What is Hospice?
Hospice is a philosophy of care that treats the whole patient. A specialized team of healthcare professionals address the physical, emotional, spiritual, psychological and social needs of the patients and family members. The goal of hospice is to bring about peace and dignity throughout life’s last journey.
When is the right time to ask about hospice?
Now is the best time to learn more about hospice and ask questions about what to expect from hospice services. Although end-of-life care may be difficult to discuss, it is best for family members to share their wishes long before it becomes a concern. This can greatly reduce stress when the time for hospice is needed. By having these discussions in advance, patients are not forced into uncomfortable situations. Instead, patients can make an educated decision that includes the advice and input of family members and loved ones.
How does hospice care begin?
Typically, hospice care starts as soon as a formal request or a ‘referral’ is made by the patient’s doctor. Often a hospice program representative will make an effort to visit the patient within 48 hours of that referral, providing the visit meets the needs and schedule of the patient and family/primary caregiver. Usually, hospice care is ready to begin within a day or two of the referral. However, in urgent situations, hospice services may begin sooner.
Will I be the only hospice patient that the hospice staff serves?
Every hospice patient has access to a hospice volunteer, registered nurse, social worker, home health aide, and chaplain (also known as the interdisciplinary team). For each patient and family, the interdisciplinary team writes a care plan with the patient/family that is used to make sure the patient and family receive the care they need from the team. Typically, full-time registered nurses provide care to about a dozen different families. Social workers usually work with about twice the number of patients/families as nurses. If needed, home health aides, who provide personal care to the patient, will visit most frequently.
All visits, however, are based on the patient and family needs as described in the care plan and the condition of the patient during the course of illness. The frequency of volunteers and spiritual care is often dependent upon the family request and the availability of these services. Travel requirements and other factors may cause some variation in how many patients each hospice staff serves.
Is hospice available after hours?
Hospice care is available ‘on-call’ after the administrative office has closed, seven days a week, 24 hours a day. Most hospices have nurses available to respond to a call for help within minutes, if necessary. At Homestead Hospice, we have chaplains and social workers on call as well.
Will the hospice staff be available if a need arises at night or on the weekend?
Homestead Hospice & Palliative Care has professional staff regularly scheduled to respond to calls from patients or family members and to make visits at night and on weekends. In addition, physicians are available to the professional staff 24 hours a day, seven days a week.
Homestead Hospice’s mission is to keep patients at home, surrounded by their family. We are dedicated to responding to our patient’s needs so that we can keep them out of the hospital. Our patient’s can count on our staff to respond to all calls within 15 minutes. Additionally, if a visit is needed after hours, our staff will be there within an hour of the decision to make a visit and will stay in the home until the crisis is under control.
How does the hospice work to keep the patient comfortable?
Many patients may have pain and other serious symptoms as illness progresses. Hospice staff receives special training to care for all types of physical and emotional symptoms that cause pain, discomfort and distress. Because keeping the patient comfortable and pain-free is an important part of hospice care, many hospice programs have developed ways to measure how comfortable the patient is during the course of their stay in hospice. Hospice staff works with the patient’s physician to make sure that medication, therapies, and procedures are designed to achieve the goals outlined in the patient’s care plan. The care plan is reviewed frequently to make sure any changes and new goals are in the plan.
Can I be cared for by hospice if I reside in a nursing facility or other type of long-term care facility?
Remember, hospice is a philosophy of care, not a place. Hospice services can be provided to a terminally ill person wherever they live. This means a patient living in a nursing facility or long-term care facility can receive specialized visits from hospice nurses, home health aides, chaplains, social workers, and volunteers, in addition to other care and services provided by the nursing facility. The hospice and the nursing home will have a written agreement in place in order for the hospice to serve residents of the facility.
What happens if I cannot stay at home due to my increasing care need and require a different place to stay during my final phase of life?
