Hospice 101 For VA

Hospice
 A philosophy of care to assist those in the

end stage of life
 Model of care originated in England
 First hospice in United States was in New
Haven, Conn., 1976
 Fast Growth -- currently over 3500
hospice programs in United States
Model of Care
 Program designed for those who want no
further curative measures of treatment
 Comfort care aimed at increasing quality of life
 Physical, Psychological, Social, and Spiritual
Care is provided
 Strong emphasis on symptom relief –especially
pain
 Patient and family form a unique, individualized
plan of care
Hospice Benefits
Hospice Team
Additional Services
Hospice Team
Patient and Family are considered the unit of
care.
Working closely with:
 Physician-directed team
 Nurse
 Social Worker
 Physical, Occupation, & Speech Therapist
 Dietician
 Home Health Aide
 Chaplain
 Volunteer
 Bereavement Counselor
Additional Services
 Durable medical equipment
 Medical supplies
 Drugs or biologicals related to the
terminal illness or needed for comfort
 Laboratory service
Program Goals
 Emphasize living
 Promote quality of life
 Encourage honesty and hope
 Rapid resolution of symptoms
 Preparation of patient and family for death
 Continued support for family after death of
loved one
Criteria for Admission to
Medicare/Medicaid Hospice
•Medicare/Medicaid eligibility guidelines available to

help with determination of terminal prognosis
•Physician certifies terminal diagnosis with 6-month
prognosis if disease follows usual course
•Primary caregiver is available
•Patient and family choose the hospice philosophy
goal of comfort care rather than curative treatment

Medicare/ Medicaid Regulations
 The hospice program must maintain
professional management responsibility of the
hospice patient’s care at all times and in all
settings
 Hospice is responsible for coordinating all care
 All care must be authorized in advance by the
hospice
 In addition to the professional management
responsibilities, the hospice program bears the
financial responsibility
Private Insurance
 Every insurance is different
 Some offer inpatient and respite services
 Some offer room and board at facilities
 Some cover medications
 Some allow hospitalization
 This is evaluated with every admission to
hospice
Common Hospice Diagnoses
 Cancer
 End-stage Heart Disease
 End-Stage Lung Disease
 End-Stage Renal Disease
 End-Stage Liver Disease
 Stroke/coma
 HIV
 Neurological Disease –Parkinsons, Alzheimers
 General Decline in Health Status
Benefits of Medicare Hospice
 Team approach to care
 Cost for home hospice covered by Medicare 100%
 Medications, supplies, and equipment related to
the terminal disease covered 100%
 Acute care in facility setting for symptoms that are
unable to be controlled in the home, collapse of
support system or imminent death
 Respite benefit for caregivers
 Ongoing support to bereaved family
Levels of Care
 Routine Home Care
 General Inpatient Care
 24 Hour Nurse for Short-term Stay
 Respite Care for Caregiver Stress
 Continuous Care
 Expanded Level of Skilled Nursing
Routine Home Care
 Most common level of care
 Can be provided in home, residential
setting or nursing home
 Includes care from team members on
regularly scheduled visits
General Inpatient
 Higher level of care
 Provided in a facility for symptom management
 Hospice continues to manage the plan of care
 General Inpatient guidelines are very specific
 Any symptom that cannot be controlled in the
home setting
 Symptoms: pain, nausea/vomiting, or caregiver
breakdown
 Each case is unique and needs to be addressed
and determined by the hospice team
Respite Care
 This level of care is reserved for caregiver relief
 Medicare/Medicaid will pay for up to 5
consecutive days of inpatient respite care per
month
 Short-termed inpatient care designed to give a
rest from handling the care of the patient
Continuous Care
 Expanded level of skilled care in patient’s
home to manage a crisis
 For Example: Terminal Restlessness
Pain Crisis
 Nursing care must equal more than total
of 50% of total hours necessary to
prevent hospitalization
 Minimum of 8 hours in a 24 hour period
Where Hospice Care Occurs
Any place a patient is living
 In their own home
 In the home of a relative
 In a skilled nursing facility
 In a hospice home or other assisted living
facility
 In shelters for the homeless
 In the penal system for incarcerated individuals
Contact Information
Nebraska Hospice and Palliative Care
Partnership
4720 Randolph St., Bethel Bldg
Lincoln, NE 68510
402/477-0204
www.nehospice.org
info@nehospice.org
Contact Information for Other
Disciplines
www.hpna.org

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Hospice

 A philosophy of care to assist those in the

•Medicare/Medicaid eligibility guidelines available to

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