When an individual enters the final stage of life, there are many questions that must be answered.
Let’s look at each of these questions. 1. Can the individual continue to live at home? The patient’s primary physician, the hospice Medical Director and RN Case Manager will be able to assess the patient’s condition and provide advice on the level and amount of care that will be needed. In the hospice environment, primary care normally is provided by a family member or another caregiver who may be a spouse, a significant other or a friend. The vast majority of hospice patients we serve are cared for in this manner. In some instances, the patient or family may choose to supplement care by using private sitters or companions. Remember that hospice care under the Medicare Hospice Benefit is provided at no cost to the patient or family. However, you must also remember that the Medicare Hospice Benefit does not include reimbursement for routine continuing patient care, such as companion care, sitters, attendants or homemakers. Private insurance companies may provide some coverage for these services, but you will need to discuss your coverage with your insurance company. If private insurance coverage is not available, then private care is an option, but the patient or family will be responsible for the costs incurred to employ private caregivers. The cost will depend on the amount of private pay care that the patient or family may elect to use, since all other services, drugs, medical supplies and medical equipment are provided by Medicare through the hospice agency. Private duty, unskilled caregivers, home companions, attendants and sitters hired through a home care staffing agency typically cost $16 to $18 an hour in the Dallas area. Agencies normally will certify that they have reviewed their employees’ work histories, references and civil/criminal histories. Agency employees typically will have had drug tests and will be bonded or the agency will have professional liability insurance coverage. You will want to confirm this with the agency. Most agencies will offer rate options, including discounts if the caregiver is hired for longer periods of time. The following are representative rates taken from the brochure of a specific agency.
Other periods of time are subject to negotiation depending on length of service (e.g., weekly or monthly). Most hospice agencies know private duty caregivers who may work for less than agency rates. Hospice agencies are aware of the quality of such caregivers’ work because these caregivers have worked for patients who are, or have been, clients of the hospice agency. However, such caregivers will not be affiliated with a staffing agency or the hospice agency and the hospice will provide no guarantees of any kind regarding their work or reliability. The patient/family will have the sole responsibility of completing any due diligence they may desire to determine if they wish to hire such caregivers. In some cases, the patient’s condition ultimately may require a level of care or an amount of care that the caregiver and family cannot provide. If the patient, family or patient’s representative determine that the patient can no longer be cared for at home, then the options described below should be considered. 2. If adequate care cannot be provided in the home, what are the options? In-Patient Hospice Facilities Nursing homes and residential assisted living homes are other options. Nursing Homes The patient passes the time either in his/her room or in a lounge-type common area typically located on the same floor. While patients usually have the ability to add items from home and arrange their rooms to provide more homelike surroundings, the rooms will still closely resemble a standard hospital room. The floors will be covered either with industrial carpeting or left bare in an effort to help the nursing home maintain cleanliness. Nursing homes rarely provide the feelings of security, comfort, familiarity and general “hominess” that patients associate with their own homes. Because the caregiver staffs typically rotate on a two or three shift basis, many different people may be involved with patient care, making continuity of care and personalized care more difficult. Questions you will want to ask the nursing home Administrator include:
You will also want to make a personal inspection tour of the facility, including the specific area where the patient will be living.
You should also ask each nursing home if it allows its residents to choose a particular hospice agency or if it requires residents to use an agency that it has selected. By Federal regulation (Code of Federal Regulations; Title 42, Section 418.24) every Medicare patient may choose a particular hospice. If the nursing home you are using does not choose to enter into a working agreement with the hospice of your choice, then it MUST assist you in finding a nursing home that does have a working agreement with the hospice you choose.
Residential assisted living homes are an entirely different approach to long term patient care. These homes are a relatively new concept in elder care and hospice care, although they are rapidly gaining popularity as more people learn about them. Such homes provide the atmosphere and care that we believe support the essential concepts of excellent hospice care. They provide a strong sense of a home-like atmosphere that promotes the patient’s personal comfort, physical and emotional well being, dignity and the feeling of being in a close knit family. They also provide more personalized care based on the caregiver’s more intimate knowledge of the resident. Residential assisted living homes are located throughout the North Texas area. In fact, you may have one in your neighborhood and not even realize it. These homes are no different than yours except for the fact that their interiors have been modified to accommodate residents with disabilities. Doorways have been widened, railings have been added to bathrooms and other modifications have been made to meet State standards. Residents rarely leave the home and you seldom notice any activity around the home that is any different than that around your own home. When you walk into a residential assisted living home, it will look exactly like your own home. It will have either residential style carpeting or hardwood floors. Each resident has his/her own room, almost always with its own bathroom. Some homes have a few semi-private rooms or rooms that share a bathroom, but private rooms with bathrooms are the normal configuration. All residents have access to all of the common areas of the home, just as they would in their own homes. Residents are able to live just as they would in their own homes. These homes typically house 4 to 8 residents depending on the size of the home. These homes have caregivers in the home around the clock to attend to the residents. Caregiver-resident ratios are typically 4 or 5 to one to ensure that each resident receives proper attention and care. All aspects of care are provided, including helping with the activities of daily living, ensuring that medication schedules are maintained, preparation of meals and so on. Since there are far fewer residents in these homes than in nursing homes, the caregiver staffs are much smaller. Staff members typically live in the home for one or two weeks at a time rather than the three shift operations used in most skilled nursing facilities. As a result, the caregivers get to know patients intimately, including their likes, dislikes and preferences, promoting a more family oriented and caring atmosphere for the resident. The Texas Organization of Residential Care Homes (TORCH) at www.txtorch.com is a good source of information on residential assisted living homes. You may also want to visit the Texas Department of Disability and Aging website for their list of long term care facilities. Their lists include both skilled nursing facilities and residential assisted living homes. This website provides a brief description of each facility and also displays the results of annual inspections made by the State. Costs of Nursing Homes and Residential Assisted Living Homes Residential assisted living homes and nursing homes are private pay facilities, meaning the resident must pay a monthly fee to live there. The Medicare Hospice Benefit does NOT include a provision for paying the monthly room and board costs to live in these types of facilities. Under certain conditions, Medicare does provide coverage for nursing home care, if the patient enters the nursing home directly from the hospital. However, this is not, and should not be confused with, hospice care coverage under the Medicare Hospice Benefit. Veterans should be aware that the Veterans Administration does have certain benefits that may apply to provide payment for some or all of such monthly expenses. Veterans should contact the Veterans Administration for more information. In the North Texas area, you can expect the monthly costs to be in these approximate ranges. 1. Nursing Homes
2. Residential Assisted Living Homes
So, where is the best place for a hospice patient to be……..at home, in a residential assisted living home or in a nursing home? Only the patient or the patient’s representative and family can make this decision. However, if your choice becomes limited to a nursing home or a residential assisted living home, the best way to evaluate the difference between facilities is simply to visit several facilities of each type. As with choosing a hospice, you should meet the staff members in each type of facility so you can determine who will provide the best and most personalized care. The differences between these types of facilities will be immediately obvious and will allow you to make an informed decision that is in the best interests of the patient. If you have immediate questions or comments, please call us.
Autumn Journey Hospice
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