A growing number of hospice programs have their own hospice facilities or have arrangements with freestanding hospice houses, hospitals or inpatient residential centers to care for patients who cannot stay where they usually live. These patients may require a different place to live during this phase of their life when they need extra care. However, care in these settings is not covered under the Medicare or Medicaid Hospice Benefit. It is best to find out, well before hospice may be needed, if insurance or any other payer covers this type of care or if patients/families will be responsible for payment.
What is Inpatient Hospice Care?
While most hospice care is provided at home, (“home” to the patient includes home, apartment, group home, assisted living facility or nursing home) hospice care may also be provided in an inpatient setting. Inpatient hospice care can be provided in either a designated unit called a hospice unit or in a "scatter bed" at a hospital. Hospice inpatient care is available for individuals needing help in controlling pain, their symptoms or for those whose family is in crisis and needing respite. It is usually used for the last two weeks of a person’s life. Inpatient hospice care is also appropriate for persons already admitted to a hospital who are actively dying. Inpatient Hospice care always depends on bed availability. Hospice will search for an available bed, call you back, and arrange for transportation if necessary. The Hospice staff tries to arrange for care in the site of your choice, but sometimes beds are scarce or not available.
Homestead Hospice has many contracts with skilled facilities, hospitals and hospice in-patient units. If the need arises, we can transfer any of our patients to local facilities for in-patient care.
At Homestead Hospice, it is our mission to provide continuous care in the home when symptoms become hard to manage with daily visits. That means that our staff will stay with the patient in their home and work with the primary care physician and hospice medical director to change the plan of care to address the immediate crisis. Because of our dedication to providing continuous care in the home, we are often able to ensure that you or your loved one is able to die at home, in peace, surrounded by loved ones.
Do state and federal reviewers inspect and evaluate hospices?
Yes. There are state license requirements that must be met by hospice programs in order for them to deliver care. In addition, hospices must comply with federal regulations in order to be approved for reimbursement under Medicare. Hospices must periodically undergo inspection to be sure they are meeting regulatory standards in order to maintain their license to operate and the certification that permits Medicare reimbursement.
How can I be sure that quality hospice care is provided?
Many hospices use tools to let them see how well they are doing in relation to quality hospice standards. In addition, most programs use family satisfaction surveys to get feedback on the performance of their programs. To help hospice programs in making sure they give quality care and service, the National Hospice and Palliative Care Organization has developed recommended standards entitled ‘Standards of Practice for Hospice Programs’ as one way of ensuring quality. There are also voluntary accreditation organizations that evaluate hospice programs to protect consumers. These organizations survey hospices to see whether they are providing care that meets defined quality standards. These reviews consider the customary practices of the hospice, such as policies and procedures, medical records, personal records, evaluation studies, and in many cases also include visits to patients and families currently under care of that hospice program. Homestead Hospice & Palliative Care (HHPC) chose to obtain Accreditation with The Joint Commission and received “Deemed Status” in it’s Chandler, AZ office in July 2010.
To what extent are physicians involved in patient care?
Homestead Hospice has 8 physicians involved in the care of our patients. Our physicians are available to visit every patient at home or in hospital or nursing home as needed or desired. A physician is available to hospice staff 24 hours a day, seven days a week.
Do I have to give up my regular physician if I choose hospice care?
Although Homestead Hospice maintains a staff of physicians, a hospice patient is not required to change doctors. Any state licensed physician can be the primary physician if he or she wishes to continue caring for the hospice patient.
What are the rules for me/my family to use hospice?
Patients must meet government standards to receive hospice care. Patients often wait too long to get help. If you or a loved one have been diagnosed with a life limiting illness that is not curable, it is important to get informed about hospice as soon as possible. Many people are surprised to learn that they could have had the help much sooner. Hospice is generally covered by Medicare and/or private insurance. To find out if you or a loved one meet the criteria for hospice, call Homestead Hospice today at 877-355-4472. Dedicated professionals are available to answer your questions over the phone. Additionally, a personal consultant is available to meet with you in person at your convenience.
