Does Medicare Cover Hospice?

Many people are still not very familiar with Medicare and hospice.  It is actually a fairly new idea.  The “end of life movement” began in the ’70s.  (The “end of life movement” is separate and distinct from the Euthanasia movement and organizations, like the Hemlock Society.)  Medicare did not cover Hospice when Medicare started in 1965.  Medicare and hospice were only put together in 1982 as part of the Tax, Equity, and Fiscal Responsibility Act under President Reagan in response to a growing awareness of end of life concerns.  The legislation was an attempt to fill the gap in care.  Awareness was growing in the country of the importance of what transpired at the end of life.

A Happy Death Is Not A New Idea

I remember when I was a teenager.  My father was up before me in the mornings.  He would take me to school on his way to work.  I would see him praying when I came into the kitchen in the morning.  One time I asked him what he was reading.  It was a small devotional booklet.  He was praying the novena to St. Joseph for a “Happy Death.”  I was startled by the subject matter.

Teenagers don’t think much about death unless forced.  I had a buddy, Herbert Woltz, killed in a motorcycle accident my senior year in high school.  That was my abrupt intro to death.

I asked my father why pray for such a crazy thing as a “happy death”?  The two subjects were oxymoronic to me.  What’s happy about death?  He reminded me that is how the Hail Mary ends.  “Pray for us . . . now and at the hour of our death.  Amen.”

After birth, he said, death is the most important event in your life.  The difference, however, is you’re aware of what’s going on in the end, and you make the most important decisions of your life at “the hour of your death.”  Praying for a “Happy Death” is about minimizing the pain and maximizing your moment of entrance into eternity.  You’re asking for God and all the heavenly hosts to be at your side to handle the fear, pain, discouragement, and loneliness a person faces when approaching death and the moment of death.

I didn’t think much about what my father shared until many years had gone by and many friends and family members had passed away, including my dad.  Medicare and hospice are something with which I have had extensive experience.  Now I know why you would want to pay for a “happy death.”

End of Life Care Is Different

As a seminary student in St. Paul, Minnesota in the early 80’s, I was looking for a part-time ministry when I wasn’t at school studying.  I found the Hawthorne Dominicans.  The Hawthorne Dominicans is a Catholic women’s religious order devoted to the terminally ill.  They had a hospice facility near my college, so I would walk down to it and help out on weekends.  Most of the patients were cancer patients.  My work was minor cleaning, but mainly it was visiting with the patients.  Keeping up their spirits.  Show them someone cared as they were coming to the end of their lives, and I would join the sisters in prayer and mass for the residents.

While I was there, I got to know the sisters.  They were remarkable young ladies.  The convent was inside the hospice facility.  The nuns lived, prayed, and worked with their dying residents around them twenty-four hours a day.  The Hawthorne Dominicans were some of the happiest people I ever met.

Their foundress, Rose Lanthrop-Hawthorne, was the youngest daughter of the famous author, Nathanial Hawthorne, and a convert to Catholicism.  In her day, cancer patients were put on an island in New York harbor–Blackwell Island–because it was believed that cancer was contagious.  Many people, especially the poor, died in incredible misery, isolation, and squalor.

Medicare and hospice were a century away.  Rose, like Mother Teresa of our time, saw the face of Jesus in the poor, and she started a ministry to the dying among the poor immigrants of the New York slums.  The Hawthorne Dominicans is a purely American woman’s religious order.  Most woman’s religious orders in our country came from Europe originally.

End of Life Care Rediscovered With Hospice & Medicare

The end of life movement in our time found its origin during a 1967 lecture at Yale University by Cicely Saunders.  She introduced the idea that the dying needed specialized care that served their unique situation.  She later founded St. Christopher’s Hospice in London.

Dr. Elisabeth Kubler-Ross, MD research into death and dying identified five stages terminally ill patients go through.  Her popular and groundbreaking book, On Death & Dying, fueled a movement to deal with issues of death and dying.

