Arranging end-of-life care can be a stressful and difficult time for any family, especially when their loved one requires 24-hour attention by skilled health professionals. Medicare benefits may be available to help cover some of the costs associated with 24-hour hospice care.
Understanding Hospice Care
A patient whose physician has determined their condition is terminal and they are unlikely to live less than six months will be advised to enter hospice care so that they can receive care that focuses on making their final days comfortable and enriching. A team of health care professionals and members of the loved one’s family often work together to create a plan of care that is tailored specifically to the patient’s needs.
Hospice care focuses primarily on pain management and comfort for a hospice patient who may be struggling with symptoms of their illness, but hospice care does not include treatment intended to care the illness. Other services, such as devotional visits and music therapy, can be part of a hospice care plan.
Different Levels of Hospice Care
Medicare defines hospice care according to four basic levels:
- Routine home care. This is the most common level of hospice care and takes place within the patient’s home. If the patient lives in a nursing home or assisted living facility, the hospice care they receive there would also be classified as home care. Members of a hospice care team will work intermittently to care for the patient according to the needs they have.
- Continuous or 24-hour home care. This level of care is required for patients who have clinically significant health concerns and need round-the-clock care to manage their pain and comfort. It is considered a short-term type of care and the patient’s need for constant care is assessed every day.
- Inpatient care. When a patient’s needs exceed the level of care they’re able to receive at home, they may be admitted to a hospital, hospice care center or a skilled nursing facility. Health care professionals are available to attend the patient’s needs at all times in this setting.
- Respite care. This specialized form of hospice care is designed to relieve family members when a patient is in need of care but does not receive 24-hour services in the home or during an inpatient stay. Families who need respite care for their loved one can request inpatient care from a qualified facility for a short period of time.
Some hospice patients may experience all levels of care during their time in hospice or they may only experience one or two. Although being in hospice care means a patient is no longer undergoing treatment to cure a terminal illness, they may still receive treatment for unrelated conditions, such as antibiotics for an infection.
Medicare Coverage for 24-Hour Hospice Care
Medicare recipients who have Part A hospital insurance can qualify for the hospice benefit it provides. Their doctor or primary care physician must certify their terminal illness and confirm that the patient’s life expectancy at the time of certification is believed to be less than six months. Medicare recipients must also sign a statement that they understand accepting hospice care, which only offers palliative treatment, means they are waiving any treatment that attempts to cure the illness.
Continuous, or 24-hour, hospice care is often considered necessary only if a patient’s symptoms are severely limiting or excessively complicated. Medicare Part A does not provide coverage for 24-hour care in the home, but it does provide coverage for doctors and nurses who can be on-call day and night. If a patient’s needs are too complex for in-home care, Medicare benefits with Part A hospital coverage can help them receive short-term inpatient care or respite care if their family needs more help.
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