Do you have to be dying to use hospice?
No. A patient must be diagnosed with an illness that is expected to limit life expectancy to 6 months or less. No one knows exactly how long one individual will live with an illness though. Often, patients live longer than the 6 month diagnosis and enjoy a much better quality of life under of hospice care.
Is hospice any different from a nursing home?
Yes. Hospice is a type of care that can be given to patients in a nursing home. This care is in addition to the care received by the nursing home staff. If a patient receives hospice care while in a nursing home, they essentially have 2 teams of clinicians caring for them. At Homestead Hospice, we have a special program for working in facilities to ensure excellent communication and collaboration of care.
How much does hospice cost? Does Insurance cover hospice?
Hospice is a benefit paid for under Medicare, Medicaid and some private insurance programs. Costs for medications, care, equipment and supplies related to the hospice diagnosis are typically fully covered by Medicare and Medicaid. Often, patients and their families are not aware that this is help they can receive in the home at no additional cost to them.
What is the average approval time on any financial assistance?
Homestead Hospice can run insurance verification for all of their patients within an hour of receiving the referral. To run insurance verification, hospice will need the patient’s name, date of birth and social security number. For Medicare and Medicaid patients, verification of enrollment is all that is needed and this only takes about an hour as well.
Is hospice care always in the home?
No. Hospice is a philosophy of care, not a place. The hospice staff provides the care wherever the patient resides. This includes the home, or a facility such as a personal care home, assisted living facility, skilled nursing home, etc…
I have heard of a lot of nursing home mistreatment. How do I know you won’t be similar?
When hospice is provided in the home, you will be able to monitor the care. When hospice is provided in a facility, not only are you watching the care, but the facility staff ensures that the hospices they work with are the best in the community.
Nursing Homes often provide great care to their resident’s, however there are incidents of inadequate care or neglect that appear on the local media from time to time. Another benefit to having hospice care in nursing homes is that you have a second team of clinicians watching out for your loved one. Hospice works in collaboration with the nursing home staff to ensure the best care possible is provided to the patient.
Hospice is highly regulated and must pass strict surveys to be certified agencies under Medicare.
Can I trust your nurses in my home?
Under hospice regulations, all staff must go through thorough background checks prior to seeing any patients. In addition, at Homestead Hospice, we check at least 2 references before hiring any staff members. Homestead Hospice is a very professional and highly regarded Hospice company in the communities we serve.
Additionally, Homestead Hospice has a very strict policy regarding patient complaints. We hold our employees to very high standards.
What is your hiring policy to make sure the staff doesn’t invade my privacy? Are they required to keep the same standards as my doctors?
Yes. In the current healthcare environment, adherence to patient and family rights is a top priority to our regulatory agencies. Each patient and family that signs on with hospice receives our 2 page policy on patient and family rights. Every staff member must also go through thorough orientation on those rights and privacy laws prior to seeing their first patient. For a complete list of those rights, click here.
What makes you different from another provider?
There are many things that make Homestead Hospice different from the competition but the main reason Homestead Hospice is different lies in our owner. We are expected to find solutions when others can’t. We are often told: “Don’t think about what can’t be done; think about how we can make it happen!”
Homestead Hospice has created many programs and processes so that we differ from other Hospice providers. We are not a cookie-cutter hospice and strive to bring enhanced care and communication every way possible.
Will my family member always have the same nurse?
Consistency of care is a priority at Homestead Hospice. We recognize that our patients and families develop relationships with our team members and those relationships can be just as important as plan of care. Because of this, we strive to assign a specific team that stays with our patients and families through their entire journey. At times, we may need to make a change, but if this happens, we ensure a smooth transition by introducing the new staff member and making sure that our patients and families are comfortable with the change.
Who will his/her health information be shared with?
Our patient’s health information is only shared with other healthcare professionals if sharing that information is necessary to further enhance the plan of care.
