Who is Eligible for Hospice Care?
Hospice of Natchitoches provides quality, compassionate, and personalized care to patients with a diagnosis of limited life expectancy. Hospice has three key eligibility criteria:
The patient’s doctor and the hospice medical director use their best clinical judgment to certify that the patient is terminally ill with a life expectancy of six months or less, if the disease runs its normal course.
The patient chooses to receive hospice care rather than curative treatments for his or her illness.
The patient enrolls in a Medicare-approved hospice program.
Patients must reside within a 50 mile radius of Natchitoches. Admission is based upon physician's referral. Patient and family must agree upon a palliative course of treatment.
No person shall be denied patient care services or employment / volunteer opportunities based on race, disease, age, handicap, religion, gender or sexual orientation.
Eligible Conditions
Approximately 50% of our patients suffer from some type of cancer. Of the remaining 50%, the diagnoses include:
Eligible conditions include, but are not limited to:
Neuromuscular Diseases
End Stages of Alzheimer's
General Debilitation from advanced age
Heart Disease
Pulmonary Disease
Kidney Disease
Liver Disease AIDS
Insurance
Generally, Medicare and Medicaid will cover four (4) levels of care, provided that sufficient documentation can be provided. However, it is important to note that most private pay insurance will only cover one (1) level of care.
Routine Home Care
A routine home care day is a day on which an individual who has elected to receive hospice care is at home.
+ Level of insurance reimbursable for Routine Home Care
This level of care is the most common since this is the normal day-to-day care. Most insurance policies will cover this level of care. Routine home care is covered regardless of the volume or intensity of services provided on any given day. Routine home care includes the following situations:
- If the patient enters into the hospital for an unrelated condition.
- If the patient is in a hospital that is not contracted with the hospice.
- If the patient is receiving outpatient services in the hospital, or for the day the patient is discharged alive from GIP (general inpatient care) or respite level of care.
Inpatient General Care
A general inpatient care day is a day on which an individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings.
+ Level of insurance reimbursable for Inpatient General Care
The final level of care a patient might enter into is General Inpatient care. This care is provided in a participating hospice inpatient unit, participating hospital, SNF or NF. General inpatient care is for care related to the terminal illness. General Inpatient care is not acute care treatment. This level of care would be appropriate when a patient requires pain control or acute/chronic symptom management which cannot be performed in another setting. In addition, this level of care would be appropriate if home support has been broken down and the breakdown makes it impossible or unfeasible to keep the patient at home. Examples of situations appropriate for this level of care might include stabilizing treatment or when a patient’s family is unwilling to permit the needed care to be furnished in the home. General Inpatient Care is not intended to be a permanent solution (usually 14 days or less). This level of care is not a benefit offered by most private pay insurance. However, if the patient is general inpatient, the admitting hospice is responsible for the agreed contracted fee.
When a hospice patient is moved to a General Inpatient setting in a participating hospital, SNF of NF the hospice agency maintains responsibility for the management of the patients care including:
- Physician rounds
- Social work/case management
- Chaplaincy
- Daily nursing visits and supervision of care
The participating facility is responsible for:
- Providing room and board
- Medications
- Recording vital signs 1 time per shift
- Providing patient hygiene
- Providing needed equipment
Continuous Skilled Home Care
A continuous home care day is a day on which an individual who has elected to receive hospice care is not in an inpatient facility and receives hospice care consisting predominantly of nursing care on a continuous basis at home.
Home health aide or homemaker services, or both, may also be provided on a continuous basis. Continuous home care is only furnished during brief periods of crisis and only as necessary to maintain the terminally ill patient at home.
+ Level of insurance reimbursable for Continuous Skilled Home Care
Medicare and Medicaid will cover this service during a period of crisis. A crisis is defined as a period of time in which the patient requires predominately nursing care to achieve palliation of management of acute medical symptoms. This level of care generally is only allowed for a 24 hour period. It is important to note that a patient who is actively dying would not be considered in crisis and would not automatically qualify for the continuous level of care. If after a 24 hour period, palliation of symptoms is not achieved the patient may be moved to a General Inpatient level of care.
Inpatient Respite Care
An inpatient respite care day is a day on which the individual who has elected hospice care receives care in an approved facility on a short-term basis for respite.
+ Level of insurance reimbursable for Inpatient Respite Care
This is a benefit of Medicare and Medicaid, but most private pay insurance policies will not cover this type of care. Respite care must be provided in a participating hospice inpatient unit, participating hospital or SNF, NF, or INF. Inpatient Respite Care is reimbursable when the primary caregiver for the patient needs respite or relief. Medicare/Medicaid Respite Care is limited to five (5) days per certification period. Most private pay insurance policies do not provide for this service and patients with Medicare could be responsible for a 5% co-payment. However, Hospice of Natchitoches and Many will pay the patients 5% co pay when on our services.
When a patient is admitted to a participating facility for respite care the hospice agency maintains supervision of and responsibility of patient. Social work/case management, chaplaincy, nursing aide services and nursing supervision of patient will be provided by Hospice of Natchitoches and Many. The hospice physician does not make rounds on a respite care level patient. This is not an acute patient care situation therefore the hospice agency provides wheel chair or other transportable DME’s as already provided for in the patients home setting (not including hospital bed). The patient provides his or her medications from home and takes medications as prescribed.
