Fast Facts

What is hospice?

Considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury, hospice and palliative care involve a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes. Support is provided to the patient's loved ones as well. At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow this to occur.

Hospice focuses on caring, not curing and, in most cases, care is provided in the patient's home. Hospice care also is provided in freestanding hospice centers, hospitals, and nursing homes and other long-term care facilities. Hospice services are available to patients of any age, religion, race, or illness whose life is expected to end in six months or less. Hospice care is covered under Medicare, Medical, most private insurance plans, HMOs, and other managed care organizations.

Palliative (comfort) care extends the principles of hospice care to a broader population that could benefit from receiving this type of care earlier in their illness or disease process. No specific therapy is excluded from consideration. An individuals needs must be continually assessed and treatment options should be explored and evaluated in the context of the individual’s values and symptoms. Palliative care, ideally, could segue into hospice care as the illness progresses.

How does hospice care work?

Typically, a family member serves as the primary caregiver and, when appropriate, helps make decisions for the terminally ill individual. Members of the hospice staff make regular visits to assess the patient’s needs and provide additional care or other services. Hospice staff is available to answer our calls 24 hours a day, seven days a week.

The hospice team develops a care plan that meets each patient's individual needs for pain management and symptom control, and the loved ones’ needs for support. The interdisciplinary team usually consists of:

• The patient' s personal physician
• Medical Director
• Nurses
• Social Workers
• Home Health Aides
• Chaplain/Spiritual Counselor
• Bereavement Counselor
• Trained Volunteers
• Dietician
• Speech, Physical or Occupational Therapists and other Counselors, as needed

This interdisciplinary hospice team:

• manages the patient’s pain and symptoms
• assists the patient with the emotional and psychosocial and spiritual aspects of dying
• provides needed medicines, medical supplies and equipment
• coaches the family on how to care for the patient
• delivers special services like speech or physical therapy
• makes short term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time
• refers family to additional community resources such as in home support / attendant care
• provides bereavement care and counseling to surviving family and friends

Medicare Benefits

The long-term survival of hospice in America depends on a public that is fully aware of the benefits of hospice and palliative care services. According to a survey conducted by the National Hospice Foundation, 75% of Americans do not know that hospice care can be provided in the home, and 90% do not realize that hospice care can be fully covered through Medicare.

More than 90% of hospices in the United States are certified by Medicare. Medicare defines a set of hospice core services, which many hospices surpass through voluntary, community-based efforts.

The Medicare Hospice Benefit, initiated in 1983, is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive a full scope of comfort-focused medical and support services for their terminal illness. Hospice care also supports the family and loved ones of the patient through a variety of services, enhancing the value of the Medicare Hospice Benefit.

The Medicare Hospice Benefit provides for

• Physician services
• Nursing care
• Medical appliances and supplies
• Medications for symptom management and pain relief
• Short-term inpatient and respite care
• Homemaker and home health aide services
• Counseling
• Social work service
• Spiritual care
• Volunteer Support
• Grief Support

Who is Eligible?

Medicare has three key eligibility criteria:

• The patient’s doctor and the hospice medical director use their best clinical judgment to certify that the patient is terminally ill with a life expectancy of six months or less, if the disease runs its normal course;
• The patient chooses to receive hospice care rather than curative treatments for his/her illness; and
• The patient enrolls in a Medicare-approved hospice program.

Payment for Hospice:

• Medicare pays the hospice program a daily rate that is intended to cover virtually all expenses related to the patient’s terminal illness.
• Because patients require differing intensities of care during the course of their disease, the Medicare Hospice Benefit affords patients four levels of care to meet their needs: Routine Home Care, Continuous Home Care, Inpatient Respite Care, and General Inpatient Care.
• The Hospice Benefit rates have increased annually based on the Hospital Market Basket Index. With the advent of costly new drugs and treatments, the average cost to hospices has risen much faster than the hospice benefit reimbursement rates.

Common Questions

Why should I choose Mission Hospice?
Mission Hospice is the oldest, independent, nonprofit hospice organization in San Mateo County and has served thousands of patients in the county since 1979. Community-based and highly regarded, Mission Hospice offers patients respectful, compassionate, and professional care while remaining sensitive to patients’ cultural and spiritual customs.

Who qualifies for hospice care?
Hospice care is for any person who has a life-threatening or terminal illness that is expected to end one’s life within six months or less. Patients with both cancer and non-cancer illnesses are eligible to receive hospice care. All hospices consider the patient and family together as the unit of care.