Do you have any communication with my primary care physician?
Yes. Hospice agencies are expected to work closely with patient’s primary care physicians and must document that communication to show collaboration between the hospice medical director and the primary care physician (PCP).
In addition, at Homestead Hospice, the notes from our bi-weekly team meetings are sent via fax to the primary care physicians.
The PCP is still directing the patient’s care outside of the hospice diagnosis so it is important that we work together to ensure our plan of care works well with the patient’s other treatments.
Do you prescribe any medications?
We request orders for medications from the primary care physician (PCP) in order to promote comfort and symptom management. The PCP must approve all medications requested.
In crisis situations, we can also use the hospice medical director for medication orders if the PCP is not available.
What responsibility do you have with administering medications?
Homestead nurses make a determination of medications based on the patients symptoms, and in collaboration with the patients Primary Care Plan and Hospice Medical Director. Once a medication treatment plan is agreed upon, medications are delivered to the patient and education is provided to the family, caregivers and the facility. The hospice team does not typically administer the medications, but may help if needed when they are in the home.
Will the hospice program force the patient to stop current medications or other treatments?
Homestead Hospice and Palliative Care assesses patients individually and makes recommendations to ensure medications are effective. Homestead Hospice & Palliative Care has an extensive list of approved medications in accordance with the National Hospice and Palliative Care Organization. In addition, Homestead Hospice will admit patients on feeding tubes and IV's, as well as those receiving chemotherapy, radiation therapy, or dialysis if they are appropriate for hospice care.
Do your nurses have CPR training?
Yes. All staff that has contact with patients must be certified in CPR prior to being assigned their first patient. In addition, our employee files are audited to ensure that these licenses are kept up to date.
What hours are nurses available?
Our nurses are available 24 hrs a day, seven days a week. We have staff on call and available should a need arise. We respond to all calls within 15 minutes and if a visit is needed, our nurse can be there within an hour of that determination.
Am I able to pick the nurse? How is my nurse selected?
Homestead Hospice puts our patients and families at the center of our care. We recognize that the relationships with our team members are just as important as the care that is provided. If we can accommodate requests, we will. As long as the nurse can get to the patient in a timely manner (does not live or work too far away from the location of the patient), we will make every effort to honor our patients and families wishes.
The model of care implemented at Homestead Hospice is focused around the ability to respond quickly to our patient’s needs. Therefore, we assign nurses a caseload based on a geographic location that is less than 25 miles. This ensures that the nurse will have plenty of time to see their patients during the week and to respond quickly in the event of a crisis.
How do I know who is supposed to show up? Do I receive a schedule?
Every patient is given a folder upon admission. Our team members are identified on our staff roster after the first visit.
Additionally, the hospice aides are scheduled according to the needs of our patients and families. You will be provided a schedule of when you can expect the team members.
If something occurs and your regularly scheduled team member can not make their visit due to illness or any reason, a call will be placed to you to let you know and to inform you of the new team member that will be visiting and at what time you can expect them.
What credentials should they present before entering the home?
All staff at Homestead Hospice will have name badges with our company logo and their picture. They should show this to you before entering your home.
Am I expected to be in the house while the Hospice staff is there?
You do not have to be in the home during the visit with the patient but they must be able to get in to the home to make the visit. Sometimes the patients are too weak to come to the door to let our staff in. Please inform our staff if there are special instructions to follow regarding entering your home when you are not there.
How long does it take to get care from the time we decide to sign-up to the first day?
Homestead Hospice is known for it’s quick response time to patients, families and referral sources. We will send a nurse out to admit a patient within just an hour or two of receiving the call for help. We immediately contact the primary care physician for an order to admit and call the family for the best time to meet to discuss hospice and all that we can do to help affect peace and dignity during this difficult time.
What information do you need from me to get started?
