I just got off the phone with my husband's Hospice nurse. I need to get him re certified for his LTC and need forms from Hospice and his facility. I asked her about possibly losing Hospice services and she said that was not about to happen. Her Hospice does a superb job of documenting to comform to MC regs. All their patients have at least one comorbidity diagnosis and they have no denial of payments from MC. She knows of no coming changes.
what are the "rules" for being able to use Hospice coverage? DH is in stage 6-7 and only see neuro every 6 mos although Dr is pretty good about answering my emails. Just curious about when I could expect Hospice services.
Apparently the rules depend on the Hospice. Used to be at last 6 month of life. Our Hospice believes in palliative care. That means keeping our loved ones comfortable even though they may live longer as dementia is considered a terminal illness. Our Hospice pays for: meds related to their diagnosis-not heart, b/p,usual meds. That includes pain meds, all comfort meds. Pays for hosp bed and depends. Their doctor has assumed care and an RN and aide supplement care given in the dementia facility. Medicare pays for Hospice as I assigned benefits to them. Koolinagrl-too much to share. Ask specific questions and I will try to help. Oh-Doctor's order is needed to initiate service.
If the patient lives beyond the six months, (at this time) Hospice can be or-ordered for another six months. I know of one woman who has been under the care of Hospice for eighteen months. She's bedridden, in a fetal position, catheter in her bladder, feeding tube..etc. Against all odds, she is still alive.
My husband was once under hospice care for 18 months and then they dropped him....3 years later I called them back in when he was dying.....
They are not set up to be long term care....so I understand the need for some sort of rules. Plus it is an expensive service. The bill for their visits....RN twice a week, CNA twice a week, ran over $5000/month. Thank God Medicare and insurance picked up the tab, but that is a lot of money.
bluedaze, there are changes coming, don't care what the Hospice people told you. The fact that they are being allowed to keep their patient's on Hospice is just what they told you, they all have co-morbidity. That is the key. When there is no other co-morbidity and the patient has been on Hospice for 6month, Medicare requires an indepth look.
$5000 for 1 person in hospice? That is ridiculous - I thought it was suppose to be cheaper than nursing homes? At least that is what i remember hearing back in the 80s.
Nothing is inexpensive these days. I think everyone is stuck on the $5000/month charge,... care facilities,... professional in home care..... It all adds up to $5000 a month no matter which way I turn. I didn't realize that Hospice charged $5000... I understand that is funded through Medicare?? or am I misinformed about that?
Koolinagirl, our hospice was as Bluedaze described. Medicare now considers alzheimers/dementia to be a terminal disease with no end of life restriction. We wanted pallative care and he died peacefully at home.
In Claude's case, he also had severe congestive heart failure if the co-morbidity rule was instituted. Most people who reach stage 6-7 usually have some other disease which most likely would be covered.
redbud73086, Many Alzheimer patients do not have co-morbidity, my husband does not, he is very healthy except for the Alzheimer. He has had Alzheimer for 9 years. Medicare does require end of life restrictions on Alzheimer patients. Sandie can vouch for that. Her Husband was bed-bound. And yes they took him off Hospice. There are restrictions, don't let anyone tell you that there are not
Hospice is changing the way they pay Hospice, it will be phased in, fully implemented by 2013. Congress will require a hospice physician or advanced practice Nurse to visit the patient to determine re-certification at the end of 180 days, clinical documentation will then be sent to Medicare review to determine if in fact the patient is to be re-certified.
The way the pay Hospice is changing folks and believe me you will see changes, if not right now in the near future. They will be paid by the length of stay, the longer the patient is in Hospice the less Hospice will be paid. This will restrict the Alzheimer Patient probably more than anyone else.
Yes indeed, my husband was dropped from hospice after 18 months and he was completely unable to do a thing for himself and was in bed in a fetal position. I was not upset that he was decertified....he wasn't facing death in six months...in fact he lived for three years longer.
I think the fee charged for the hospice service is way over the top. My husband had an RN visit twice a week and a CNA who came two times a week to bathe him in bed. Now, that was wonderful, but was it really $5000 worth? I don't think so....I realize that I could have asked for more help, but I was basically doing hospice care on my own for the last three years he was alive and didn't really need much help. The only other items provided by them were his fentanyl patches and some bottles of peri-wash. I didn't use their incontinent supplies because the ones I had been buying were of a much better quality. I already had a hospital bed and the air mattress pad that kept him from getting pressure sores.
I am not saying that I didn't appreciate their help....when he was actively dying last year it was comforting to have them come in to let me know that he was not in pain or discomfort and it was just a waiting game. But, they are not set up or intended to be a long term care system...this time they were on board for only two and a half weeks before he died.
The system needs to be able to provide a service to help people care for AD victims at home that does not require hospice which is very specialized and therefore very expensive. In some states there is a program known as PACE...I have no personal information about it, but the little that I read it may provide some answers for caregivers.
There is so little help available it is no wonder that full time caregivers burn out, get ill and die before their time.
Sandie, the system is changing even more now, and the Hospice programs are going to be paid less the longer the patient is in the system. We will see more and more people not qualifying for Hospice until the last few weeks, or months, and YES, I do agree with you that it is not good for the amount they charge Medicare and what they do. The thing I was protesting is that they do not look at Alzheimer as physical enough to re-cert like they would a cancer patient etc. Alzheimer is so hard to predict as to the length till time of death. It is so unfair to the Alzheimer patient. They should just set up a system that is for Alzheimer only and not lump it in with other morbidity.
RE: Hospice. I often read obituaries that say "Memorials to be sent to Hospice..etc." If it's a Medicare funded agency, where to the memorials/contributions go? They have fundraiser booths at venues I've attended. Odd.
I asked that question at the Hospice I used for my mom. She said they used donations to provide things for those who couldn't afford to buy them and that Hospice /Medicare didn't provide. Ex. room air conditioner and I forget other items she mentioned.
A lot of people volunteer for hospice to do the things that Medicare won't pay for - respite care etc. All that takes a lot of administrative work, which isn't for free.
Jane, I should have said "many". Age also has something to do with it. By the time many people reach their 80s (Claude was three weeks from being 87), they have a co-morbidity.