What is Hospice Care & Why is it Important?

Hospice supports people near the end of life with compassionate care by:

• Pagbuo ng mga pinasadyang plano ng pangangalaga na nakatuon sa layunin at kahilingan ng bawat pasyente
• Pamamahala ng mga sintomas at pananakit
• Improving quality of life in the patient’s preferred setting of care
• Paghikayat sa mga pasyente at sa kanilang pamilya na pagsamantalahan ang kanilang oras na sila ay magkasama

At VITAS, our care model is inclusive and is designed to meet the unique needs of diverse patients facing a broad array of advanced illnesses, medical conditions, and accompanying symptoms.

Once a patient is deemed eligible for hospice by their physician, the transition can start as soon as they—or the person who is designated to make healthcare decisions on their behalf—agrees to shift from a curative focus and begin hospice services.

Whether you’re a patient, family member, or clinician who treats patients with serious illnesses, having correct information about hospice services can help you make the best decisions about whether hospice care is appropriate.

Table of Contents:

• What Services Does Hospice Provide?
• What Is Usually Not Included in Hospice Care?
• What Is the Difference Between Hospice and Palliative Care?
• Sino ang Kwalipikado para sa Hospice Care?
• Where Can You Receive Hospice Care?
• How Long Does Hospice Last?
• How Do You Pay for Hospice?
• Begin the Hospice Conversation Early
• What to Ask Your Hospice Provider
• What VITAS Will Do for You in Hospice Care

What Services Does Hospice Provide?

Hospice offers compassionate care to improve the quality of life for seriously ill patients who have a prognosis of six months or less if the disease runs its course as expected.

Because hospice is not a place, patients can remain in their home, whether that is a private home or senior living community such as senior living, memory care, or a nursing home. Services include:

• Clinical symptom and pain management, including medications to help with symptoms.
• Care coordination, including the delivery of home medical equipment and supplies related to the cause of the illness.  Kabilang dito ang mga upuan para sa shower, mga oxygen tank, mga hospital bed, mga supply para sa banyo, at marami pang iba.
• Training for family members or friends who are the primary caregiver(s).
• An expert, multi-disciplinary team makes regular, scheduled visits to the patient's household. For patients who live in senior living communities and nursing homes, the hospice team works with the facility staff.
• Therapies, including physical and occupational therapy. VITAS also offers respiratory therapy, music therapy, and spiritual and complimentary therapies in many programs.
• Spiritual support and bereavement care.
• Around-the-clock access to a clinical expert who can treat and triage over the phone or via a telehealth visit.
• When medically necessary as per Medicare guidelines, VITAS offers Intensive Comfort Care(R), a higher level of care when patients experience symptom exacerbation. Care is delivered at the patient's bedside in temporary shifts of 8-24 hours until symptoms stabilize.
• Short-term care in an inpatient hospice unit as needed (for patients) or respite care (for caregivers)
• A minimum of 13 months of grief and bereavement support for patients’ loved ones.

What Is Usually Not Included in Hospice Care?

Below are some items that are not included in the hospice benefit:

• Medications unrelated to the patient’s serious illness.
• Emergency room care not arranged by the patient’s hospice care provider.
• Curative treatments intended to heal the patient. If a new curative medication, therapy, or treatment for the patient's serious illness becomes available, they can withdraw from hospice care to receive it.
• Housing or room and board, aside from an inpatient unit hospice stay when medically necessary. The patient and their loved ones remain responsible for their home, assisted living community, or nursing home and related costs such as rent, mortgage, and food.

What Is the Difference Between Hospice and Palliative Care?

Palliative care can occur at any point in life, for any duration, and it can occur in conjunction with curative care.

Hospice is for patients who are not responding to disease-directed treatments and are expected to live six months or less.

Both types of care offer pain and symptom relief with clinical and psychosocial services. Hospice is the only one of these options covered by the Medicare Hospice Benefit (Medicare Part A).

Sino ang Kwalipikado para sa Hospice Care?

A patient's physician will determine hospice eligibility based on the patient's prognosis. Hospice becomes an option when curative treatments are no longer effective and the patient has a life expectancy of six months or less as certified by their attending physician and a hospice doctor-either the hospice's medical director or the director's designee. Increased hospitalizations or emergency department visits, typically more than three per year, may be a sign of hospice eligibility.

Diseases that may lead to functional decline and hospice eligibility include:

• Cancer
• Cardiac and circulatory diseases
• Dementia/Alzheimer’s
• End-stage liver or kidney disease
• Respiratory diseases
• Stroke, neurological diseases, ALS (Lou Gehrig’s disease)
• Sepsis and post-sepsis syndrome

Hospice care remains a patient’s choice. Patients can choose to stop receiving hospice services or “revoke” hospice without a physician’s consent. They can then resume curative efforts. If they decide to return to hospice, they can do so as long as they meet eligibility guidelines.

Where Can You Receive Hospice Care?

Hospice is a service provided by a team of experts that comes to the patient in the place they prefer to receive end-of-life care. This means patients can remain surrounded by the faces and things they know and love:

• In a private home
• In a senior living community
• Sa isang nursing home

When medically necessary, short–term treatment in an inpatient unit is available for some hospice patients.

How Long Does Hospice Last?

There is no limit to the amount of time a patient can receive hospice care. Although hospice is for patients who have six months or less to live according to a physician, the patient’s stay can be extended when necessary.

