Rather than a place to receive medical care, hospice is an approach to medical care for patients nearing the end of life. Its goal is to enhance the quality of life for patients with terminal illness. Hospice focuses on pain management and symptom relief, while addressing the patient’s emotional, social and spiritual needs – as well as those of family members. Hospice lets patients and families share the end-of-life experience with dignity and, in most cases, in the comfort of their own homes. Although some hospice care is administered in assisted living facilities, nursing homes, hospice centers, and inpatient settings, approximately 80 percent of hospice services occur in the patient’s own home.
Medicare pays a great deal of the services provided by Hospice throughout the country. In order to be eligible, a patient must be covered under Medicare Part A and must also have certification from a physician that the patient’s life expectancy is six months or less, assuming the illness runs its normal course. There is a great deal of confusion about the six-month standard. It does not mean that the patient will lose his or her Hospice benefits after six months. Instead, it simply means that in order to be eligible, there must be a six-month life expectancy. After the initial period of certification, however, the patient can have an unlimited number of additional sixty-day periods.
To enroll in Hospice, the patient must sign a statement electing the Hospice benefit. A great benefit of Hospice care is that the medication related to the terminal illness is covered with a minimum co-pay. Patients also can have a one-time educational consultation by a Hospice physician to the terminally ill patient, even when the patient is not yet in Hospice. The consultation could occur in a care facility or at home, and should also include a pain assessment, along with counseling on care options and advance planning. The question frequently arises…does Hospice pay for nursing home care? If the patient is a nursing home resident, there will be Hospice benefits available; however the Medicare Hospice benefit will not cover the costs of room and board at the nursing facility.
Once the decision is made to move from curative medical care to Hospice care, patients often begin to wonder if there are additional steps they should take. And while Hospice treatment, in some cases, can go on for years, in reality the patient is dealing with a terminal illness, and they need to get their affairs in order. There are steps which should be taken. Among those things which are appropriate for everyone, probably the most important is to have the right powers of attorney in place. After executing durable powers of attorney for finances, health care, and a health-care-treatment directive, you and your family may need to consider other legal planning.
Whenever a “major life event” occurs, I recommend that you review your wills and trusts. Your current legal documents may no longer be appropriate. Illness is a “major life event” worthy of review. The plans that we put in place when everyone was healthy may no longer be appropriate. You may want to make changes that reflect the new circumstances.
Planning for someone who has a life-threatening illness can be complicated. You may be torn by the emotional component…thinking that if you put your wishes down in the form of a last will and testament or a trust, you are somehow surrendering your fight and giving in to the disease. In my experience, I find that my clients experience a great peace of mind once they have done their planning so that they can concentrate on the other issues they are facing. With proper planning, you will insure that things are handled according to your wishes and that you’ve taken the best steps possible to protect your loved ones and to protect your family’s financial security.
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