Understanding Hospice Care and the Eligibility Requirements

Hospice care is a special way of caring for a patient whose disease cannot be cured. It is available as a benefit under Medicare Hospital Insurance. Medicare beneficiaries who choose hospice care receive non-curative medical and support services for their terminal illness. Hospice care is also covered by Medicaid and most private insurance plans. Most hospice care is delivered at home. Hospice care is also available to people in home-like hospice residences, nursing homes, assisted living facilities, veterans' facilities, hospitals, and prisons. To be eligible, the illness must be certified by a physician as terminal with a life expectancy of six months or less. Hospice care is not a cure. The emphasis is on helping the person to make the most of each day of remaining life by providing comfort and relief from pain. If you are in need of hospice care for a loved one, here are some questions to consider when evaluating potential hospice care providers: • Is this hospice program Medicare certified? Medicare certified programs have met federal minimum requirements for patient care and management. • Is the program licensed by the state, if required by your state? • Does the organization have written statements outlining services, eligibility criteria, costs, and payment procedures, employee job descriptions, and liability insurance? • How many years has the organization been serving the community? Can the organization provide references from professionals, such as a hospital or community social workers? • Does the organization create a plan of care for each new patient? Is the plan carefully and professionally developed with you and your family? • Does a nurse, social worker or therapist conduct a preliminary evaluation of the types of services needed in the patient’s home? • How does the organization handle payment and billing? What resources does the organization provide to help you find financial assistance if it is needed? Are standard payment plan options available? • Does the hospice offer specialized services such as rehabilitation therapists, pharmacists, dietitians, or family counselors when these could improve the patient’s comfort? • Can you tour the inpatient unit or residential facility? • Ask to see a copy of the organization’s patient’s rights and responsibilities information.