Choosing Hospice Under Medicare
What is hospice, and when can someone get it under Medicare?
What is hospice? Hospice is an alternative to regular medical care for people in the final months of life. Instead of continuing to try curing or delaying the fatal disease or condition, hospice ends treatment altogether. Instead, its goal is to control pain and other symptoms and make the patient's last stretch of life as comfortable as possible. Hospice can result in a significant improvement in the patient's quality of life, with a focus on her as a person rather than on her disease.
If someone chooses hospice, it means she can leave the hospital or nursing facility and spend her last weeks or months in her own home or in a family member's. Hospice caregivers are specially trained to carefully calibrate pain medication and other symptom relief so that a patient is as comfortable as possible and able to appreciate the time she has left with loved ones.
Because hospice caregivers work wherever a patient is staying, they can also bring relief to you or others who are providing most of her daily care. Hospice can even move a patient into a special hospice facility for a few days of what is called "respite care," giving you and other caregivers a short break from your duties.
When and how can a patient choose Medicare hospice? If she's enrolled in Medicare Part A and meets certain conditions, she may choose to receive Medicare-covered hospice care, which covers nearly the full cost. To qualify, her treating physician must certify that she has a terminal illness and that she probably has less than six months to live.
Of course, doctors usually can't predict exactly how long someone will live. And they are sometimes reluctant to say what they think about life expectancy. So Medicare builds in a protection in case the prediction proves wrong -- if a patient chooses hospice but lives longer than six months, hospice can be continued as long as she needs it. Or, if her condition stabilizes or even improves, she can give up hospice and return to regular Medicare coverage.
The other condition is that she must formally give up any further treatment of her terminal illness or condition. This "giving up" may be very difficult, both for caregivers and the patient. But recognizing the futility of further treatment is an essential part of the transition to hospice and is necessary for hospice to bring maximum relief and comfort to her.
Does choosing hospice mean someone gives up all medical treatment? By choosing hospice, a patient gives up all treatment of her terminal illness or condition. But that doesn't mean she gives up treatment -- and Medicare coverage -- for any other illness or condition that might trouble her during her last months of life. If she gets the flu or has trouble with her back or has any other medical problem, she can receive treatment from her doctors and have it covered by Medicare Part B in the normal way.
Is choosing Medicare hospice a decision a person is stuck with? There are several reasons why someone eventually might want to discontinue hospice care. She might simply change her mind about giving up treatment, or her doctors might advise her about a new treatment. Her condition might stabilize or even improve, changing the doctor's prognosis about how long she has to live. Or for some reason she might not like hospice care and prefer to return to regular Medicare coverage (which still allows her to refuse any specific treatment she doesn't want). For any of these reasons -- or for no reason at all -- a patient can end hospice care at any time and return to regular Medicare coverage.
