Frequently Asked Questions
This section will help you if you are seeking information about either hospice and palliative care or home care services. You may be recovering from surgery or need rehabilitation therapies and desire home care support. On the other hand, if you or a loved one are very ill and not likely to recover, you will benefit from knowing about hospice and palliative care. There are often many questions regarding these various services, how to access them, and what you may expect from the agency that provides the care. You may be asking: Where will I get the support and help I need? Will my pain or other symptoms be kept under control? What happens if I need more care?
All these questions and more are common. In response to this, we have compiled a list of frequently asked questions that people have when confronted with the need for hospice, home, and/or palliative care services. Whether you are a patient, a family member or a friend, we hope that these questions and answers will serve to better inform you so that you can get the care you need and desire.
Home Care FAQ
- What is Home Care?
Home Care Services: Home care provides services to persons of all ages and includes preventive, acute, sub-acute, rehabilitative, and long-term care. Services range from simple assistance in activities of daily living to high-tech IV therapy. "Home care" is a simple phrase that encompasses a wide range of health and social services. These services are delivered at home to recovering, disabled, chronically or terminally ill persons in need of medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living.
Medicare Certified Home Care Agencies: The term "home care agency" often indicates that a homecare provider is Medicare certified. A Medicare certified agency has met federal requirements for patient care and management and therefore can provide home care services that are paid for by Medicare or Medicaid. Due to regulatory requirements, services provided by these agencies are very specific and must meet all the Medicare and/or Medicaid rules. - What Services Are Provided?
Medicare Certified home care agencies offer these basic services:
Home Care Nursing Services: Initiated by a registered nurse who develops the plan of care with you, your doctor, and your family. Skilled nursing care can include physical exam assessment, wound care and dressing changes, catheter care, IV therapy, colostomy care, and patient and family teaching. The nurse coordinates your care at home and keeps the doctor informed of your progress.
Home Care Aide Services: May assist with the care provided by the registered nurse by helping with daily needs. Services include assistance with personal care: bathing, shampooing, and changing linens. The aide also can help with meals, simple prescribed exercises and limited household tasks.
Physical Therapy Services: Provide pain relief, improve post-hospital disability and restore function for maximum independence through a home exercise program designed by a physical therapist.
Occupational Therapy Services: Helps to adapt to daily routines, tasks, and surroundings for more independent living. Occupational therapy includes instruction in self-care and homemaking tasks.
Speech Therapy Services: Provides assistance with pronunciation, swallowing or hearing, and can help with the development of language skills in children or adults.
Medical Social Services: Facilitates personal, family, and financial problems that may develop as a result of your illness or disability that impacts your healing.
Medical Supplies: Supplies required to provide the patient's care such as dressings, tape, and catheters are available from the home health agency. Incontinent supplies - diapers and chux - may also be appropriate, based on patient needs.
Equipment: Durable medical equipment required by the patient, such as a wheelchair, walker or hospital bed, if needed, can be obtained with assistance from the home care agency. - What are Personal Care Agencies?
These agencies usually provide non-medical services such as companions, homemakers, chore services, transportation or almost anything else people need to help them remain in their home. Ohio does not require these agencies to be Medicare certified but in some cases they provide services under the Ohio Departments of Aging such as PASSPORT or the Ohio Department of MR/DD such as the IO Waiver or Level One Waiver and meet those regulatory requirements.
If the agency only provides services for which the individual must pay privately, in Ohio, there no laws or regulations under which they operate. - How are Home Care Services paid for?Payment comes from many sources. Depending on your age, diagnosis or financial status, Medicare or Medicaid may pay for your care in the home. Private insurance and other insurance, also, offers coverage of home care service, or consumer can pay for his/her care in the home. Home care insurance specialists help you verify coverage before services are provided. Most home care providers will take care of all paperwork and billing.
Medicare: Most Americans, older than 65, are eligible for the federal Medicare program. If an individual is homebound, (meaning he/she cannot leave the home without physical assistance) is under a physician's care, and requires medically necessary nursing or therapy services, he/she may be eligible for services provided by a Medicare-certified home care agency.
Depending on the patient's condition, Medicare may pay for intermittent skilled nursing, physical, occupational and speech therapies, and/or medical equipment. The referring physician must authorize and periodically review the patient's plan of care. The services the patient receives must be part time and provided by a Medicare-certified home care agency for reimbursement. This means a nurse, therapist or home care aide comes to the patient's home for brief periods. Medicare does not cover care shift-type services in the home, only specific tasks performed in concert by a nurse, therapist or home care aide.
