The Scope of Hospice Care

In response to your article printed in the December 15-22 issue regarding the Spreading Appreciation for the Benefits of Hospice Care you provided a clear picture of care provided by the hospice team, it’s under utilization, the hurdles pertaining to physician referrals, the new Medicare rules, and the Medicare cuts for hospice care. However, you fail to clarify the inpatient level of care and 24 hour home care requirements, which implies that these services are typical for all hospice patients. Although a hospice agency is able to provide inpatient level of care and 24 home care to patients in need of these specific services, these services are short term in nature and not the typical setting in which hospice is provided for most patients. The inpatient level of care reimbursement may be as high as $601 per day, depending on where you live, and it covers the cost of the room in which the patient is located (the skilled setting), the medications, ancillary services, and the hospice team. Likewise, the $789 per day for 24 hour home care also depends on where you live, and it covers the cost of the caregiver (nurse, certified nurse assistant) and all other hospice related expenses. In reality, most hospice patients receive routine level of care, which is the caring for the hospice patient at home. The reimbursement for routine care is approximately $120 to $ 140 per day and this amount has to cover the cost of the medical equipment, medications related to the diagnosis, the hospice team, and keep the hospice organization afloat. This “generous” dollar amount as barely covers the cost for many patients. With the rising cost of hospitalizations, treatments and services, Medicare is saving money when patients enter hospice care, not generously covering the cost of care. Yes, the new Medicare rules for providers will improve on quality of care standards and improve on day to day management, but the cuts will limit the services that are now provided. Yet, the one question asked by many families is, “hospice doesn’t provide nursing home room and board or live in caregivers”, the answer is, “Medicare does not provide for nursing home room and board or a live in care giver”. Although the Medicaid patient residing in a nursing home has coverage for room and board, the Medicare patient does not. Maybe since Medicare is saving hundreds of dollars because the hospice patient is at home, and not in the hospital, it could provide for 24 hour homemaker services to those that need this service or match the services provided by Medicaid.

Rhonda Jones of IL 1:38AM January 24, 2009