1. What can we expect from the Autumn Journey Hospice staff?
Our interdisciplinary team is made up of very experienced health care professionals and volunteers. Each is highly skilled and specially trained to meet the needs of the terminally ill and their families.
The team is headed by our hospice Medical Director who, together with the patient, his/her family and primary physician, determines the patient’s eligibility for hospice. The Medical Director consults with the patient’s primary physician and the interdisciplinary team to develop the patient Plan-of-Care. With the help of the hospice team, the Medical Director also monitors the patient’s condition and prescribes palliative medications as needed to ensure that the patient is comfortable.
Our Registered Nurse Case Managers make regularly scheduled visits to the patient to provide expert pain management and symptom control care. The Case Manager provides training and counseling to the primary caregivers and patient so that care is provided properly and safely. The Case Manager also keeps the primary physician and our Medical Director informed about the patient’s condition. Support from our Registered Nurses is available, as needed, on a 24/7/365 basis.
Social workers provide assistance with practical and financial concerns as well as emotional support, counseling and bereavement follow-up. They evaluate the need for volunteers and other support services needed by the family and facilitate communication between the family and community agencies.
Chaplains provide non-denominational spiritual support to patients and families, often serving as a liaison between them and their religious community. They offer support services ranging from crisis help to private and group grief support. Chaplains also often assist with memorial services and funeral arrangements.
Our Certified Nursing Aides function as home heath aides, providing personal care and assistance with activities of daily living, feeding and bathing and hands-on care. They also perform limited household services to maintain a safe and sanitary environment in the areas of the home used by the patient.
Trained volunteers provide a number of important services. Volunteers offer direct patient support, companionship and practical, caring help. Volunteers can assist the primary caregivers by sitting with the patient to provide the caregivers respite from the sometimes overwhelming task of providing around the clock care for a loved one. Volunteers may also provide non-direct patient support by assisting the agency in its office and clerical work.
Finally, the most important thing you can expect from the Autumn Journey Hospice staff is an aggressive, passionate belief in, and adherence to, our philosophy of hospice patient care. Our philosophy is best described by the following verse.
“Now take my hand and hold it tight.
I will not fail you here tonight.
For failing you, I fail myself
And place my soul upon a shelf
In Hell’s library without light.
I will not fail you here tonight.” 1
2. When is hospice appropriate?
Hospice care becomes an appropriate method of care when a patient has reached the last phase of a life-limiting illness or condition. The subject of hospice care can be addressed at any time as the physician and patient discuss treatment options.
When a patient chooses hospice, the decision is made to give up curative measures in favor of comfort care that focuses on pain management and symptom control, as well as emotional and psychosocial support for both patient and family.
3. Should I wait for our physician to bring up the subject of hospice
or can I ask about it first?
The decision to choose hospice should be made by patient and family with the input of a physician. Open and honest discussions about treatment options should be held throughout the course of the illness. If a patient or family feels that a physician is reluctant to discuss hospice care, it is always appropriate for one or the other to approach the subject.
4. What if our physician doesn’t know about hospice?
Most physicians know about hospice. However, if your physician would like more information, he or she may call us at (972) 233-0525 or email us at wecare@autumnjourneyhospice.com
5. When should a decision about entering a hospice program be made and
who should make it?
At any time during a life-limiting illness or condition, it is appropriate to discuss all of a patient’s care options, including hospice. By law, the decision regarding hospice care belongs to the patient.
There is no definite time because each patient/family situation is different; however, Medicare studies and our own experiences have shown that early referrals are very beneficial for the patient both physically and emotionally. Hospice care should be considered when the patient enters the final stage of life and the patient/caregiver/family need help and counseling to adjust to the diagnosis, learn how to care for the patient at home and prepare for future changes.
Understandably, most people are uncomfortable with the idea of stopping an all-out effort to overcome an illness or condition. Autumn Journey Hospice staff members are highly sensitive to these concerns and are always available to discuss them with the patient, family and physician.