In 1972 she testified at the first national hearings on death with dignity conducted by the U.S. Senator Special Committee on Aging.  Organizations, like The National Hospice and Palliative Care Organization (NHPCO), sprang up to study and promote awareness around the end of life issues.   Finally, because of raised public interest and concerns, Medicare added hospice care to the list of services provides in 1982.

Medicare And Hospice Are Huge

In 2014 approximately 2.6 million people died in the US.  Of those deaths, 80% were on Medicare.  Medicare is the largest insurer for persons during the last year of life.  A quarter of the Medicare budget is just for those who are in the last year of life.  That number has been consistent for decades.  The high cost of health care at the end of life is not surprising considering the number and complexity of health issues, so CMS (Center for Medicare & Medicaid Services) is acutely aware of end of life issues.

Today, hospice is an important benefit for terminally ill Medicare beneficiaries.  Currently, nearly half of Medicare beneficiaries receive hospice benefits before their deaths.  Medicare is the primary source of payment for hospice care in this country.  Yet, hospice still remains somewhat of a mystery, and Medicare beneficiaries know very little about what Medicare does with hospice until they are forced into the situation.

How Does Medicare Cover Hospice?

Hospice is defined as a program of care and support for people who are terminally ill.  Terminally ill means a life expectancy of six months or less.  The primary goal of hospice in Medicare is to help terminally ill people live a comfortable life and manage their pain and discomfort.  Hospice care is palliative care versus skilled nursing and home health care.  That is, it is not designed to cure the patient, but rather to aid the person in the dying process.  Because hospice care is so intimately involved and in such a big way with Medicare beneficiaries, understanding Medicare and hospice is essential.

Prayer to St. Joseph 

O St. Joseph whose protection is so great, so strong, so prompt before the throne of God, I place in you all my interests and desires. O St. Joseph do assist me by your powerful intercession and obtain for me from your Divine Son all spiritual blessings through Jesus Christ, Our Lord; so that having engaged here below your heavenly power I may offer my thanksgiving and homage to the most loving of fathers. O St. Joseph, I never weary contemplating you and Jesus asleep in your arms. I dare not approach while He reposes near your heart. Press Him in my name and kiss His fine head for me, and ask Him to return the kiss when I draw my dying breath. St. Joseph, patron of departing souls, pray for us. Amen.

John Joseph Grimmond 1934-2013  R.I.P.

What Is Medicare Hospice?

Death & dying is an area most people do not wish to ponder, so there are many misconceptions about Medicare-covered hospice care.

What Medicare Hospice Is Not?

Hospice is not a place.  When my mother was terminally ill with ovarian cancer, I was thinking of taking her to a place.

When I was in college in the 80s, I had volunteered in a hospice facility run by the Hawthorne Dominican sisters.  The hospice facility was an actual place people went to die.  The nuns took care of everything: medical, personal care, food & lodging; and patients stayed there until the end.

That is what I had in mind when the doctors spoke to my family about hospice for our mother.  That is not, however, how Medicare thinks of hospice. 

Medicare does not pay for a hospice facility that provides room & board unless the care is tied to something like a skilled nursing facility.  Medicare does, however, pay for hospice personnel and the medications they administer during hospice.

Where Do You Go For Hospice?

Hospice can be given virtually anywhere.  A Medicare beneficiary can receive hospice at a hospital, hospice in a skilled nursing facility, hospice in an assisted living residence, and hospice at home.  Medicare will pay for hospice care in assisted living, nursing homes, and other facilities if it is a Medicare-approved facility.

The end of life movement that started in the ’70s sees passing at home as the ideal.  Most Medicare patients, when surveyed, prefer hospice in the home.  That is where people feel most comfortable, but because of the level of care required, hospice care may have to move to a hospital in the last few days or another location.

Hospice can be given virtually anywhere. 

Medicare.gov

What Kind of Illness Makes You Hospice Eligible?

When we think of hospice, we usually think of cancer, but there are other illnesses that result in hospice.

Grandpa Joe was 98.  Grandpa had beaten cancer 4 times, lockjaw, and the Second World War.  Dying didn’t seem possible. He had always been there, and we grandkids assumed he would always be there. Terminal illness and Grandpa Joe didn’t fit. 