The Medicare/Medicaid benefit requires the participating hospital, SNF, NF, or INF to provide only room and board and assistance with medications if patient is unable to attend to him or herself.
Guidelines for Admission to Hospice
Patient has been diagnosed with a life-threatening condition, not just cancer.
Patient has a life expectancy of six months or less.
The attending physician, patient, and family agree that further curative treatment is of no benefit to the patient.
Patient lives within the Hospice of Natchitoches service area.
Patient has a primary caregiver (someone other than Hospice staff) available to coordinate care on a 24-hour basis.
Payment for Hospice Care
Approximately 75% of our patients receive services covered by Medicare.
About 8%, have services covered by their private insurance.
Close to 8% have services covered by Medicaid.
About 9% of our patients receive "free" services made possible by support of the community.
A Community Service
When Hospice of Natchitoches was established in 2000, one of the guiding principles was a pledge to care for “our” community. Since then nearly all medically eligible patients, regardless of their ability to pay for services, have been accepted into our services. Since that time, we have dedicated ourselves to compassionate care for the dying as a form of community ministry rather than as a business and set quality of care, not financial reward, as the ultimate measure of our success.
The Indigent Patient Fund
To establish and maintain an indigent patient fund—from which the cost of providing care to patients without means can be paid—Hospice of Natchitoches has relied on the generosity of the community, memorial gifts, donations, and special events fundraising.
Levels of Insurance Reimbursable For Hospice Care
Generally, Medicare and Medicaid will cover four (4) levels of care, provided that sufficient documentation can be provided. However, it is important to note that most private pay insurance will only cover one (1) level of care.
Routine Home Care
A routine home care day is a day on which an individual who has elected to receive hospice care is at home.
Inpatient General Care
A general inpatient care day is a day on which an individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings.
Continuous Skilled Home Care
A continuous home care day is a day on which an individual who has elected to receive hospice care is not in an inpatient facility and receives hospice care consisting predominantly of nursing care on a continuous basis at home.
Home health aide or homemaker services, or both, may also be provided on a continuous basis. Continuous home care is only furnished during brief periods of crisis and only as necessary to maintain the terminally ill patient at home.
Inpatient Respite Care
An inpatient respite care day is a day on which the individual who has elected hospice care receives care in an approved facility on a short-term basis for respite.
“I expected the last few weeks of my father’s life were going to be a nightmare – but the team at Hospice of Natchitoches made the transition a beautiful one where we understood everything taking place. I can never thank them enough for their loving support.”
— Tiffany S.
Hospice vs. Home Health.
Hospice is a philosophy of caring for the terminally ill. The philosophy holds that end-of-life care should emphasize quality of life. Hospice is about the living that goes on during the time between the diagnosis of a life-threatening illness and death.
Hospice is all-inclusive care:
The object of hospice care is to treat the whole person, not the disease. It is family-centered care that addresses the physical, spiritual, emotional, and practical needs of a patient with a life-threatening illness. An interdisciplinary team of health care professionals works with the patient and family to design and implement a plan of care unique to each patient. In addition to the care provided by the hospice team, hospice provides medications, services, and equipment directly related to the terminal illness. Hospice care does not end with the patient’s death; rather, it continues with at least 13 months of bereavement counseling for the family and other loved ones.
Hospice cares for people where they live, whether at home or a nursing facility.
Too many Americans still die alone or in pain. Too many endure costly and ineffective treatments. Unfortunately they are being referred to hospice care too late, or not at all.
Americans are aging.
Today, there are nearly 40 million seniors in the U.S. In the next 30 years, that number is expected to double, as baby boomers reach age 65. In light of end-of-life discussions taking place in the media, online, and in other arenas, these boomers will likely place high importance on dying well, just as they emphasized living well. Hospice provides the quality care that allows people to live well at the end of life.
Hospice care is what Americans want.
National Hospice Foundation research shows that the top four services Americans feel are most important for a loved one who has less than six months to live are:
Someone to be sure that the patient's wishes are enforced with the goal of rehabilitation;
Choice among the types of services the patient can receive;
Pain control tailored to the patient's wishes; and
Emotional support for the patient and family.
Hospice: The model for quality, compassionate care
Considered to be the model for quality, compassionate care at the end-of-life, hospice care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes. Support is extended to the patient's loved ones, as well.
At the center of hospice is the belief that each of us should be able to die pain-free with dignity, and that our families receive the necessary support to allow us to do so. The focus is on caring, not curing.
Many patients experience pain and other distressing symptoms as illness progresses. Hospice staff receive special training to effectively anticipate, assess, treat, and prevent all types of physical symptoms that cause discomfort and distress.
Hospice care adds quality and value.
A recently released government study recognizes that hospice care improves the quality of end-of-life care provided to nursing facility residents. The hope is that the Medicare Hospice Benefit will be expanded to ensure access to hospice services by all terminally ill Americans whether they are in nursing homes, their own homes, freestanding hospice facilities, or in hospitals.
Although there are inpatient hospice facilities and some hospice are is provided in hospitals or nursing homes, the vast majority of hospice patients are cared for in their home. Today, 94.5 percent of hospice days of care are provided at the patient’s residence, whether home, nursing home, or assisted living facility.