what is hospice?

When you receive a life limiting diagnosis, you have two options: the first option is to continue receiving medical care the way you always have and the second is hospice. You must make your choice with the knowledge that neither option will change the outcome. The question becomes which option will maximize your time and which option will make you the most comfortable?

Continuing with "normal" medical care means you are in and out of the doctor's office, laboratories, and constantly leaving home to seek care and relief from your symptoms, probably at a hospital. As your health deteriorates, this can be increasingly difficult and it takes a significant amount of time away from the people and things you love most. Generally, it will not extend your life, it just treats the symptoms.

Hospice brings all of the medical care to you. Our entire team serves you in the comfort of your home. And because we are specialist in end of life care, we have the expertise to appropriately help you and your family learn to live with the limitations of time your diagnosis forces on you. We also care for your family by providing professional social workers, counselors and spiritual advisors, as well as bereavement services for one year after death. Last, medications related to your diagnosis, medical equipment you need in your home and medical supplies are all provided by the hospice at no additional charge. There are no deductibles or co-pays.

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The Medicare regulations require that using their best clinical judgment, your attending physician and the Hospice Medical Director certify to Medicare that your prognosis is for a life expectancy of six months or less if your terminal illness runs its normal course. Because no one has a crystal ball, many hospice patients live longer than six months from the date of their certification for hospice. Initially at 90 days, and then subsequently at intermittent intervals dictated by Medicare, working with your physician, we determine whether you continue to meet the criteria. Some patients receive hospice benefits for as much as a year or longer.

It is also important to know that just because you qualify for hospice, doesn't mean you have to choose hospice. And, once you have chosen hospice, you are always free to revoke hospice and return to traditional health care.

If you are currently receiving or are eligible for Medicare benefits, Medicare covers the entire costs of hospice. The benefit includes all of our services; our medical director, our nurses, social workers, counselors, chaplains, home health aides, therapies, all related prescriptions, medical equipment and supplies. There are no out of pocket co-pays or deductibles. This is generally true even if you have a Medicare replacement policy or a Medicare supplemental policy.

If you are receiving or are eligible for Medicaid, Medicaid provides a hospice benefit which is virtually identical to Medicare. If you have private health insurance, the hospice benefit may or may not be included. If you have no coverage, we accept private pay patients. Generally, we negotiate a rate that is at the same level of reimbursement we receive from Medicare.

If you have any questions concerning your eligibility, just call us and we will verify your benefits.

Hospice is unique in the spectrum of health care. Every other aspect of healthcare requires the patient to go to the healthcare provider and conform to their hours, practice patterns and rules. Hospice reverses all of that and puts the patient in charge. There are no referrals, no additional paperwork, no co-pays or deductibles and no waiting in someone's office. Everything is brought to the patient and our visits are scheduled around your schedule. Here are a list of our services, all delivered in your private home, assisted living facility, nursing home or other place of residence:

• Physician Services – Our medical director makes home visits as needed
• Nurse Practitioner – Our Licensed Nurse Practitioners make home visits to facilitate and expedite assessments and orders
• Registered Nurses – Our nurses make frequent and scheduled visits to assess your condition and make modifications to your plan of care as your needs change
• Licensed Vocation Nurses – Our LVNs make regular scheduled visits to assist with a wide variety of your needs, always under the direct supervision of our registered nursing staff and Director of Nurses
• Licensed Social Workers – Our LSWs meet with you, your family members and caregivers to coordinate benefits, explore conflict resolution when necessary, investigate potential resources and services you may qualify for, and to assess the impact your diagnosis is having on your family and caregivers
• Licenses Professional Counselors – Our LPCs are available to help you and your family address a wide variety of issues that commonly arise when a life limiting illness is identified. These may include grief, bereavement, acceptance, conflict resolution, caregiver exhaustion, emotional strain, depression and unhealthy thought patterns
• Chaplains – Our staff of chaplains are available to address spiritual questions and issues in this phase of life. They will work individually with you, or coordinate with leaders from your own faith community
• Dieticians – Our licensed dieticians assist our clinical staff to help with nutritional issues, lack of appetite and the impact poor nutrition may be having on comfort levels
• Physical, Occupational and Speech Therapy – If your hospice diagnosis requires these services, we can provide them all in–home
• Home Health aides and/or Certified Nurse Assistants – These caring professionals are available to meet a wide variety of needs like bathing, feedings, repositioning and other services that do not require a licensed nurse
• Massage Therapy – Though not required, we include these services for many of our patients whose limited mobility, long hours of inactivity and lack of physical exercise make a massage a special gift
• Music Therapy – At our patient's request, we have musicians who will offer live music in the home to relax and refresh our patients
• Respite Care – Consistent with regulatory guidelines for criteria, Alamo Hospice will make arrangements for periodic, short term in patient care in a licensed nursing home to give care givers a respite from the strains of caring for their loved ones
• In Patient Care – Consistent with regulatory guidelines for admission criteria, Alamo Hospice provides in patient care when the patient's condition will not allow the hospice goals of comfort and palliative care to be met in the residential setting

One of the wonderful things about hospice is that it comes to the patient. So, wherever you are, is where we come. Most of our patients are in a private residential home, theirs or a family member or a special friend. A smaller percentage of our patients are in nursing homes. We have some patients who have chosen an assisted living facility as their primary residence. Wherever you call home, we and our entire team come there.

One of the amazing things about hospice is that with so much specialized care and attention, some patients improve. While this does not change their diagnosis or indicate any reversal of their condition, it may impact their eligibility for hospice services. When this happens, if the improvement is so significant that the patient no longer meets the criteria for admission, then we must discharge them from our services. At a later point in time when they begin to decline again, they have the option to re-enroll in hospice.

Occasionally, but rarely, a patient improves and while still meeting the technical criteria for hospice services, decides to discontinue the services. The patient is always free to discontinue hospice services and return to whatever care providers they were seeing before they chose hospice.

As a caveat, while the decision to leave hospice may be exercised by the patient at any time, there are some technical regulatory requirements for re–entering hospice. So, if you choose to leave hospice there may be a short waiting period before you can re-enter. As with anything you read here in our web page, call us with any questions you may have.

Unfortunately, the answer is no. The level and extent of commitment to the patient and their family varies widely among hospice providers.