Step by step guide to help you prepare for the future healthcare of those you love as well as for yourself.
Comfort care is a concept of care that focuses on quality of life.
Comfort care is a type of care for individuals who have a terminal diagnosis and a life expectancy of six months or less. It focuses on comfort measures vs restorative treatment and is categorized as hospice.
The goal of hospice is to provide physical, emotional and spiritual care to decrease the pain and agitation that may accompany this phase. It is also an important resource for caregivers by providing peace and support to those overwhelmed with caring for their loved one.
Hospice is comfort care not curative care. Hospice is a concept of care that allows the natural progression of a terminal disease state to take its course while providing peace and comfort to the patient instead of the pain and agitation that restorative treatments can cause.
A three-year study published in the Journal of Pain and Symptom Management comparing hospice and nonhospice patient survival states the mean survival was 29 days longer for hospice patients than for nonhospice patients.
Hospice care is a gift and can bring great relief and comfort to the individuals on hospice care as well as the family and friends serving as their caregivers.
Step One
Have a Conversation
Get to know the wishes of your loved one while they are capable of providing you with their preferences. Let someone you love know how important their care is to you and your willingness to ensure their wishes are fulfilled. It’s never too early to have the conversation.
What type of care do you want?
Aggressive measures?
• full code
• feeding tube
• hospital care
• chemotherapy / radiation
• clinical trials
• all medications
• all extraordinary measures taken
Comfort care?
• DNAR – Do Not Attempt Resuscitation
• care at “home” NOT hospital care
• no chemo / radiation / transfusions
• consolidation of medications for patient comfort / condition
• focus on quality of life vs length of life
Where do you prefer to live while you get your care?
• your current home
• family / friend’s home (which one’s)
• extended care facility
Be gentle. Respect their wishes. Reevaluate when health changes.
Step Two
Understand Different Types of Care
Hospice Care Services
Every level of service includes an interdisciplinary care team (IDT): doctor, nurse, hospice aide, social worker, chaplain, volunteers, PT/OT/ST
Every level of service includes: 24/hr 7/days on-call nurse
Home Hospice Care
• In home (personal home or other living facility)
• Visits by interdisciplinary care team (IDT) based on need
• Formal review weekly
Respite Care
• Inpatient facility
• Short-term stay to relieve caregivers (5 nights 6 days)
• Continuous 24 hr care
Inpatient Care
• Inpatient facility
• Short-term stabilization (days not weeks or months)
• Continuous 24 hr care
• Formal review every 24 hrs
Continuous Care
• In home (personal home or other living facility)
• Continuous 12 hr or 24 hr with patient
• Formal review every 12 hrs
Step Three
Prepare an Advance Directive
Formalize Your Wishes NOW
Living wills and advanced medical directives are written, legal documents. They outline your preferences for your medical care should your physical or mental state cause you to be unable to do so for yourself. They are for all ages.
Advance Medical Directives
• Encompasses a range of instructions regarding your medical care
• Includes healthcare proxy
• Keep copies with doctors and family
• Update as needed if health, preferences or healthcare proxy changes
Living Will
• A type of advanced directive
• Takes effect when you are unable to express your wishes
Do Not Resuscitate (DNR) or Allow Natural Death (AND) or Do Not Attempt Resuscitation (DNAR) and Do Not Intubate (DNI) Orders
• Firm directives as to your end-of-life wishes
• DNR or AND or DNAR – do not attempt to restart the heart after it stops
Physician Orders for Life-Sustaining Treatment (POLST) or Medical Orders for Life-Sustaining Treatment (MOLST)
• It provides instructions to medical providers
• Stays with you in hospital, nursing home, etc
• Is displayed on the wall near you to guide caregivers
• May include: resuscitation, ventilation, tube feeding, do not transfer to hospital, pain management
Power of Attorney – also know as Durable Power of Attorney, Health Care Agent, Health Care Proxy, Health Care Surrogate, Health Care Representative, Health Care Attorney-in-fact or Patient Advocate
• Choose a person to be your health care agent
• Cannot be your doctor
• Will adhere to your wishes and make judgements for unanticipated needs
• If there are no written medical directives, the POA will make judgements on your care
Step Four
Ensure Insurance Coverage
Hospice Care Eligibility
• Medicare Part A (Hospital Insurance)
• Terminally ill diagnosis
• 6 months or less life expectancy (recertification periods: First 90 days / Second 90 days / Every 60 days thereafter)
What Medicare Covers
• Care Team Services: doctor, nurse (case manager), hospice aide, physical/occupational/speech therapy, social worker, spiritual counseling, grief counseling
• Medical Equipment: hospital bed, wheelchair, walkers, etc
• Medical Supplies: bandages, catheters, adult briefs, etc
• Prescription Drugs: associated with your hospice diagnosis
• Short-term Inpatient Care
• Short-term Respite Care
What Your Hospice Benefit Does Not Cover
• Treatment intended to cure your terminal illness
• Prescription drugs: not associated with your hospice diagnosis
• Care from non-hospice care providers
• Room and board: nursing home, personal care home, etc
• Hospital care
What You Pay for Hospice Care
• Medicare pays the hospice provider for your hospice care. There’s no deductible. You’ll pay:
• Your monthly Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) premiums
Medicare Advantage
• Traditional Medicare covers hospice services
• Advantage plans are not necessary for hospice
Medicaid
• Coverage for low-income individuals
• Community Care Service Program (CCSP) and Source are two forms of Medicaid
• Medicaid can cover both hospice care and room and board
Medicaid Spend Down
• Financial strategy used when individual’s income is too high to qualify for Medicaid
IF you have both Medicare and Medicaid, Medicare will be used first.
Step Five
Live Well
Be at Peace and Live Well
When you have captured your medical wishes and have someone you trust willing to fulfill them when the time comes, you can be at peace knowing you will be cared for in the manner you wish even when you are incapable of expressing your preferences.
Maintain your physical, mental, emotional and spiritual health and live your best life!