FICTION OR FACT

Fiction or Fact – Learning the Truth About Hospice

Hospice: A caregiving team of professionals (including physicians, nurses, social workers, home care aides, therapists, and counselors) and volunteers working together to service terminally ill patients and their loved ones. The medical, psychological, and spiritual support, primarily given in the home, enables families and friends to remain together in peace, comfort, and dignity.

Fiction: 

Hospice is a place where the terminally ill go to die.

Fact: 

Hospice is not a place, but a concept of care. More than 90% of the hospice services provided in this country are based in the home. Care provided in the home allows families to be together when they need it most…sharing the final days in peace, comfort, and dignity.

However, when home care is not an option, in-patient care can be available through a contracting hospital, skilled nursing facility, or the hospice’s own in-patient facility (if available). In addition, in-patient care is available to those receiving home care in emergency situations, or when family members need respite care.

Fiction: 

Hospice only serves people diagnosed with cancer.

Fact: 

Although 57.4% of the patients who were admitted to hospice agencies in 1998 had conditions related to cancer, 42.6% had other admission diagnoses. Those include congestive heart failure, chronic obstructive pulmonary disease, stroke, and Alzheimer’s disease.

Fiction: 

A patient needs Medicare or Medicaid to afford hospice services.

Fact: 

Although insurance coverage for hospice is available through Medicare and in 43 states under Medicaid, most private insurance plans, HMOs, and other managed care organizations include hospice care as a benefit. In addition, through community contributions, memorial donations, and foundation gifts, many hospices are able to provide patients who lack sufficient financial means with free services. Other programs charge patients in accordance with their ability to pay.

Fiction: 

A physician decides whether a patient should receive hospice care and which agency should provide that care.

Fact: 

The role of the physician is to recommend care, whether hospice or traditional curative care. It is the patient’s right and decision to determine when hospice is appropriate and which program suits his or her needs. Before entering a hospice, however, a physician must certify that a patient has been diagnosed with a terminal illness and has a limited life expectancy.

Fiction: 

Hospice is very expensive because 24-hour, on-call services are provided.

Fact: 

Generally, hospice costs less than care in hospitals, nursing homes, or other institutional settings for one basic reason:  in those facilities, a patient is charged each day for all general services, such as food services and basic medical supplies. With hospice, a patient pays only for the services he/she or the family cannot provide and that are not covered by insurance.

Fiction: 

To be eligible for hospice care, a patient must already be bedridden.

Fact: 

Hospice care is appropriate at the time of the terminal prognosis, regardless of the patient’s physical condition. Many of the patients served through hospice continue to lead productive and rewarding lives. Together, the patient, family, and physician determine when hospice services should begin.

Fiction: 

After six months, patients are no longer eligible to receive hospice care through Medicare or other insurance.

Fact: 

According to the Medicare hospice program, services may be provided to terminally ill Medicare beneficiaries with a life expectancy of six months or less. However, if the patient lives beyond the initial six months, he or she can continue receiving hospice care as long as the attending physician recertifies that the patient is terminally ill. Medicare, Medicaid, and other private and commercial insurance will continue to cover hospice services as long as the patient meets the hospice criteria of having a terminal prognosis and is recertified with a limited life expectancy of six months or less.

Fiction: 

Once a patient elects hospice, he or she can no longer receive care from the primary care physician.

Fact: 

Hospice reinforces the patient-primary physician relationship by advocating either office or home visits, according to the physician preference. Hospices work closely with the primary physician and consider the continuation of the patient-physician relationship to be of the highest priority.

Fiction: 

Once a patient elects hospice care, he or she cannot return to traditional medical treatment.

Fact: 

Patients always have the right to reinstate traditional care at any time, for any reason. If a patient’s condition improves or the disease goes into remission, he or she can be discharged from a hospice and return to aggressive, curative measures, if so desired. If a discharged patient wants to return to hospice care, Medicare, Medicaid, and most private insurance companies and HMOs will allow readmission.

Fiction: 

Hospice means giving up hope.

Fact: 

When faced with a terminal illness, many patients and family members tend to dwell on the imminent loss of life, rather than making the most of the life that remains. Hospice helps patients reclaim the spirit of life. It helps them understand that even though death can lead to sadness, anger, and pain, it can also lead to opportunities for reminiscence, laughter, reunion, and hope – hope that hospice will enable a patient to live his or her remaining life to its fullest.
Source:  Hospice and Pallative Care Association of New York State

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