Will hospice care hasten my death?
No, hospice care neither hastens death nor prolongs life. Hospice care allows you to remain comfortably in your home until the disease ends your life. When you accept hospice services, your doctor and your caring hospice team provide gentle and loving support as you undergo the physical, emotional, and spiritual changes that a terminal illness brings.

Doesn't a referral to Mission Hospice mean that my doctor or I have given up?
Hospice referrals are made when all available treatments either have failed to cure your illness or your quality of life has declined significantly. A hospice referral means that people really care about making your last days as comfortable and as peaceful as possible when all other treatments are no longer helpful.

Why should I choose Mission Hospice instead of having my family care for me at home with my doctor’s assistance?
Your family would be taking care of you at home with your doctor’s assistance. By accepting Mission Hospice’s highly skilled team, you gain additional expertise and support that allows your family to have more quality time with you and the confidence to provide the best care of you.

Mission Hospice’s nurses provide pain and symptom management and teach your family about medications and physical changes that occur as you decline. Medical social workers offer emotional support, counseling, and connections with other community resources. Chaplains, who support people of all faith traditions and those with no faith tradition, assist with spiritual and religious concerns, as well as funeral planning and connections to community clergy.

Home health aides assist with personal care and light housekeeping services. Volunteer caregivers provide a variety of services, including companionship and relief care. Dieticians provide counseling and education about nutrition and diet. Physical, occupational, and speech therapists provide care that may allow you to walk safely or speak more clearly. And your doctor is still in charge of your care and works with Mission Hospice’s medical director and nurses to ensure that the care you receive is tailored to your needs.

How much will hospice care cost me?
It will cost you very little. Eighty percent of people in hospice care are over the age of 65 and use the Medicare Hospice Benefit for hospice services, medical equipment and supplies, and medications related to the terminal illness — with little out-of-pocket expense for the patient or family. Also, private health plans with hospice benefits and Medical in 45 states and the District of Columbia provide for hospice services. As a result, you are relieved of the financial burdens usually associated with caring for a terminally ill family member.

What if I want everything possible done to prolong my life or my loved one’s life? Or, what if my loved one or I get better?
You always have a choice about continuing curative treatment or receiving hospice services for comfort care. And sometimes, because hospice care is so nurturing and caring, people do get better and live longer than at first expected. In either case, you can simply revoke your hospice benefit and seek treatment under your regular insurance. If treatment fails and you again qualify for hospice care, you can return to Mission Hospice and receive its services.

What if I want my minister involved in my care?
Although our chaplains enjoy working work side-by-side with other ministers as together they comfort and care for you, we respect your right to choose where you obtain your spiritual and religious care.

What if I change my mind about hospice care and no longer want it?
You can revoke hospice services just as you would if you wanted to have curative treatment or your condition improved.

Will you tell my friends and neighbors that I’m receiving hospice care?
No, we will not. Privacy laws and our agency’s confidentiality policies prevent us from sharing anything about your care unless you have authorized this in writing.

What are some questions that you should ask when looking for a hospice program?
Hospice care is a philosophy of care that accepts dying as a natural part of life. When death is inevitable, hospice seeks neither to hasten nor postpone it. Below is a list of questions you should consider when looking for a hospice program.

• Is the hospice Medicare-certified and licensed as a hospice?
• What services are provided?
• What kind of support is available to the family/caregiver?
• What roles do the attending physician and hospice play?
• What does the hospice volunteer do?
• How does hospice work to keep the patient comfortable?
• How are services provided after hours?
• How and where does hospice provide short-term inpatient care?
• Can hospice be brought into a nursing home or long-term care facility?
• What bereavement services are available for loved ones ?

Where does hospice care take place?
The majority of hospice patients are cared for in their own homes or the homes of a loved one. Home is also construed to include services provided in residential care facilities for the elderly, hospitals and prisons.

Below is a list of services available to Medicare hospice recipients.
Physician services for the medical direction of the patients care.

• Regular home visits by registered nurses and licensed vocational nurses.
• Home health aides for services such as dressing and bathing.
• Social work, counseling and spiritual care
• Medical equipment such as hospital beds.
• Medical supplies such as bandages and catheters.
• Medications for symptom control and pain relief.
• Volunteer support to assist patients and loved ones.
• Physical therapy, speech therapy, occupational therapy, and dietary counseling.
• Bereavement support services for the patient’s loved ones

What role do volunteers play in hospice care?
Hospice provides trained volunteers to aid the family and patients. Our hospice
volunteers are trained to relieve the primary care givers by giving respite care and staying with the patient. Perhaps the most important task , however, is their ability to simply listen to the patient and their loved ones voice their concerns during this emotional time.