health professionals and volunteers for patients with terminal illness.

The goal is to make the patient comfortable, pain-free, and provide emotional support in the patient's home. Typical hospice patients are only expected to live six months or less, so hospices focus on therapeutic, not curative treatment. In most cases care is provided in the patient's home. Hospice care can take place in other environments also, such as our Hospice House, a nursing home, assisted living facility, in a hospital or in a skilled nursing facility.

Many consider hospice care the defining model of compassionate care for people facing a life-limiting illness or injury, when curative treatments bring extreme side effects or are not effective. Hospice involves a team approach to providing comfort, expert medical attention, pain management, and emotional and spiritual support tailored to the patients' needs and wishes. At the center of the hospice care philosophy is the belief that each of us has the right to be pain-free and to live and die with dignity.

Who Pays/Costs?

Many organizations pay for home health and/or hospice care. Examples of such sources are: Medicare, Medicaid, the Department of Veterans Affairs, HMOs, most private insurance plans and other managed care organizations. Along with this, community contributions, memorial donations, and foundation gifts allow Pocono Health System Visiting Nurse & Hospice Care to provide low or no cost services to patients who cannot afford payment.

Hospice care, a fully reimbursable Medicare Part A benefits option for beneficiaries and providers since 1983, offers the services designed to address the physical and emotional pain through effective palliative treatment when cure is not possible. In the event that a beneficiary has been advised by his/her physician, that a cure for his/her illness is no longer possible, Medicare beneficiaries may discuss hospice care as an option. Physicians and other health care practitioners can be encouraged that the Medicare program includes a hospice benefit that provides coverage for a variety of services and products designed for those with terminal diagnoses. When properly certified and appropriately managed, hospice care is a supportive and valuable covered treatment option.

Not only did Pocono Health System Visiting Nurse & Hospice Care help with my aunt, just 3 years later they helped with my Mother. They will always be a part of my family and in my prayers. I can't begin to thank them enough for all of their love and friendship. I would call them again in a minute if I needed their services. I will forever be grateful. ~ Artie C. (Stroudsburg, PA)

Hospice care that is covered by Medicare is chosen for specified amounts of time known as "election periods." Essentially, a physician may certify a patient for hospice care coverage for two initial 90-day election periods, followed by an unlimited number of 60-day election periods. Each election period requires that the physician certify a terminal illness. Payment is made for each day of the election period based on one of four per diem rates set by Medicare, commensurate with the level of care.

Generally speaking, the hospice benefit is intended primarily for use by patients whose prognosis is terminal, with six months or less of life expectancy. The Medicare program recognizes that terminal illnesses do not have entirely predictable courses, therefore, the benefit is available for extended periods of time beyond six months provided that proper certification is made at the start of each coverage period. Recognizing that prognoses can be uncertain and may change, Medicare's benefit is not limited in terms of time. Hospice care is available as long as the patient's prognosis meets the law's six month test.

The "six month" test is a general one. As the governing statute says: "The certification of terminal illness of an individual who elects hospice shall be based on the physician's or medical director's clinical judgment regarding the normal course of the individual's illness."

CMS recognizes that making medical prognostication of life expectancy is not always an exact science. Thus, physicians need not be concerned. There is no risk to a physician about certifying an individual for hospice care that he or she believes to be terminally ill.

Medicare covers a number of specific services as defined in regulation and in the Medicare Hospice Program Manual. Most of these services are familiar to health care professionals and other practitioners who have worked with hospice and home health services. Covered services include:

  • Medical and nursing care
  • Medical equipment (such as wheelchairs or walkers)
  • Pharmaceutical therapy for pain relief and symptom control
  • Home health aide and homemaker services
  • Social work services
  • Physical and occupational therapy
  • Speech therapy
  • Diet counseling
  • Bereavement and other counseling services
  • Case management

Hospice care also is covered by Medicaid in many states.