Understanding Medicare Hospice Benefits

Hospice care is a difficult program to digest, both from an emotional and financial/practical standpoint. At Regency Nursing Centers statewide, we contract with various Hospice providers to offer our families compassionate and dignified end-of-life care.

Furthermore, our social workers regularly sit with families to discuss the nuances and ramifications of placing their loved one on Hospice Care.

Understanding the specific Medicare Hospice Benefits can be a daunting and overwhelming task. Here is some valuable information in a condensed form and I will also link you to an excellent and informative pamphlet published by Medicare.gov at the end of this article.

Medicare’s hospice benefit covers palliative
and support services for terminally ill
beneficiaries who have a life expectancy
of six months or less if the terminal illness follows its     hospice
normal course. A broad set of services is included, such as nursing care; physician services; counseling and
social worker services; aide and homemaker services;
short-term hospice inpatient care (including respite
care); drugs and supplies; physical, occupational,
and speech therapy; and bereavement services for the
patient’s family.

Beneficiaries must “elect” hospice care for defined
benefit periods; in doing so, they agree to forgo
Medicare coverage for conventional treatment of the
terminal illness. Under current policy, the first hospice
benefit period is 90 days. For a beneficiary to initially
elect hospice, two physicians—a hospice physician and
the beneficiary’s attending physician—are generally
required to certify that the beneficiary has a life
expectancy of six months or less if the illness runs its
normal course. If the patient’s terminal illness continues
to engender the likelihood of death within six months,
the patient can be recertified for another 90 days. After
the second 90-day period, the patient can be recertified
for an unlimited number of 60-day periods, as long as
he or she remains eligible. For recertification, only the
hospice physician has to certify that the beneficiary’s
life expectancy is six months or less. Beneficiaries can
transfer from one hospice to another once during a
hospice benefit period and can disenroll from hospice at
any time.

Under the Medicare hospice benefit, there are four
types of care: routine home care, continuous home
care, general inpatient care, and inpatient respite care.

Routine home care, which can be provided in a variety
of settings—including the patient’s home, a nursing
facility, an assisted living facility, and other types of
facilities—makes up more than 97 percent of hospice
days. Medicare makes a flat payment per day (adjusted for differences in wage rates across
geographic areas) for routine home care, regardless of
whether the hospice staff visits the patient each day.
Beneficiary cost sharing for hospice services is
minimal. There is no cost sharing other than for
prescription drugs and inpatient respite care. For
prescriptions, hospices may charge 5 percent
coinsurance (not to exceed $5) for each prescription
furnished outside the inpatient setting. For inpatient
respite care, beneficiaries may be charged 5 percent of
Medicare’s respite care payment per day. In practice,
hospices do not generally charge or collect these
copayments from Medicare beneficiaries.

For an excellent pamphlet on this topic, click here.

Tutorial on Advance Medical Directives

Happy Monday.

Ok, let me be blunt.

Regency Nursing Centers has the most educated, knowledgeable and compassionate social workers in the country! Social work is not an easy profession, especially when you need to guide families on the minutia of crucial and relevant topics, where important decisions must be made.

One such topic is that of Advance Medical Directives.

We have just put together this important and informative tutorial and we hope you will find it beneficial.

Advance Medical Directives
Making the choices that are right for you

What would you do if at some future time you became physically or mentally unable to make choices about your own medical care? Would your family be able to “speak” for you and make your wishes known regarding critical medical intervention and life-sustaining treatment? Who will direct your health care providers if not a family member? What types of medical care and treatments will be consistent with your religious beliefs and personal values? These issues become more important as you grow older, which is why every adult who has not already done so should consider creating an Advance Medical Directive.

What is an Advance Medical Directive?
Simply put, an Advance Medical Directive is a legal document that allows you to appoint a health care agent (proxy), give instructions for your future medical care, request or refuse certain medical procedures, and express your feelings about other health care and quality of life issues. For example:

• The circumstances under which you would consider complex surgery, resuscitation (CPR) or other life sustaining treatment like ventilator care or tube feeding

• The kind of medical treatment you would want if you were terminally ill, in a vegetative state, or likely to be permanently disabled and dependent on someone else for all your care

• Any religious beliefs or principles that you would want to be respected when deciding on your care

Types of Advance Directives
There are several basic Advance Directives to consider, the most important of which are the Durable Power of Attorney or Combined Directive. A Living Will alone, since it does not name a health care proxy, may leave unanticipated questions and decisions unnecessarily open to interpretation.

Durable Power of Attorney for Healthcare.

Also called a Health Care Proxy, a Durable Power of Attorney allows you to name a person as your “agent” or patient advocate who will make health care decisions for you in the event you are unable to do so. This may be a family member, friend or any other person you trust. Just make sure the person you choose is at least 18 years old, in reasonably good health and willing to support your stated wishes. This person should be familiar with your feelings regarding different types of medical treatments and know under what conditions you would accept or reject those treatments. The person you choose should also be made aware of any religious principles you want to adhere to, for example, those regarding life-sustaining nutrition and hydration.