We would like to take this opportunity to clear up a misconception regarding the Medicare Hospice Benefit. Unfortunately, many people believe the use of the Medicare hospice benefit somehow guarantees that the patient has less than six months to live. We offer the following explanation and clarification from Medicare regarding its hospice benefit program.
“Generally speaking, the hospice benefit is intended primarily for use by patients whose prognosis is terminal, with six months or less life expectancy. [However], the Medicare program recognizes that terminal illnesses do not have entirely predictable courses.”
“Recognizing that prognoses can be unpredictable and may change, Medicare’s benefit is not limited in terms of time. Hospice care is available as long as the patient’s prognosis meets the law’s six month test. This test is a general one……based on the physician’s and/or Medical Director’s clinical judgment regarding the normal course of the individual’s illness. Medicare recognizes that making medical prognostications of life expectancy is not always an exact science.”
6. Where do I go to get hospice care?
Autumn Journey Hospice provides the majority of its care in a patient’s home, with family and friends acting as caregivers. If the patient no longer lives at home, we can provide care in retirement homes, nursing homes, residential assisted living homes, or other types of assisted living facilities. If a patient requires inpatient care in order to address severe symptoms or to provide respite for a caregiver, we will arrange that for the patient. There is no charge to the Medicare patient for inpatient care. Many private insurance plans also pay for this service.
7. Is it true that hospice is where you go when there is “nothing else to be done”?
Hospice is the “something else” that can be done for the patient and family when the illness or condition becomes life- limiting. It is a concept based on comfort-oriented care. Referral to hospice is a movement into another mode of care which is more appropriate.
8. What if I don’t understand what is happening and don’t know how to
make the right decisions?
Autumn Journey Hospice provides patients and families the information and education they need to make informed decisions about hospice and the patient’s Plan of Care. Our Links to Information Resources on this website would be a good place to begin your research. The patient and family should also consult with the patient’s physician and the members of the hospice Interdisciplinary Team to ensure that all questions are answered and all concerns are discussed
9. What does the admission process involve?
A phone call to Autumn Journey Hospice at (972) 233-0525 is all that you need to do to start the admission process.
One of the first things we will do is contact the patient’s physician to make sure the physician agrees that hospice care is appropriate for the patient. One of our registered nurses will then visit the prospective patient and family to ask important questions about the illness and previous treatment, as well as questions about the home and family situation that would affect care giving.
The nurse will explain what the patient and family can expect from the hospice, how hospice provides care, the services that are available and information on the illness or condition that will help prepare the family for the coming days. Medicare and/or other available benefits also will be discussed at that time.
10. How do I refer someone to Autumn Journey Hospice?
A referral can come from the attending physician, a family member, a friend, clergy, a health care provider or even from the patient. You only need to call our office at (972) 233-0525 to provide your referral.
11. Can I keep my own doctor?
Yes. If that is your desire, your doctor will continue as your primary physician and will approve your admission to hospice care, delivery of services to you and changes in your Plan of Care. The hospice team members will work closely with your doctor in administering and providing your care.
However, you and your doctor may also elect to have our Medical Director assume primary responsibility for your hospice care, since Hospice Medical Directors have extensive experience and expertise in the full spectrum of hospice and palliative care. In either case, Autumn Journey Hospice functions as an extension of, not in place of, your primary physician. Even if our Medical Director has primary responsibility for your care, your physician will always be given updates on your status and the status of your care. Your physician also will continue to provide non-hospice related services to you and will be able to continue billing Medicare for the non-hospice related services he provides.
Our Medical Director is also available to help patients who do not have a primary physician.
12. Who pays for hospice services?
Hospice care coverage is widely available. Autumn Journey Hospice is a state licensed and Medicare certified agency. For those eligible for Medicare Part A benefits, all hospice care costs are covered. Many private insurance carriers pay 80% to 100% of hospice charges up to a pre-determined limit. To be sure of private insurance coverage, families should, of course, check with their employer or health insurance provider. In some cases, the patient may elect to pay for services directly.
