Hospice

Hospice is a comprehensive health care program that provides end-of-life care to patients with terminal illnesses defined by a life expectancy of six months or less. The program provides full-time medical and nonmedical services aimed at helping the patient and caregivers cope with physical and psychological end-of-life issues associated with a terminal disease. Central to the mission of hospice is the belief that people in the final stage of an incurable disease have the right to die with dignity and be free from controllable pain. Accordingly, the medical objective of hospice is focused on providing palliative management of symptoms related to the terminal illness with emphasis on pain control and preservation of physical functions rather than attempting to cure.

The nonmedical services include emotional, spiritual, and respite support for the patients and their primary caregivers.

An interdisciplinary team delivers medical, nursing, social, volunteer, bereavement, respite, and inpatient services. The hospice staff is typically composed of a primary care physician, hospice medical director, primary care nurse, personal care provider, social worker, pastoral care provider, and volunteers. Hospice care can be administered at home by the patient's primary caregiver with 24-hour, 7-days-a-week support by the professional hospice staff. Depending on an individual patient's needs, services can also be provided by free-standing hospice facilities, hospitals, and long-term care facilities such as nursing homes.

Enrollment into a hospice program requires (a) a signed statement from the patient documenting a self-arrived-at decision to elect noncurative care rather than treatment for the terminal illness, and (b) certification of terminal status by the patient's physician and the hospice medical director.

Reimbursement for hospice services can be covered by Medicare (Part A, Hospital Insurance), Medicaid, and private insurance with hospice benefits. Not-for-profit hospices are also entitled to solicit and receive charitable donations to fund services provided to patients who lack insurance or financial means to pay for their care. For-profit programs can only receive but not solicit donations.

Hospices are reimbursed by payers on a per diem basis that depends on the number of days a patient is enrolled in the program rather than on the amount of services the patient receives. An exception is 24-hour home nursing care that is reimbursed on an hourly basis. Under Medicare, hospice coverage is provided for two 90-day periods. If needed, an unlimited number of 60-day periods can also be added. At all times, the patient retains the power to cancel hospice care and switch to standard Medicare coverage for curative treatment. If necessary, return to hospice coverage is also allowed.

In a situation where the patient survives beyond four benefit periods, a recertification of terminal status is required for continual enrollment in a hospice program and Medicare coverage.