Eligible patients benefit most from hospice services if they are referred early in their end-of-life journey. In surveys, family members often say, "We wish we had known about hospice sooner."

How Do You Pay for Hospice?

Ang karamihan sa mga pasyente ng hospice ay walang gastos mula sa sariling bulsa. Medicare Part A covers up to 100% of the cost of hospice care related to a hospice-eligible patient’s illness, with no deductible or copayment.

Ang health coverage na pribado o galing sa pinagtatrabahuhan ay maaaring kakaiba. Makipag-ugnayan sa iyong insurance provider para sa mga detalye tungkol sa pagiging karapat-dapat sa hospice, sa coverage, at sa mga gastos mula sa sariling bulsa. Medicaid provides hospice coverage, but specific services and eligibility criteria vary by state.

Begin the Hospice Conversation Early

Hospice care provides the most meaningful improvement to the patient’s quality of life when it begins sooner in their disease process rather than later.

VITAS recommends end-of-life care conversations begin as soon as a serious diagnosis is made. Matitiyak ng mga pasyenteng matatanggap nila ang pangangalaga na gusto nila-at kung kailan nila ito gusto-sa pamamagitan ng pagkakaroon ng mas maaga at patuloy na pakikipag-usap tungkol sa mga layunin at kagustuhan ng kanilang pangangalaga sa kanilang pamilya, doktor, o staff ng pasilidad.

Physicians can help patients understand their options and identify their preferences during advance care planning sessions and goals-of-care consultations. Ang mga pakikipag-usap na ito na ini-re-reimburse ng Medicare ay nagreresulta sa mga advance na directive, mga dokumentong may medikal na awtoridad na dapat masunod, na nagsasaad kung paano dapat gamutin ang isang pasyente, sa anong sitwasyon sila dapat i-resuscitate, sino ang makakagawa ng mga medikal na desisyon sa kanilang ngalan, at higit pa.

Ang sinumang lampas sa edad na 18 ay dapat mayroong advance na directive para mapanatili ang kontrol sa kanilang pangangalaga kung sakali mang hindi na nila magawang makapagsalita para sa kanilang sarili. Kabilang sa mga advance na directive ang mga living will, mga durable/medical power of attorney, isang Five Wishes na dokumento, mga kautusan ng doktor/medikal na kautusan para sa paggamot na makapagpapanatili ng buhay, at iba pang mahahalagang mga dokumento.

Questions to Ask Your Hospice Provider

When considering hospice care for yourself or a loved one, understanding a potential provider's capabilities, history, and philosophy will enable you to make a more confident care decision. Makakatulong ang mga tanong na ito upang malaman kung ang isang provider ay naaangkop para sa isang pasyente:

• Paano nasasaklaw ang mga gastos sa hospice? Does the provider accept Medicare, Medicaid, VA benefits, and private insurance?
• Ano ang mga ibinibigay na level ng pangangalaga? How often will care team members visit the patient at home?
• Ano ang proseso ng admissions? Gaano kabilis makakapagsimula ang pangangalaga?
• Ano'ng mangyayari kung sakaling magkaroon ng emergency o mga agresibong sintomas? Naghahandog ba ang provider ng 24/7 na suporta?
• Magagawa ba ng provider na mapamahalaan ang mga komplikadong sintomas sa bahay? Naghahandog ba sila ng mga dalubhasang serbisyo para sa respiratory disease, dementia, cancer, heart disease, sepsis, HIV/AIDS, atbp.?
• Is population-specific care available for veterans, LGBTQ+ patients, religious minorities, etc.? Can the provider accommodate and honor specific religious or cultural traditions?

What VITAS Will Do for You in Hospice Care

Ang VITAS ay ginagabayan ng isang pangunahing pagpapahalaga: "Mga pasyente at pamilya muna." Ang bawat serbisyo ng VITAS ay idinisenyo para mabigyan ang mga pasyente, ang kanilang mga pamilya, at tagapag-alaga ng supportang nagpapabuti sa quality of life, namamahala ng kanilang mga sintomas at pananakit, at nasisiguro ang kaginhawahan at dignidad sa pinakamahirap pero makabuluhang buhay ng isang tao.

Once a patient is ready to consider hospice care, VITAS can typically conduct an eligibility assessment within 24 hours and, if appropriate, begin an immediate transition to our services. We can take on new patients day or night, even on holidays and weekends.

Tinutukoy ng "palaging available" na pamamaraan na ito ang aming buong modelo ng pangangalaga. Isang pagtawag lang sa telpono ang kailangan para makatanggap ng klinikal na suporta para sa mga pasyente, pamilya, at tagapag-alaga.

A VITAS interdisciplinary care team is assigned to each patient, working from an individualized care plan built around the patient’s unique needs, goals, and preferences.

Members of the team-including a physician, nurse, aide, social worker, chaplain, bereavement counselor, and other specialists-will visit routinely to manage the patient's clinical, psychosocial, and spiritual symptoms. Nakadepende ang dalas ng pagbisita sa mga pangangailangan ng bawat pasyente at pamilya.

Upon the patient’s death, spiritual staff and other members of the care team can be present to assist with end-of-life rituals, funeral home arrangements, and the challenges of grieving.

For at least 13 months after the patient’s death, VITAS bereavement specialists continue to help the family navigate their loss with personal check-ins, grief support groups, and other practical measures.