13. If the patient is eligible for Medicare, will there be any additional
expenses to be paid?
Medicare covers all services and supplies related to the terminal illness or condition for the hospice patient. Although Medicare does allow the hospice provider to collect a 5% co-pay on medications, preferred hospice providers do not ask for this payment. Autumn Journey Hospice NEVER asks for any payment of any kind from its Medicare patients.
14. Do I lose any Medicare benefits because I am on hospice care?
If you are using your Medicare Hospice Benefit, it is important to understand that the hospice agency only uses that portion of your Medicare Part A benefit (hospitalization) related to the medical diagnosis or condition that qualified you to receive hospice care. The remaining portion of your Medicare Part A benefit and all of your Part B benefit (physician visits) continue to be available for your use. You will still be able to consult with your physician on any issue that does not involve the diagnosis or condition that made you eligible to receive hospice care. Your physician also will be able to continue billing Medicare for the non-hospice related services he provides to you.
15. I’ve heard that hospice agencies provide unnecessary services so they can
make more money. I’ve also heard that hospice agencies can use up my Medicare benefits by providing unnecessary services. Is this true?
Our answer to this question is long because we want you to understand how your Medicare Hospice Benefit works.
Unlike most other providers in the healthcare industry, hospice agencies do not bill Medicare for specific services. Hospice agencies are paid a fixed per diem amount for the hospice care they provide. This being the case, you should actually be concerned if you see LESS rather than MORE hospice services provided.
The only way a hospice agency can increase its net revenue is by controlling its costs. The primary way to control hospice care costs is by limiting the amount of care provided. So, you should monitor the hospice agency to ensure that an adequate number of regularly scheduled visits are made by ALL the members of the Interdisciplinary Team….that is, the Registered Nurse Case Manager, the Social Worker, the Chaplain and the Home Health Aide. You should ensure that you understand the Plan of Care developed for the patient by the Interdisciplinary Team members and our Medical Director, and approved by the patient’s physician. Our team visits and all aspects of care, including medications, are based on this Plan of Care.
Typically, you should expect:
- Case Managers to visit at least twice each week and more if necessary.
- Social Workers to visit two to three times each month and more if necessary.
- Chaplains to visit two to three time each month and more if necessary.
- Home Health Aides to visit at least three times each week. We typically increase this to five or six times each week, if the patient needs the added visits.
As part of your due diligence in choosing a hospice agency, you should ask each hospice agency what type of staff visitation schedule they use and what the schedule is based on.
Some hospice agencies will limit expenses by asking the patients to pick up their prescriptions at the pharmacy. We always deliver to your door.
Some hospice agencies may ask for a 5% co-pay for each prescription they provide. We never have and never will.
It is not possible for a hospice agency to “use up your Medicare benefits” since hospice agencies are only entitled to bill Medicare for that portion of your Part A (hospitalization) benefit that specifically applies to hospice care. In fact, Medicare reimbursements to hospice agencies are limited to an maximum amount per patient. This limitation, or “cap”, is approximately equal to 150 days of patient care.
So, you may wonder, what happens at the end of this 150 day period, if the patient continues to receive hospice care? The short answer, as it applies to the patient, is that nothing changes. Care continues at the same quality and amount as it did for the first 150 days.
There is a simple explanation for this. In order for a hospice agency to maintain its Medicare certification, the agency MUST continue to provide all services in this manner. Also, the agency can NEVER discharge a Medicare patient from hospice care simply because the “cap” limitation has been reached. To ensure care continues to be appropriate, Medicare requires its member hospice agencies to maintain meticulous records for each patient to demonstrate the quality and amount of care being provided. These records must always be available for Medicare/State inspectors. You should never be concerned that Medicare hospice care might stop or that the quality of care might deteriorate.
If you have concerns about any aspect of the care the patient is receiving, you should discuss them with the members of the Interdisciplinary Team and the hospice agency until you are satisfied. If you still have concerns after these discussions, then you may want to consider transferring to a different hospice. Please see Question 20 for an explanation of the transfer process.