In contrast, Hospice services are available to individuals who are terminally ill and have a life expectancy of six months or less; there is no requirement for the patient to be homebound or in need of skilled nursing care. A physician's certification is required to qualify an individual for the Medicare Hospice Benefit.
Medicaid: Medicaid is a joint federal-state healthcare program for low-income individuals. Ohio's Medicaid program pays for home care and has other Waiver programs for in-home support if people meet eligibility requirements. Home care agencies will educate consumers to those eligibility requirements.
PASSPORT: Is a Waiver administered by the Ohio Department of Aging and is available to low-income seniors over the age of 60. Each local Area Agency on Aging operates the PASSPORT program in their locale. Seniors are offered support services that allow them to remain in the community such as: personal care aide, transportation, meals on wheels, medical and adaptive equipment, nutritional consultation, and daily living non-aide services to assist with bills and errands, to name a few. Home care agencies will often make referrals to PASSPORT for seniors needing additional services.
Private Insurance: Commercial health insurance policies often cover some homecare services for a person recovering from surgery or illness. Benefits for these services, however, vary from plan to plan. Commercial insurers, including Blue Cross and Blue Shield and others, generally pay for medical care in the home with a cost-sharing provision. Such policies occasionally cover personal care services such as help with meal preparation and light housekeeping. Most commercial and private insurance plans will cover comprehensive hospice services, including nursing, social work, therapies, personal care, medications, and medical supplies and equipment. Cost sharing varies with individual policies, but often is not required.
Long-Term Care Insurance: As the public's need and preference for home care has grown, private long-term care insurance policies have expanded their coverage for in-home care as well as nursing home care. Although, home care benefits vary greatly among plans, most plans today will cover home care. If an Ohioan needs Medicaid coverage, a new law was passed that if they purchase a long-term care insurance, they will be able to retain many of their personal assets. Previously, the consumer was required to give those assets to the state to pay for their care.
Self Pay Insurance: People can arrange to pay for home care services on their own. Home care providers coordinate arrangements and billing. Rates and services available vary by provider.
Other: There are other sources of payment for home care services. These can include Workers Compensation, the Veterans Administration, TriCare, the Older American's Act and more. Some home care providers have foundations that will pay for home care for low-income families.
Hospice FAQ
- Is hospice care for cancer patients only?
No. This is a common misconception. Hospice care is for any individual, of any age, who has a life-limiting illness. - How do you "qualify" for hospice care?An individual becomes eligible to receive hospice care when two physicians certify that an illness is terminal, and when the patient elects hospice care.
- What diagnoses are covered under hospice?
Again, any illness that is life-limiting, and has progressed to advanced stages can permit a person to become eligible to receive hospice care. - When should a decision about entering a hospice program be made, and who should make it?
At any time during a life-limiting illness, it's appropriate to discuss all of a patient's care options, including hospice. By law, the decision rests with the patient. Understandably, most people are uncomfortable with the idea of stopping aggressive treatment to "beat" the disease. Hospice staff members are highly sensitive to these concerns and always available to discuss them with the patient and family. - What does the hospice admission process involve?
One of the first things that hospice will do is contact the patient's physician to make sure he or she agrees that hospice care is appropriate for the patient at this time. The patient will also be asked to sign some consent forms. The hospice election form reads that the patient understands that the care is palliative (aimed at pain relief and symptom control) rather than curative. It also outlines the services available. - Will a hospice accept a patient who has a feeding tube?
It is generally left up to individual hospices to implement policies regarding patients with feeding tubes. Please consult your local hospice(s) for information about this. - How do I choose the best hospice?
There is no organization authorized by the federal or state governments to rank or rate hospice agencies. A good indicator of quality hospice care is to find out if the hospice is accredited by an organization such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). If a hospice is accredited by JCAHO, it agrees to inspections by JCAHO and must meet higher standards of care than those hospices that are not JCAHO accredited. - Is hospice care available around the clock?
Hospice is an intermittent care program, meaning that care is provided through visits by hospice team members.
Hospice does not provide 24-hour care for the patient at home, nor does hospice provide caregivers when a family member is at work. However, hospice will provide support to the family, and will work with families to "piece together" a plan that will provide appropriate care for the patient, as well as rest for the family members who are caring for the patient. - Do family members need to be in the house 24/7?
No. It is quite common for hospice staff or trained volunteers to give family members a break for an hour or so if they wish. Respite care can be made available for those families who have need of a break for several days. Respite care will allow the patient to be transported to a health care facility for several days while the family takes a break. - Do I have to use a hospital bed rather than my own bed?
