Hospice Care Confusion

ElaineD

Dear Alzconnected Friends:

There are so many posts here about Hospice Care, especially the 'evaluation' of readiness for hospice care and also the location of care (home vs. facility outside of the home).  But everyone seems to refer to HOSPICE as if it is ONE provider?

This is the Mayo Clinic's discussion of Hospice Care.

 

https://www.mayoclinic.org/healthy-lifestyle/end-of-life/in-depth/hospice-care/art-20048050

Depending on where you live there may be MORE than one company/entity offering Hospice Care.  There are at least 10 Hospice providers in the greater Raleigh area. 

So when your LO is evaluated for Hospice care, should you seek an evaluation from more than one provider?  Or do all Hospice providers use exactly the same criteria?  I don't think so. 

I have also heard of people being 'in hospice care' for more that a year.  How does that happen?

I know that Hospice has come to our Independent Living facility to provide care in the Resident's apartment.

2. Another Hospice provider has a 'stand alone' facility that provided care for my friend's husband with Alzheimer's Disease.

I am confused.  For example: Are all Hospice Providers 'non-profit' companies?  If the fee for services is based on ability to pay, how does a Hospice Provider manage to cover costs?

It seems like researching Hospice/Palliative Care options should happen earlier rather than later.

ElaineD

   

harshedbuzz

ElaineD wrote:

Dear Alzconnected Friends:

There are so many posts here about Hospice Care, especially the 'evaluation' of readiness for hospice care and also the location of care (home vs. facility outside of the home).  But everyone seems to refer to HOSPICE as if it is ONE provider?

IME here, most often when a poster suggests calling in hospice; they suggest interviewing a few as some will have more experience with dementia care than others. Often, if a LO, is already in a MCF/SNF members are advised to ask them if they have providers with whom they've worked previously that they recommend. 

This is the Mayo Clinic's discussion of Hospice Care.

https://www.mayoclinic.org/healthy-lifestyle/end-of-life/in-depth/hospice-care/art-20048050

Depending on where you live there may be MORE than one company/entity offering Hospice Care.  There are at least 10 Hospice providers in the greater Raleigh area. 

That would be typical of most medically well-served communities. 

So when your LO is evaluated for Hospice care, should you seek an evaluation from more than one provider? 

Yes, unless you have a situation where you've recently had services from the same company and were happy with them. Be aware, some do provide things like incontinence supplies which could be useful for a family who doesn't have a lot of money left for care.

Or do all Hospice providers use exactly the same criteria?  I don't think so.

I think it's more a matter of how they interpret the criteria and presentation of the PWD.

I have also heard of people being 'in hospice care' for more that a year.  How does that happen?

People can go in and out of meeting the criteria for hospice care. Other people meet the criteria and don't die for a period of time. My MIL was medically complex and was in hospice care for almost 6 years.

I know that Hospice has come to our Independent Living facility to provide care in the Resident's apartment.

2. Another Hospice provider has a 'stand alone' facility that provided care for my friend's husband with Alzheimer's Disease.

Hospice is a service. Sometimes the service is provided where a person is a;;ready living, but under certain circumstances it might be a hospice unit within a SNF or even a hospital. Often the latter are often cancer patients whose pain is difficult to control in a home setting.

I am confused.  For example: Are all Hospice Providers 'non-profit' companies? 

They seems to be around here. Some are affiliated with religious groups and /or hospitals as well.

If the fee for services is based on ability to pay, how does a Hospice Provider manage to cover costs?

I've not heard of this angle. Most often, Medicare will pay for hospice services: Medicaid and CHIP will as well.

It seems like researching Hospice/Palliative Care options should happen earlier rather than later.

Absolutely, though quality can vary over time if key personnel change. 

ETA: I would also say that some hospice providers/units tend to specialize. There's a CCRC near me that has a very well respected hospice unit that is routinely thanked in obituaries when a LO dies from things like cancer and ALS but rarely if the cause is CHF or COPD- they seem to go to a different facility on the other side of my small town. 

   

Cynbar

All hospice providers are definitely not non-profit. We had a large one in our area close rather abruptly when the parent company decided it was no longer profitable. Yes, most areas have several to choose from. They may differ in what they cover --- hospice services are paid by a patient's health insurance and the company gets a flat rate per patient, whether they cover items such as incontinence supplies is up to them (many do not.) They can also differ in how they interpret the evaluation criteria (although these in theory are the same for everyone.) These services are provided where the patient lives, generally either at home or in a facility. Often facilities have either their own hospice or one they prefer to work with, that company will have more of a presence in the building but in theory a patient can choose another hospice. Totally separate are hospice houses, which can vary quite a bit in payment sources and cost and services offered. We have one in our area which is only private pay, about $450/day, but patients check in and sometimes stay quite awhile. Other hospice houses have no charge but are only for short stays to manage uncontrolled symptoms such as pain or agitation.It all really can be confusing and take time to sort out.

Iris L.

Hospice care used to be only for life expectancy of less than six months.  But now "failure to thrive" was added as an admitting diagnosis.  This can apply to PWDs not with the risk of imminent death.  It is best to ask around. 

Iris

June45

Iris L. wrote:

Hospice care used to be only for life expectancy of less than six months.  But now "failure to thrive" was added as an admitting diagnosis.  This can apply to PWDs not with the risk of imminent death.  It is best to ask around. 

Iris

Yes, this is how my husband was admitted to hospice at stage 6d.  My husband was recently recertified at the initial 90-day review and the nurse said that he would continue to get recertified at the 60-day reviews because he is continuing to decline (i.e. he is not going to get better).  I am sure he will be in the hospice program well over 6 months, possibly 2-3 years or more. Who knows.