When Grandma Hilda announced to the family, Grandpa had congestive heart failure and was going into hospice, it didn’t quite register with us grandkids. 

Grandpa Joe seemed the same old Grandpa Joe. When I was home from college, we chatted about the Cornhuskers, baseball, and politics.  Nothing seemed to have changed, but there was a procession of nurses and therapists who came in and out of their home.

When Grandma Hilda finally called to tell us Grandpa had passed in his sleep, his death hit me like a sledgehammer.

Grandpa’s passing was hard on everyone, but Medicare providing and paying for hospice lightened the burden, especially for my parents and grandparents.

Who Can Go Into Hospice?

Hospice is also not exclusively for the old.  I have a number of clients who are in their twenties and thirties.  Not everyone on Medicare is sixty-five and older, though the majority are. 

Accidents or illnesses permanently disabled some, and some are terminal.  Hospice is for them too.

How Much Is Hospice?

Hospice care is not expensive for those on Medicare.  Medicare pays for the vast majority of the hospice costs under Medicare Part A with very little out-of-pocket costs.  Medications, some equipment, and nurses are covered. 

Like I said earlier, hospice does not usually include custodial care or housekeeping.  That can be very costly if the family cannot provide that type of care themselves.

How Do You Get Medicare To Pay For Hospice?

A Medicare beneficiary is eligible for Medicare’s hospice care benefit if she is entitled to Medicare Part A and meets the following conditions.

1. The hospice doctor and the person’s regular physician certify that the person is terminally ill with a life expectancy of six months or less if the illness runs its expected course.
2. The person accepts palliative care for comfort instead of care to cure her illness.
3. The person must sign a statement choosing hospice care instead of other Medicare-covered treatments for her terminal illness and related conditions.
4. The care is provided by a Medicare-certified hospice agency.

When these 4 critical are met, Medicare pays for hospice. At any time, a person may choose to exit hospice.

Is Hospice Euthanasia?

Hospice does not accelerate the dying process. 

I have had people describe hospice to me as akin to euthanasia where someone actively terminates a life.  Hospice is not euthanasia or assisted suicide.  You do not intentionally cut short a person’s life.  Hospice is about allowing the dying process to take its natural and inevitable course without assistance.  Hospice care is about alleviating the suffering and providing comfort while the person dies.

An uncle of mine was a retired Omaha police captain. Uncle Bill had a severe stroke with many complications.  He was put on a ventilator. 

Uncle Bill was a strong and courageous individual.  A vegetative existence was not for him not to mention impoverishing his wife with medical bills.  He ordered the ventilator turned off.

Without the ventilator, he would quickly stop breathing.  He knew it.  The doctors made him as comfortable as possible with heavy sedation.  His body fought hard against the loss of breath.

We gathered around his hospital bed.  Over the course of a day, he passed peacefully from this life to next surrounded by his loving wife and children.

Hospice Is Up To You

I’ve known many individuals over the years who have gone on hospice for a time.  Instead of dying, their health improved, or they resumed a normal life and quit hospice because the decline stopped.  You are free to remove yourself from hospice at any time.

Hospice Is Also For The Living

Hospice is the option when all other alternatives have been exhausted.  It is the option to bring the highest possible quality of life to a person’s remaining time.  The hope is family members will look back on their time and know that everything was done to preserve, prolong, and then peacefully say goodbye.

While you may struggle with the challenge of terminal illness, the end of your life and hospice is as much about your loved ones as it is about you.  Watching you suffer and your family’s grief afterward will be their burden.  Dying is equally about them.  Understanding that there is something for them as well as you in a scary time can give you all hope that the last great challenge in life will be a little less daunting.

While hospice ends with a patient’s death, family grief counseling can continue for up to a year.  Medicare pays for that hospice care too.

One’s mortality is difficult to face, but the chance you will go on Medicare hospice at the end of your life is more than 50%.  That is an extraordinary number, so having confidence Medicare will pay for hospice is critical.