CCMC Definitions Related to End of Life Issues
Hospice care is a team approach, coordinated by a case manager with a hospice medical director, home health aide, social worker and chaplain all involved with the plan of care. Hospice care also covers medications and durable medical equipment. Not covered under the hospice benefit are room and board, medications to cure the disease and treatments to cure the disease.
Hospice care can be provided in the home or inpatient setting. “Home” is where the patient lives and does not need to be a traditional home, but can be an assisted living facility, nursing home, homeless shelter or any other place the patient calls home.
The Hospice Case Managers goals are individual to each patient and frequently include:
- Controlling pain and other symptoms, giving the patient a better quality of life.
- Providing the patient and family the information they need to make informed decisions regarding treatment and the plan of care to ensure the patient has a dignified death.
- Coordinating and facilitating care.
A Do Not Resuscitate (DNR) is not necessary before enrolling in hospice, but is one of the areas the patient and family are educated on, with the goal of having the DNR in place before the patients death.
Medicare Hospice Benefit
- Patient has Medicare part A
- Hospice program is Medicare approved
- Physician certifies the the patient has a life expectancy of 6 months or less if the illness runs its normal course.
- Patient must waive the normal normal medicare benefit for the hospice diagnosis. This means that Medicare will not pay for hospitalization related to that diagnosis. For example, if a patient was admitted with a hospice diagnosis of pancreatic cancer, Medicare would not pay for a hospitalization for jaundice related to the pancreatic cancer. If however the patient fell and broke their hip. Medicare would cover that hospitalization.
Hospice care is given in benefit periods.
- 1st benefit period – 90 days
- 2nd benefit period – 90 days
- followed by unlimited 60 day benefit periods.
- At the start of each benefit period a physician must certify that the patient is terminally ill.