FAQ about Hospice, Part 3: The Final Chapter (?)

Greetings!  Today I’m going to wrap up this little series on Hospice FAQ.  It may be something of a hodgepodge, as it’s mainly the bits that didn’t fit into the first or second posts.  But, hopefully after this, you will have a pretty good idea of what hospice is all about.  I’m sure there are some things I haven’t covered, though, so feel free to contact me if you’d like to know something that I haven’t answered.  I will probably put a version of these FAQ as a new page on the blog, so you can refer back to it if you so desire. Starting next week, I will talk about….something else.   We can be generous and assume I will have come up with a topic.  In the mean time, though, here it is…the much anticipated….FAQ about Hospice, Part 3: The Final Chapter!

“What’s the difference between hospice and this palliative care thing I’ve heard about?” Ah, another good question. Excellent, in fact.  It can be very confusing.  The word “palliative” means: “relieving pain or alleviating a problem without dealing with the underlying cause.”  This, of course, is exactly what we do in hospice.  However, there is a branch of medicine called “palliative care,” which is a rather broad, somewhat amorphous (but wonderful!) medical specialty that focuses on pain management.  Any of us in pain, no matter how generally healthy we are, would probably want some palliative care.  You don’t have to have a terminal diagnosis to receive it.  It comes in a variety of forms and programs. Here and here are some nice explanations.  We actually have a palliative care branch to our hospice, which provides in-home pain management to people who do not meet the requirements of hospice.  However, in our program they do have to have a life-limiting illness, which is not always a requirement for all palliative care programs.  Depending on their prognosis and needs, sometimes our patients switch from our palliative program to our hospice, or sometimes the other way around (that’s always nice!).  Palliative care programs are paid for differently than hospice–it’s usually a fee-for-service program, as opposed to an all inclusive program like hospice is.

“So, wait, how is hospice paid for again?”  Hospices receive a standard daily rate for each patient that it cares for. This often comes from Medicare or Medicaid–private insurances may do things a bit differently.  In any case, this standard daily rate will cover whatever services, medications, etc. that you receive from hospice.  This is quite different from the fee-for-service model that most health care is based on, where each each service, visit, medication etc. is paid for separately, and you often pay at least percentage of that.  Hospice often ends up saving the patient a good deal of money because under Medicare the highest co-pay a hospice can charge is $5.

“Wow, that Medicare hospice benefit really is wonderful.  How generous of them!”  Well, yes, it is really wonderful, and it has made a world of difference for many people.  And, get this, it has another benefit as well:  hospice saves Medicare money.  How ’bout that?

“Does everyone in hospice have cancer?” Good question.  This comes  up a lot.  The answer: Nope. Certainly, a lot of hospice patients do have cancer, but not all. Patients with dementia, COPD (Chronic Obstructive Pulmonary Disease), CHF (Congestive Heart Failure) and a variety of other illnesses can all receive hospice services.  At one point, AIDS accounted for many hospice admissions, but now, happily, for many people it can be treated as a chronic disease.  Again, it comes down to a life expectancy of six months or less.  As some diseases have a more predictable timeline (e.g., some cancers) than others (e.g., dementia), it is sometimes hard to come up with a definitive prognosis.  But as long as two physicians (one is usually the hospice MD) certify that they believe a person has a life expectancy of six months or less, then they are considered “hospice appropriate,” regardless of the disease.

“Is hospice just for old people?” Well, you probably already know the answer to that, so I won’t pile on the praise for this question. (In case you were wondering, yes, I made it up myself).  Again, the answer is “nope.”  People of all ages can be in hospice.  But even though the question itself isn’t stellar, this is a good opportunity for me to mention that there are actually pediatric hospice programs that cater to children.  People unfamiliar with this are often somewhat horrified at the thought.  I have found that people usally contort their face in a very consistent pattern when they first hear me mention pediatric hospice.  Yes, it can be very sad to think about, I agree (I think I made that same face when I first heard about it).  But, for children that need that kind of care, it is a real blessing.  In pediatrics, the divide between hospice and palliative care can be very blurry.  While a much needed service, it unfortunately is often not covered by insurance.  This article talks more about that.  The financial end of pediatric hospice is another sad topic.  Because so few children have this covered by insurance, at our hospice, we provide this care for free when necessary.

“Wow, you sometimes provide care for free? That’s awfully nice. How do you make any money?” Why, thank you. Yes, we are awfully nice. And no, we really don’t make any money. We are a non-profit hospice, and most of the funding for programs like pediatric hospice come from kind donors.  There are also for-profit hospices, which have a different financial structure.  All hospices certified by Medicare, regardless of profit status, provide the same basic services, however.  Whether or not it makes a difference if you receive care from a non-profit or for-profit hospice is a matter of great debate, which you can read a bit about  here, or here, or here.  I won’t go into that debate now, but probably will some other time.  While I will say that you can receive excellent care from both kinds,  I do think that you should know that they both exist.

“Why do you keep writing in the first and second person?  It seems like you think that I’m asking about myself, as opposed to someone else.” Well, ignoring the fact that I’m the one who actually made up most of these questions, let me say this: I’m doing it on purpose.  I’m doing it with the hope that on some subtle level, it might make all of us realize that even if we are perfectly healthy at the moment, we are all mortal.  Unless we die suddenly, chances are that one day we may very well find ourselves needing hospice care not just for someone else, but for ourselves.  And, maybe if we start thinking that way now, it might not be as scary when it happens.  Sneaky, huh?

“Yes, that’s very sneaky.  You’re probably the type of person who sneaks broccoli into cookies.  What else are you sneaking in here?”  I don’t put broccoli in cookies; I’m way too lazy to do that.  It’s much easier to just steam it and throw it on a plate.  I do put baby greens in smoothies, but that that’s both easy and blatant as it turns the whole thing green (it doesn’t taste like anything, though).  In all seriousness, I’m not trying to sneak in anything at all.  I will always strive to be up front and honest in these posts, and if I do have a bias, I will let you know.  Indeed, I will admit that I am quite dedicated toward the goal of increasing your comfort with death as a general concept, so consider yourself warned!  See you next week…and thanks for reading.

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