Frequently Asked Questions (FAQ) About Hospice and End of Life Planning
As unfamiliar as the hospice program may be to you, there are questions which come up repeatedly. Since there are many articles online that discuss hospice and one can visit the Medicare hospice website at medicare.gov for significant substantive information. Let’s at least review some of the questions that seem to frequently come up.
Hospice care focuses on the quality of life of a person with a terminal illness approaching the end of life. It includes emotional, medical, home care, therapy and spiritual support for both the patient and their loved ones. Still, deciding whether and when to enroll in hospice can be a difficult decision, and it may cause people to feel doubtful about its appropriateness.
What is Hospice Care?
Hospice care is a Medicare insured service for people with a terminal illness who choose not to initiate or prolong treatment to cure their illness. People may enroll in hospice care if their treatment is unlikely to be effective or if continuing becomes too burdensome. Hospice aims to provide comfort and support to help improve quality of life of a person nearing death. It also helps family members cope with their loved one’s illness both before and after their family member dies, including help with grieving, sometimes called bereavement care. Medicare pays directly for hospice services when a physician determines that a patient has a life-expectancy of 6 months or less.
Many people with a serious illness choose hospice care. A serious illness may be defined as a disease or condition with a high risk of death and negatively affects a person’s quality of life or ability to independently perform daily tasks. Most serious illness affects daily life and leads to caregiver stress. Examples of serious illness include Alzheimer’s, ALS, dementia, cancer, heart failure, and chronic obstructive lung disease.
Am I eligible for hospice care?
Anyone with a serious illness who doctors think has a short time to live — generally 6 months or less —usually qualifies for hospice care. For Medicare to pay for hospice care, patients must stop medical treatment intended to cure or control their illness.
Does hospice benefit people with advanced dementia?
Most people with advanced dementia cannot communicate clearly, which means they may not be able to share their concerns with their caregivers. Caregivers may find it difficult to provide adequate care at the end of life because of this and other concerns. Hospice care can help with this situation. Hospice — whether used at home or in a medical facility — can provide caregivers and the person with dementia the support they may need near the end of life. Studies show that family members of people with dementia who received hospice report better quality of care and having more of their needs met at the end of life.
What are the benefits of using hospice care?
Studies have shown that when a person enrolls in hospice care they are more likely to have increased family satisfaction and better symptom and pain management. They are also less likely to undergo tests or be given medication they don’t need or want.
What services does hospice care provide?
Hospice care can provide a range of different services depending on the patient’s symptoms and end of life care wishes. These services include, but are not limited to, emotional and spiritual support, home care assistance, relief of symptoms and pain, help with advance care planning, therapy services, like physical or occupational therapy, medication administration and much more.
Where does hospice take place?
Hospice can be provided in many settings — a person’s home, a nursing home, assisted living facility, or in a hospital. Many people choose to receive hospice care at home so their friends and family can visit as they wish. Other considerations include financial costs, and the stability of the person’s condition. Choosing where to receive hospice care is a personal decision, but it may be helpful to talk with family members, your caregiver, or your doctor about the level of care you need and if it can be provided at home. The costs for receiving hospice care may differ based on where the care is given. Hospice under Medicare does not cover the costs of room and board at a nursing home, assisted living facility or in your home.
Should I include hospice care in my advanced care planning?
Yes! Advance care planning involves making decisions ahead of time about the health care you want to receive at the end of your life. Studies have shown that patients who have participated in advanced care planning receive care that is more aligned with their wishes and are more satisfied with their care.
Do I have to stop all my medications if I’m on hospice?
When you begin hospice care, certain but not all medications and other treatments to cure or control your serious illness will stop. For example, chemotherapy that is meant to cure your cancer must end before you can enter hospice care. However, a person in hospice can continue to take medications to treat other conditions or symptoms, for example, high blood pressure. Pain medication will also continue.
Will my insurance cover hospice care?
Most Medicaid, Medicare, and private insurance providers will cover some of the services provided by hospice. Older adults enrolled in Medicare can receive hospice care if their healthcare provider thinks they have 6 months or less to live. In most cases, the patient or their authorized representative will need to sign a statement choosing hospice care instead of other Medicare-covered treatments for their illness.
Does hospice include 24/7 care?
While some may think hospice provides 24 hours a day, 7 days a week custodial care, or full-time care at home or at a facility, this is not the case. Although hospice provides a lot of financial support, most of the day-to-day care of a dying person must be provided by family and friends. However, a person from a hospice care team is always available by phone 24/7.
Is a married couple always required to spend down one half of their assets before qualifying for Medicare?
No! In fact, oftentimes, couples have over $250,000 – $1,000,000+ and qualify for hospice benefits without having to spend down their savings. Federal and state laws were written to protect individuals from becoming impoverished if their spouse needs hospice care. There are certain “safe harbors” that, with expert advice from a knowledgeable professional, can save hospice applicants and their families thousands of dollars. An experienced elder law attorney can help you determine if there are ways to protect additional assets in your situation.
Understanding the Difference Between Palliative Care and Hospice Care
| Question | Palliative Care | Hospice Care |
| Who can receive this care? | Anyone with a serious illness, regardless of life expectancy, can receive palliative care | Someone with a serious illness and a life expectancy measured in months, not years. |
| Can I continue to receive treatments to cure my illness? | You may receive palliative care and curative care at the same time. | Treatments and medicines aimed at relieving symptoms are provided by hospice. The goal is comfort, not cure. |
| Does Medicare pay? | Some treatments and medications may be covered by Medicare and private insurers, but not all. | Medicare pays all charges related to hospice. Most private insurers also have a hospice benefit. But again, palliative care, not hospice. |
| Does Medicaid pay? | Some treatments and medications may be covered. | In most states, Medicaid pays all charges related to hospice. |
| Does private insurance pay? | Some treatments and medications may be covered. | Most private insurers have a hospice benefit. |
| Is this a package deal? | No, there is no ” palliative care” benefit package. | Yes, hospice is a comprehensive benefit covered by Medicare and most Medicaid programs. |
| How long can I receive care? | This will depend upon your care needs, and the coverage you have through Medicare, Medicaid or private insurance. | As long as you meet Medicare’s criteria of an illness with a life expectancy of months, not years. |
| What organization provides these services? | Hospitals Hospices Nursing Facilities Healthcare Clinics | Hospice organizations Hospice programs based out of a hospital Other healthcare organizations |
| Where are services provided? | Home Assisted living facility Nursing facility Hospital | Usually, wherever the patient resides. In their home, assisted living facility, nursing facility, or hospital. Some hospitals have facilities where people can live, like a hospice residence, or receive care for short-term reasons, such as acute pain or symptom management. |
| Who provides these services? | It varies. However, usually there is a team including doctors, nurses, social workers and chaplains, similar to the hospice team. | A team – doctor, nurse, social worker, chaplain, volunteer, home health aide, and others. |
Fredrick P. Niemann Esq.
If you would like to speak to our Hospice Planning lawyers, contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com to schedule a consultation about your particular needs. He welcomes your calls and inquiries and you’ll find him very approachable and easy to talk to. Our offices are conveniently located on Route 9 North in Freehold, NJ.
Written by Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a New Jersey Hospice Care Attorney
Fredrick P. Niemann, Esq. NJ Hospice Care Attorney
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