16. Are you a for-profit or a non-profit agency?
We are a for-profit agency. We bill Medicare and private insurers for our services to our patients. The difference between us and a non-profit agency is that we have a very specific and well defined revenue stream based on the number of patients we serve and the specific providers we work with.
The aspect of non-profit hospices that is sometimes overlooked is that a non-profit hospice has the very same expense structure that for-profit hospices do. The primary difference between the two is the source of revenue.
Non-profit hospices derive revenue from patients who have Medicare, Medicaid and private insurance coverage. For patients who do not have any type of hospice coverage, the non-profit agency relies on personal and charitable donations, grants, fund drives and the net revenue it gains from patients who do have hospice coverage. In the event of a financial shortfall, the non-profit must either limit the number of non-revenue patients it serves and/or the level of services it provides to its patients.
The for-profit agency is limited only by its ability to increase the number of patients that it serves. As its patient census increases, the for-profit agency is able to add additional staff and continue to grow. It literally controls its own destiny, while the non-profit agencies are, to an extent, captive to the amount of funding they receive.
Both for-profit and non-profit agencies have their places in the home health services community. Both provide valuable and necessary care for their patients. Most importantly, both provide care according to well established, detailed criteria mandated by the State and, where applicable, Medicare.
17. What if I do not haveMedicare, Medicaid or private insurance or enough
personal income to pay for services?
While our services are limited to those patients covered by Medicare, private insurance or direct pay, no one is ever denied hospice care due to inability to pay. Should you be in that situation, we will be happy to assist you with a referral to a hospice source appropriate for your needs.
18. When does hospice care stop?
Hospice care is provided as long as the patient continues to meet the Medicare, Medicaid or private insurance enrollment criteria and desires to have hospice care.
We also provide bereavement care for the family after the patient expires. Medicare requires hospice agencies to provide twelve months of bereavement. Autumn Journey Hospice provides bereavement care as long as required, without regard for any time limit.
It is important to understand that a Medicare certified hospice agency cannot terminate a patient’s Medicare Hospice Benefit unless one of the following conditions (listed in the Medicare Conditions of Participation) occurs. These conditions are the ONLY conditions that can terminate Medicare funded hospice care.
- The patient moves out of the hospice agency’s service area or decides to transfer to another hospice.
- The patient makes the decision to resume curative treatment. In this case, hospice care may be revoked and the patient immediately resumes his regular Medicare coverage. The patient may, at any time, return to hospice care by re-enrolling with Autumn Journey Hospice or another hospice provider.
- The patient is no longer eligible for hospice care, as determined by the patient’s primary physician and our Medical Director.
- The patient’s (or other persons in the patient’s home) behavior is disruptive, abusive or uncooperative to the extent that delivery of care to the patient or the ability of the hospice to operate effectively is seriously impaired. The hospice agency must do the following before it seeks to discharge a patient for cause:
- advise the patient (or patient’s representative, if patient is unable to make
decisions) that a discharge for cause is being considered;
- make a serious effort to resolve the problem(s) presented by the patient’s
behavior or situation;
- ascertain that the patient’s proposed discharge is not due to the patient’s
use of necessary hospice services;
- document the problem(s) and efforts made to resolve the problem(s) and enter
this documentation into the patient’s medical records maintained by the hospice
agency.
19. Can an Autumn Journey Hospice patient who shows signs of recovery be
returned to regular medical treatment?
Certainly. The patient always has this option. If improvement in the condition occurs and the disease seems to be in remission, the patient can be discharged voluntarily from hospice and return to aggressive therapy or go on about his or her daily life. If a discharged patient should later need to return to hospice care, Medicare and most private insurance companies will allow the patient’s remaining benefit to be used.
20. What if a Medicare hospice patient wants to transfer to a different
hospice agency?