No. Hospice seeks to increase the patient's comfort. If you feel more comfortable in your own bed than in a hospital bed, please let the caregivers know. If there are reasons that a hospital bed would be helpful, the hospice staff will let you know. - Will hospice help me with funeral arrangements?
Hospice staff, especially the social worker and/or the chaplain, will be happy to guide the family in making decisions about the funeral. Let the hospice staff know you'd like to talk about this. - How many patients are assigned to each hospice nurse?
The National Hospice & Palliative Care Organization (NHPCO) recommends no more than 10-12 patients per nurse. Ask your local hospice(s) about their standard of care in this area. - What bereavement services does hospice offer, and for how long?
Hospice chaplains and social workers work with families in helping them deal with the grief of losing a loved one. The amount of time can vary depending on each individual case, but usually bereavement services end at 13 months following the death of the patient. - Do I have to have a 24-hour caregiver to receive hospice care?
No, there are no requirements for having or not having a caregiver. - Isn't hospice a "place?"
While some hospices have a free-standing facility to offer care to patients, many do not. It is more accurate to think of hospice as a type of care, that is comprehensive care for persons facing end of life illnesses. - Must a patient have a Do Not Resuscitate Order (DNR) to be eligible for hospice?
The law states that hospices cannot discriminate against eligible patients because of any advanced directive choices they have or have not made. - Do I have to give up my own doctor to receive hospice care?
You have the right to choose your own attending physician as desired. - Is the physician the only person who can refer a patient to hospice?
Anyone can make a referral to hospice. Admission requires a physician's certification of eligibility, but it is every eligible person's right to receive hospice care if they want it. - Is hospice care limited to six months?
Patients may receive hospice care as long as their condition remains appropriate. The hospice team continually assesses that the condition warrants continued care. To fully benefit from our services, patients and families should seek care early. - What if my condition improves?
Occasionally, the quality of care provided by hospice leads to substantially improved health, and life expectancy exceeds six months. When this happens, the hospice provider will transfer care to a non-hospice care provider. Later, when patients become eligible for hospice, they can re-elect the hospice benefit. There is no penalty for getting better! - Who pays for hospice care?
Hospice is covered by most insurance plans, including Medicare and Medicaid, with few out-of-pocket costs to the patient. The Medicare hospice benefit covers costs related to the terminal illness, including the services of the hospice team, medication, medical equipment and supplies. Medicare reimburses for different levels of hospice care recognizing sometimes patients require special attention. - Question: What are the different levels of hospice care?
Most hospice patients live at home or in a nursing home. Routine home hospice care covers the services, of the interdisciplinary hospice team, medications and equipment. Other categories of care are available when needed.
Inpatient Care: Sometimes pain or symptoms cannot be controlled at home, and the patient is taken to a hospital or other inpatient care center. When the symptoms are under control, the patient returns home. Insurance usually covers the cost of inpatient room and board.
Respite care: Many patients have their own caregivers, often family members. When caregivers need a rest from their care giving responsibilities, patients can stay in a nursing home or hospice residential care center for up to five days. Medicare covers the cost of room and board, as do many other insurance plans.
Continuous care: Sometimes a patient has a medical crisis that needs close medical attention. When this happens, we can arrange for inpatient care, or the hospice provider staff can provide round-the-clock care in the home. When the crisis is over, the patient returns to routine home care. - What services does hospice provide?
Hospice includes the services of an interdisciplinary team of health care professionals:
Physicians (the patient's own physician and the hospice physicians, who are specialist in controlling pain and other symptoms of serious illness) prescribe medications and other methods of pain and symptom control.
Nurses are experts at maintaining patient comfort. They assess the patient frequently and help family members provide the necessary support.
Nurse assistants and home health aides provide personal care and help the patient and family with activities of daily living. They also provide companionship and valuable emotional support.
Social workers coordinate community resources and help the patient and family with non-medical concerns. They can help family members mend damaged relationships, plan for the future and ease other emotional difficulties.
Chaplains and spiritual counselors help patients and families cope with spiritual questions and concerns at the end of life, either directly or by coordinating services with the patient's and family's spiritual advisors.
Bereavement coordinators help patients and families deal with grief. Grief support services continue for at least one year after the death of a hospice patient.
Volunteers provide companionship and emotional support and offer help in myriad ways.
Hospice also provides medications, medical equipment and supplies necessary to promote comfort at home or in other hospice settings.