Before a patient can be admitted to hospice, we will need an order from a physician to evaluate and admit the patient if they are deemed appropriate for hospice care. To ensure patients are appropriate, the last visit notes from the doctor or latest History and Physical is requested. If we determine that the patient meets the criteria clinically, then we have the patient of family member sign the legal documents that show that hospice care has been chosen and our team will begin caring for the patient immediately.
Is there a contract that I need to sign in order to receive Hospice?
There are legal documents that must be signed before hospice services can begin. These documents include the Hospice Benefit Election Form, The Medicare Hospice Benefit Form, The patient and family rights form, and other forms. These documents are necessary to show that you have chosen hospice as the plan for care and have been informed about your rights, how the hospice program works, how it is paid for, and what is covered under the hospice benefit. Our consultant will answer any questions you have regarding these documents before you sign them.
What happens if my family member passes before care starts or during your care?
While we hope that we are called in to help before death becomes imminent, as long as the legal documents and initial nursing assessment is complete, the patient is considered a hospice patient. Whether that is for just a few hours, days, weeks or months, they have a right to the full hospice benefits. That means that after the patient dies, the family members will receive the full bereavement care for up to 13 months after the patient’s death. Our chaplain and bereavement coordinator will stay in touch through letters, calls and perhaps visits to help our families through the first year grieving process.
Why hospice over personal care?
8Hospice is a specific type of care. Included in that care is personal care for approximately an hour a day for three to seven days a week, based on the patient’s needs. Personal Care will help with a patient’s activities of daily living. Under Hospice care, you also receive pain and symptom management and social workers, chaplains, bereavement coordinators, volunteers to help in bringing comfort and peace during this difficult journey. Personal care is not as specialized. Personal care is often provided in addition to hospice services for those patient’s that need round the clock care
What if I have more than one person who needs care?
As long as a patient meets the clinical criteria and we have the appropriate doctor’s order and legal documents signed, we can care for as many people in one home as needed. At Homestead, we have had several spouses that have had hospice at the same time. This is a benefit to them because they will see our nurses and other team members more often. They will also have the hospice aide in the home for a longer period of time each day.
How many people will be involved in the care of our loved one?
There are several members of the hospice team that are dedicated to caring for our patients. Each patient will have an assigned Nurse, hospice aide, social worker, chaplain, bereavement coordinator and volunteer if needed. Additionally, all care is overseen by the hospice Medical Director, who works in conjunction with the patient’s primary care physician to ensure the best treatment plan is implemented for each patient.
How far will you travel?
Hospices are regulated so that team members can get to the patients in a timely manner. The rules states that we must be 60 miles or within 1 hour of our patient’s residence.
Under what circumstances will you NOT enter my house?
We make every effort to provide care to all patient’s that need hospice. However, we must also ensure the safety of our team members. If the environment is unsafe, we will work with the family to place the patient in a safe environment and provide care there.
What else should I know about you?
You should know that you are important. You should know that you area a whole person that has contributed to the world and deserves the best care possible through this last journey in life. You should know that the team at Homestead Hospice takes the responsibility of your care very seriously and that we will do everything possible to make this time as positive as possible. You should know that you have a right to receive this care and that it is not giving up. Hospice is actually very intense care that should be provided to you when you decide that comfort and quality are what you want for the rest of your like.
What help can I expect with direction to resources outside of the hospice program?
Homestead Hospice & Palliative Care features a team of licensed clinical social workers. In addition to helping patients and family members cope with the emotional challenges involved in facing the end of life for themselves or someone they love, the hospice social workers are skilled in identifying and connecting patients and their families with services of other community organizations. For example, they can help with wills and estate planning, funeral arrangements, financial assistance for medications, meals for homebound senior citizens and arrange for sitters. In addition, we have a non-profit organization called The Homestead Hospice HOPE Foundation that is dedicated to educating and informing seniors and their families about ALL available resources so that they can make the best choices for the rest of their life.
Through the foundation, a network of highly regarded resources has been created to offer assistance. You can learn more about the Homestead HOPE Foundation and the resources available by clicking here.