A Durable Power of Attorney is a binding document that can be used to either accept or refuse any kind of treatment. It may be enforced only in the event you become unable to make decisions for yourself. When drafting this document, it’s important to state your wishes clearly and in detail. Your designated advocate can only enforce those wishes and instructions you have provided.

Living Will.

A Living Will is an Advance Directive that does not require you to name a specific individual to oversee your medical and quality of life decisions. It only takes effect if you are no longer capable of making decisions about your health needs. A Living Will lets you choose, in advance, the kind of medical care you want to receive and under what circumstances. It should also indicate the point at which drugs, respiration and other life-sustaining measures should be discontinued.

Combined Directives.

This option combines elements of both a Durable Power of Attorney and Living Will into a single document, including the naming of your Health Care Proxy and a detailed statement of your medical treatment preferences.

By creating your written Advance Directive, you can alleviate some of the burden a loved one may feel when forced to make important, potentially life-sustaining medical decisions on your behalf.

Do Not Resuscitate (DNR) Order.

Designed specifically for those situations where a patient is faced with an ongoing medical crises, a Do Not Resuscitate (DNR) order notifies medical personnel that you do not wish to receive cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. A copy of this directive should be included in your medical records and/or hospital chart since medical personnel will generally only refrain from taking life-saving measures if a direct order is present.

Religious and Personal Belief Considerations

In addition to making sure your own personal wishes are followed, there may be guidelines you wish to observe based on your faith or personal values. For example, certain faith-based directives maintain that nutrition and hydration, being basic to human life, are aspects of normal care. Thus as long as nutrition and hydration are serving to preserve life and do not contribute to further grave complications and burdens, they may not be discontinued. If end-of-life care is provided in a faith-based environment, these kinds of distinctions may affect compliance with your directives.

In order to be certain that decisions made on your behalf are consistent with the tenets of your faith, it is important to appoint a Health Care Proxy who understands and sincerely intends to respect these guidelines. If your Health Care Proxy is not familiar with the teachings of your faith, encourage him or her to seek guidance from your own spiritual counselor or another knowledgeable source. You can include the name and contact information of that person in the health care directive. You may also want to give this information to your medical provider.

How to Create an Advance Directive

An Advance Directive does not have to be a complicated legal document. It can be a short, simple statement about what your wishes are. There are several ways to write an Advance Directive. The first and simplest way is to obtain the form and write your wishes down by yourself. You may obtain Advance Directive forms and information from your state health care system, medical society or bar association. There are also computer software packages available that can help you write your Advance Directives.

Advance Directive forms that are in line with the ethical principles of your faith are also available.

It may be advisable to consult with your doctor about what scenarios and aspects of life-sustaining care you should consider including in your Advance Directive. He or she may also be able to provide you with a sample form to use as a guide.

For purposes of clarity, it is important to have your lawyer and, if applicable, your spiritual counselor review your completed statement. In the event you want to conform to religious guidelines concerning end-of-life or critical medical care, remember that your instructions must comply with your particular state’s laws and criteria set down by your faith.

Once you are satisfied with your directives, copies should be given to your responsible family member, health care proxy and/or doctor. You should also know that advance directives may be amended at any time, as long as you are considered of sound mind to do so. Any changes must be made in writing, signed and witnessed (or notarized) according to the laws in your state.

When to Create an Advance Directive

Many people wait until they develop a serious, perhaps life-threatening illness before creating an Advance Directive. Unfortunately, a devastating trauma or illness often strikes quickly and unexpectedly, a stroke, heart attack or an unforeseen accident, for example. Any of these events could leave you unable to express your wishes concerning your own medical care, thus, placing those decisions in the hands of others. In these difficult situations, even close family members may be at odds about what they consider to be best for you. By creating your written Advance Directive before it is actually needed, you can help prevent conflicts and misunderstandings among loved ones and alleviate some of the burden they may feel when forced to make important decisions about your care. Clearly, when it comes to documenting your choices and instructions in these matters, there’s no time like the present.

Compassionate Hospice Care and Technology

Regency Nursing and Rehab Centers across New Jersey have become synonymous with the very best in compassionate care and skilled nursing, while embracing every available technology to enhance their programs.

I was therefore excited to come across a recent groundbreaking initiative from the Hospice of Michigan.

Hospice Mobile App

Beginning February 20, 2013, Hospice of Michigan is providing its patients and their family members with a free mobile app that will help them stay connected with the teams caring for their loved one.

Studies have shown that 50 percent of family members do not live near enough to their ailing family members to participate actively in their care. HOM wants to close that distance so that caregivers, patients and their friends and family members can stay connected no matter where they are.

The HOM Cares mobile app alerts family and friends when their loved one has received a visit: they can see a picture and read a short bio of the HOM team member making the visit; understand the role of that team member — whether medical, spiritual, social work, volunteer or another type of support and see the date and duration of the visit.

The app was developed with a grant from Verizon Wireless for $24,500 and a matching in-kind donation provide by Compuware, the organization that developed the app for HOM.

Additionally, the organization said it is exploring ways to expand interaction after a patient death that might include sharing of family photo albums, comments or memories, providing details on funeral arrangements and connecting those mourning a loss with grief support and related services.

The free app is available to current Android and iOS device users, who can download it from the Google Play app store or Apple App Store