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A short history of hospice care

The term, hospice, was first used by Dame Cicely Saunders a physician who started giving care to the terminally ill in 1948 and created the first modern hospice facility, St. Christopher’s Hospice. From there, hospice care grew with the first states-based hospice being founded in Branford, Connecticut in 1974.

The Health Care Financing Administration (or HCFA) launched cost-effectiveness assessment programs at 26 American hospice facilities in 1979. Just a few years later, Congress included a hospice care provision for Medicare within the Tax Equity and Fiscal Responsibility Act of 1982. But it wasn’t until 1993 that hospice officially became a guaranteed national benefit.

Throughout many years of further research and changes made to the hospice care part of national care, in 2014, NHPCO celebrated 40 years of hospice care in 2016. And today, hospice is still a priority for end-of-life care.

Who should consider hospice?

According to Medicare guidelines, hospice care is for individuals with a life expectancy of 6 months or less, depending on the course of the illness or injury. However, exceptions can be given for those who live longer than 6 months if the medical director of the hospice care you choose will recertify the terminal illness. For hospice care, age does not matter, the only requirement is terminal illness or injury.

Hospice patients most frequently have the following illnesses:

1. HIV
2. Cancer
3. Stroke and Coma
4. Pulmonary Disease
5. ALS
6. Liver Disease
7. Dementia and Alzheimer’s disease
8. Adult Failure to Thrive

However, there are other diagnoses given the physician’s certification for the patient and their specific needs and health status.

Hospice care can also be given to patients no matter where they live. If the patient resides in a nursing home or assisted living facility, hospice care can still be enacted.

Eligibility requirements

If the patient is diagnosed with a terminal illness or injury, the first requirement is already met. However, other requirements will need to be met, depending on Medicare, Medicaid or private insurance coverage and the state you reside in.

Medicare

In order to be eligible for Hospice through Medicare, the patient must be eligible for Medicare Part A and have a certifiable diagnosis by a physician. The patient must also have a prognosis of 6 months or less to live if the disease is to continue its normal course. You can see these requirements here.

If these requirements are met, Medicare will allow the patient a one time visit with an employee or medical director of the hospice facility for an interview for hospice care. This interview will discuss pain management needs, counseling and any advanced care planning that must be done.

This interview can only be given to patients with a terminal diagnosis, who have not made a hospice election as of yet and those who have not had previous pre-election services. Other requirements may be needed depending on the state of residence for the patient.

Long-term care insurance

Individuals with private long-term care insurance that are not eligible for Medicare or Medicaid can also receive hospice care, depending on their plan details. The plan itself will have coverage predetermined for these patients with payments outlined within their elected benefits. With private insurance companies, the eligibility requirements will differ from one to another. However, the major companies will agree that hospice should only be given to patients that are deemed terminally ill by a physician with a certification of care performed. It is best to check with the patient’s insurance company for the requirements per the health insurance provider.

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