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by Betty Soldz

 The one thing we all have in common is that everyone faces life's end. The difference is how. One of the ways we can die with dignity is by making our own decisions about what kind of treatment we want at the end of life. To accomplish this, Hospice care which is a special way of caring for people with terminal illness, may be a choice for you to consider.

The primary aim of Hospice care is to help patients die with dignity. The Hospice focus is on palliative care, not cures. It strives to meet the entire patient's needs physical, emotional, social and spiritual as well as the needs of the family. Emphasis is on helping the person make the most of each day of remaining life by providing comfort and relief from pain. According to the Hospice Association of America, Hospice recognizes death as the final stage of life and serves to enable Hospice patients to live their final days to the fullest in the comfort of home, surrounded by their loved ones. Many of us believe the Hospice program is for seniors only but, in reality, there is no age limit for this program. Children as well as adults may receive the support of a Hospice program.

To be eligible for Hospice under Medicare a doctor must certify that a beneficiary is terminally ill (has 6 months or less to live) and the program must be Medicare-certified. There are hundreds of Hospice programs in the United States. Although their programs may differ somewhat, death with dignity is the stated aim of all. One of the ways that is achieved is by allowing patients, whenever possible, to make choices about their treatment.

Most Medicare Hospice programs provide visiting nurses, nurse's aids and homemakers. They also supply medical appliances and medical supplies. They also provide trained volunteer visitors who offer respite for the caregiver. They frequently offer bereavement counseling for the family and some offer support groups.

Nurses coordinate the care for the patient under a plan approved by the patient's physician. The Hospice care team will probably include a social worker that will provide counseling to the patient and family and help the family learn how to make use of community resources. If the patient desires, clergy are available to provide spiritual support. Home care aids provide personal care and homemakers are sometimes available to help with light housekeeping. Physical, Occupational and/or Speech Therapists may help the patient learn new ways to accomplish activities of daily living such as walking, dressing or feeding oneself. A Hospice team member should be available 24 hours a day, seven days a week to give advice by phone or, if necessary, to make a home visit.

The time to investigate the Hospice program near you is before you or a loved one is faced with a terminal illness. Medicare and most Health Maintenance Organizations for seniors, as well as Medicaid will normally pay most of the cost of this care. Normally, the only expense to the patient is limited cost-sharing for outpatient drugs and inpatient respite. With private insurance, Hospice coverage varies. Some plans include a benefit similar to Medicare, while others pay for care similar to home health care. There is no standardized Hospice benefit in private insurance and the amount of hospice services a patient can receive may be up to the type of insurance they subscribe to.

Since there may be differences between Hospice programs it is important to be sure you understand exactly what you and your family can expect. The following are some of the questions you might want to ask when considering this program:

  • What services are available to you or your loved one and for how many hours per week?
  • How do you obtain these services?
  • Does your Insurance, Medicare or Medicaid pay for these services. If not what is the cost to you?
  • How are families involved in care?
  • How are professional staff and volunteers chosen and trained?

    You will probably have many other questions to ask and writing them down down before meeting with the hospice representative is advised.

    When you elect to receive Hospice under Medicare, you will be asked to sign an elective statement indicating that you understand the nature of your illness and of Hospice care. When signing this document, you surrender your rights to other Medicare benefits related to a terminal illness. (If you are unable to sign a family member may do so for you.)

    Although Hospice care may not be appropriate for everyone, it is worth investigating so that you can make an informed decision at this time of life. Not all areas have Hospice agencies. If you want to locate a Hospice program in your area call your Visiting Nurses Association or a local hospital Social Service Department, Medicare, the National Hospice and Palliative Care Organization 1(800) 658-8898 or The Hospice Association of America ((202) 546-4759.


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