The Medicare hospice patient has the right to transfer from one hospice agency to another once during EACH benefit period without loss of any Medicare hospice benefits. Should a patient decide to transfer a second time during a benefit period, he or she would forfeit the remainder of the current benefit period. However, since the Medicare benefit includes an unlimited number of 60-day periods, the patient would not forfeit his or her total remaining hospice benefit.
The transfer process is very simple, requiring only that the patient or the patient’s legal representative write a letter to each hospice agency. The letters need only indicate that the transfer is taking place and the date of the transfer. The letter to the previous agency should also contain a request that the patient’s records be transferred to the new hospice agency. Most agencies have transfer forms available that make the process even easier. The two agencies will then coordinate to ensure that the transfer is completed smoothly and safely.
21. Is there any special equipment or changes I have to make in my home
before hospice care begins?
Autumn Journey Hospice will assess your needs, recommend any necessary equipment and help make arrangements to obtain it. In most cases, required medical equipment is included at no charge as part of our service to you.
22. How many family members or friends does it take to care for
a patient at home?
There is no set number. One of the first things that Autumn Journey Hospice will do is prepare an individualized care plan that will meet the needs and goals of the patient and family. Our staff members visit regularly and are always accessible to answer questions and provide support.
23. How difficult is caring for a dying loved one at home?
It is never easy and sometimes can be quite hard. At the end of a long, progressive illness, nights especially can be very long, lonely and difficult. Autumn Journey Hospice has staff available around the clock to consult with the family and to make night visits when appropriate.
24. What if we have a problem on a
week night, weekend or holiday?
Help from the Autumn Journey Hospice team is available on a 24/7/365 basis. We have Registered Nurses on call to resolve concerns by telephone, or if necessary, with a visit. We are always there for the patient, the caregivers and the family.
25. Does Autumn Journey Hospice do
anything to make death come sooner?
No.
Autumn Journey Hospice does nothing either to speed up or slow down the dying process. Just as doctors and nurses lend support and expertise during the time of childbirth, so hospice provides its presence and specialized knowledge during the normal progression of the dying process.
26. How does Autumn Journey Hospice manage pain?
Our registered nurses and doctors are highly experienced in hospice and palliative care. They work diligently to remain current on the latest and most effective medications and devices for pain and symptom relief. We also believe that emotional and spiritual pains are just as real and in need of attention as physical pain, so we address these as well. Counselors, including pastoral counselors, are available to assist family members as well as patients.
27. What is Autumn Journey Hospice’s success rate in controlling pain?
According to our patients, our success rate is very high.
Using a combination of medications, counseling and therapies, most patients attain a level of comfort that is acceptable to them.
28. Will medications prevent the patient from being able to talk or
know what is happening?
Usually not.
It is our goal to help patients be as comfortable and alert as they desire. By constantly consulting with the patient, caregivers and family, Autumn Journey Hospice has been very successful in reaching this goal.
29. Does Autumn Journey Hospice provide any help to the family
after the patient dies?
The Medicare Hospice Benefit provides bereavement support for family members and loved ones for a period of 13 months. We provide continuing contact and bereavement support to family members and loved ones as long they need us.
30. Is Autumn Journey Hospice affiliated with any religious organization
or other hospice?
No.
We are a locally owned and independent organization. We serve the entire community and do not ask or expect patients to adhere to any particular religion or set of beliefs. We accept patients without regard for age, disability, race, color, creed, sex or sexual preference.
31. Is hospice care more expensive than regular care?
No.
Studies have shown that hospice care is no more expensive than regular care. Frequently it is less expensive than conventional care during the last six months of life. Comfort care is provided rather than curative care and family, friends and volunteers provide 90% of the day-to-day care at home. If the patient has Medicare Part A benefit coverage, the Medicare Hospice Benefit, including medications, medical supplies and medical equipment, is provided at no cost.
32. How does Autumn Journey Hospice use and/or disclose my personal health
care information?
Autumn Journey Hospice maintains privacy protection and adheres to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).More information on this can be found in the Notice of Privacy Practices.
1. Dean Koontz, By The Light Of The Moon (Bantam Books, Random House, 2002); Prologue
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