Does it make a difference if the hospice is a “for profit” or “not for profit” organization?
Non-profit agencies aren’t always better than for-profit. There are some really bad non-profit agencies and some really good for-profit. You shouldn’t let ownership of an agency be your deciding factor. The focus should be on how the hospice cares for the patients and families they serve. The best way to choose a hospice company is to ask questions based upon your needs and make a determination on which hospice to choose based on those answers.
Will my loved one be admitted even if we have no payment source?
Hospice companies, by law, must accept all patients regardless of their ability to pay. The Homestead Hospice HOPE Foundation helps to cover the cost of professional services, medications, durable medical equipment, and emergency assistance for patients without a payment source.
Will care under hospice be terminated if my loved one is still alive after six months?
Homestead Hospice follows the Medicare Hospice Benefit, which allows re-certification after a six-month period based on the patient continuing to meet hospice eligibility criteria. We will not terminate a patient’s care based on time in the hospice program. That decision is made solely based upon whether the patient is clinically appropriate to receive hospice care.
Can I expect regular in-person visits from the hospice chaplain?
The Homestead Hospice pastoral care staff includes six chaplains from varying religious backgrounds. The Chaplains visit each patient based on the needs of that patient and family. Typically, the chaplain will make one to two visits per month, but can visit more often if necessary or requested.
Does the hospice program provide a volunteer to visit patients or assist the family with errands?
Homestead Hospice & Palliative Care has a dedicated Volunteer Coordinator for each office that is responsible for recruiting, training, retaining and scheduling our volunteers. Our volunteers share our belief in the right of each person to spend their final months in peace and comfort.
Hospice volunteers are generally available to provide different types of support to patients and their loved ones including running errands, preparing light meals, staying with a patient to give family members a break, and lending emotional support and companionship to patients and family members. Because hospice volunteers spend time in patients’ and families’ homes, each hospice program generally has some type of application and interview process to assure the person is right for this type of volunteer work. Homestead Hospice & Palliative Care volunteers go through an extensive training program. Areas covered by these training programs often include understanding hospice, confidentiality, working with families, listening skills, signs and symptoms of approaching death, loss and grief and bereavement support.
To volunteer or to learn more about the Homestead Hospice Volunteer Program, click here.
Can the hospice program still manage my care or that of my family member if I need to go to the hospital?
Under hospice care, the patient may be hospitalized to control heightened symptoms. If the patient chooses a hospital that the hospice is contracted with, they can stay on service with that hospital. Or, they can go to a hospital of their choice and revoke hospice while they are in the hospital. The hospice can be re-elected after discharge from the hospital.
How inclusive is the program of bereavement care?
The bereavement counselors who specialize in grief therapy are available to our families for up to 13 months after the loss of a loved one. They offer a comprehensive program of individual counseling, support groups, workshops, and letter programs at no cost to family members. In addition, Homestead Hospice, through it’s HOPE Foundation, offers an annual Bereavement camp for families. For more information on Camp Monarch, click here.
Does the hospice have an on-going program to monitor the quality of care provided to its patients?
At Homestead Hospice & Palliative Care, quality is our main focus. That is why we chose to go through Joint Commission “deemed status” accreditation. When accredited, the hospice has in place several measures of quality care. One example of such measure is the Family Satisfaction Survey, sent to the primary care giver approximately one month after the patient’s death. That survey helps us determine -- among other factors -- our rate of success in managing the patient’s pain and discomforting symptoms, educating the family members in the care of their patient, and preparing the family emotionally for the death of their patient. Another measure is a survey completed by family members in the bereavement program. That survey helps us determine how well we have helped family members cope with their loss after the patient's death.
© 2012 Homestead Hospice
What is Hospice?
Homestead Hospice does not discriminate against any person on the basis of race, color, national origin, disability or age in admission,
treatment or participation in programs, services and activities or in employment.