Frequently Asked Questions About Hospice Care

Care Expectations & Practices

• How does hospice care start?

  An evaluation for hospice can be requested at any time, then a terminal diagnosis will be required by a doctor for care to be approved. At this point a hospice provider can be contacted to start the hospice admission process (please note that “admission” refers to the start of service and does not necessarily reflect the patient being physically admitted to facility or new location).

• Can I ask for hospice?

  If your loved one has a terminal condition and you think they may benefit from hospice care then we encourage you to speak to their physician about hospice. Some doctors are familiar with hospice and suggest is readily, but others may not be as familiar with its benefits and less likely to recommend it.

• When should someone consider hospice?

  The option for hospice should be a serious consideration when a patient’s life expectancy is limited and they or their loved ones decide comfort and dignity are the ideal goals, though it is good to start the conversation before an illness reaches this stage. In terms of the patient’s wellbeing, Hospice is best considered when quality of life is lessened due to an ongoing state of care or treatment that is not projected to help the patient live any longer or more comfortably. The answer is different for each patient and their family, but in simplest terms, the option of hospice should be weighed when quality of life outweighs quantity of life.

• Why should someone consider hospice?

  In terms of the patient’s wellbeing, Hospice is best considered when quality of life is lessened due to an ongoing state of care or treatment that is not projected to help the patient live any longer or more comfortably. 

• When is a good time for hospice?

  The answer is different for each patient and their family, but in simplest terms, the option of hospice should be weighed when quality of life outweighs quantity of life.

• Who decides if a person goes on hospice?

  The option of hospice is generally discussed among the patient (if possible), the primary care physician, the family and, when relevant, the patient’s care facility. In cases where the patient is unable to make the decision for themselves, an Advance Healthcare Directive can provide invaluable guidance. In cases where there has been no advanced planning the decision to start hospice is often left to the individual with Power of Attorney for the patient.

• Is hospice constant care?

  Except for exceptional circumstances involving 24 hour care for pain management or other acute conditions, most hospice cases involve periodic visits from doctors, nurses, volunteers and other team members. Care for the patient must still be provided predominantly by family, privately-paid in home caregivers or caregivers at the facility where they reside.

• Does hospice provide 24 hour caregivers?

  In most cases, daily ongoing care for the patient must still be provided predominantly by family, privately-paid in home caregivers or caregivers at the facility where they reside. In exceptional circumstances 24 hour constant care for pain management or other acute conditions may be covered at the request of the attending medical staff.

• How long are the hospice team visits?

  Visits from the hospice team can vary greatly depending on the patient’s conditions and needs, so it is not possible to give an accurate estimate. It is best to plan to address your needs and observations prior to the team member’s arrival to make the most of their visit.

• How often will team members visit?

  Frequency of visits by team members depends upon the patient’s needs and condition, as well as the number of hospice programs the patient opts to receive or is eligible for. As a guideline it is best to assume that the nurse will visit twice weekly with periodic visits from other team members.

• Does a patient have to go to a hospice facility in order to receive care?

  Hospice services can be provided at any number of locations, including most retirement and assisted living facilities. Because comfort and tranquility are the goals, great effort is taken to keep patients in place and prevent stresses involved with hospital readmissions or relocations to a dedicated hospice facility. Silverado does not operate hospice facilities. Our hospice teams work on-site at patients’ residences, be they a private home, assisted living or other facility.

• Can a person leave hospice?

  A patient or their family have the right to stop hospice at any time to resume curative care. Alternatively, some hospice patients can actually “graduate” off hospice if their life expectation goes beyond six months.

• What does it mean to graduate from hospice?

  A person who graduates from hospice has a change in condition to where their prognosis has improved and death is no longer imminent within six months.

• Can a person survive hospice?

  On some occasions an individual’s condition will improve enough that their live expectancy improves beyond the six-month hospice window and they can resume curative treatments.
  

• Can a hospice patient recover?

  Occasionally a patient’s condition will show a marked improvement while they are on hospice. This can happen for any number of reasons, but if doctors believe the patient will live past six months then hospice care is stopped and the patient is said to have graduated.

• Do we have to switch doctors to be on Silverado Hospice?

  The Silverado Hospice team is purposefully assembled to cover all aspects of end-of-life care. That said, a patient’s relationship with their doctor is a very important one and we realize that familiarity is vital and helpful. The Silverado Hospice team is experienced in working with patients’ existing doctors to facilitate comfort for both patients and their families.

Hospice Medications

• What kinds of medications are used for hospice?

  Drugs to reduce or eliminate pain can be prescribed by a hospice provider, which may include morphine. Existing medications are removed on a per-case basis, taking into account factors such as drug interactions, quality of life and the family’s wishes. Silverado hospice associates will make every effort to explain changes in medication to a patient’s loved ones.

• Will morphine cause a hospice patient to become sleepy or not be themselves?

  Controlling pain is vitally important to allowing a patient to die with grace and dignity, and so is allowing the patient and their family a chance to share their remaining moments. Morphine is a proven medication that, in most cases, allows both to happen. Upon starting a drug like morphine a patient may experience some initial drowsiness, but after a few days the body builds up resistance to the sedating effects. Most patients whose pain is being successfully controlled by morphine do not have a problem with unusual sleepiness. However, there is a percent of patients whose alertness may decrease, leading them to choose an alternative method of pain control that may be less effective.

Hospice Payment, Coverage and Insurance

• Is hospice expensive?

  Hospice is funded by Medicare, Medicaid and also by most individual insurers. Hospice coverage is available to anyone that has a six-month or less terminal prognosis. The costs associated with most medications and therapies that relieve pain and provide comfort are covered as a part of hospice. Hospice services can actually remove some financial burden families or responsible parties, who may otherwise need to pay out-of-pocket for medications or equipment like beds or wheelchairs.

• Is hospice free?

  Hospice is covered by Medicare, Medicaid and also by most individual insurers. While it does not generally cover expenses such as full-time caregiving, it can remove some financial burden families or responsible parties, who may otherwise need to pay out-of-pocket for medications or equipment like beds or wheelchairs.

• Does insurance cover hospice costs?

  Most individual insurance providers do cover hospice, and most hospice providers can tell you if their services are covered.

• Does Medicare cover hospice?

  Yes, the hospice benefit is covered by Medicare.

• Does hospice mean losing existing care or benefits?

  No. A patient who goes on hospice does not lose the ongoing care they are receiving for things like vision, dental, diabetes and more. A hospice representative should be able to help you understand more about how hospice care interacts with existing insurance and benefits.

• What does hospice pay for?

  The costs associated with most medications and therapies that relieve pain and provide comfort are covered as a part of hospice. Certain supplies and equipment, such as hospital beds, wheelchairs, oxygen equipment and others, are also provided under hospice coverage.

• How long is the hospice benefit?

  For eligible patients, Medicare covers two 90-day benefit periods initially and an unlimited number of 60-day benefit periods after that so long as the hospice physician certifies that the patient remains eligible.

• Does Medicaid cover hospice?

  Yes.