Caregiving > Evaluating Hospice and Home Care Options

At some point in the caregiving process, the primary caregiver may become aware that they can no longer solely provide for their loved one’s physical and emotional needs. If the patient has expressed a desire to remain in their own home rather than in hospital or nursing home care, the hospice option may be explored.

Hospice Care

The function of hospice is to provide professional medical care, to manage pain and other symptoms and to meet the patient’s social, emotional and spiritual needs. The hospice philosophy allows patients to be at home, close to family and friends, while still under professional medical supervision. It is sensitive, dignified health care. Following are some points of the hospice concept as defined by the Hospice Foundation of America.

• Hospice is a concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to aggressive, cure-oriented treatments.
• Hospice care is provided by a team-oriented group of specially trained professionals. This team consists of physicians, nurses, aides, social workers, spiritual caregivers, counselors, therapists and volunteers. Patients and families who choose hospice care are the core of the hospice team and are at the center of all decision making.
• The goal of hospice care is to improve the quality of a patient’s life by offering comfort and dignity while addressing all symptoms of disease. The hospice team works with the patient and their family to develop a personalized care plan, reviewing and revising the plan as the patient’s condition warrants.
• Hospice deals with the emotional, social and spiritual impacts of disease not only for the patient, but for the patient’s family and friends as well.
• Hospice care is covered under Medicare for patients with a prognosis of six months or less. This benefit covers all services, medications and equipment related to the illness including physician services, nursing services, home health aids, medical appliances and supplies, spiritual, dietary and other counseling, continuous care during crisis periods, trained volunteers and bereavement services. Hospice care services are also provided under many private health insurance policies and HMOs, as well as by Medicaid in many states.

Home Care

Unlike hospice programs which offer only palliative care (that which treats the symptoms of the disease), home care services may include treatment that aggressively targets the mesothelioma cancer. Home care is provided through both for-profit and non-profit private agencies, public and private hospitals and public health departments. Members of the health care team visit the patient at home, and can provide treatments, pain medications, nutritional supplements, physical therapy and many complex nursing and medical care procedures.

Members of a health care team, which often include doctors, nurses, and social workers as well as family members, address the specific needs of the patient and coordinate efforts to administer treatment and make the patient comfortable. Like hospice care, home care can also manage pain and reduce other symptoms. Additionally, they have access to medical equipment which the patient may need, and may help the primary caregiver by running errands, preparing meals, or assisting with personal hygiene. The primary care physician monitors his patient through members of the team and keeps in contact by phone and with office visits.

Most insurance plans cover brief home visits. Twenty-four hour care, performed by trained volunteers, often is not covered by insurance. Benefits of private health care policies may vary according to the plan purchased. While policies generally pay for services administered by skilled professionals, the patient may be responsible for a deductible or co-payment. Many HMOs require that home care be implemented by authorized agencies. It is always best to check with your insurance company about your coverage.

Government-sponsored programs such as Medicare, Medicaid, the Older Americans Act and the Veterans Administration cover home care for those who meet their criteria. For information on these agencies, call the numbers listed below or visit them on the web.

MEDICARE

MEDICAID

Contact your local state welfare office, state health department, state social service agencies, or your state Medicaid office.

THE OLDER AMERICANS ACT

Contact your local Administration on Aging (AOA) for information and referrals to services and benefits in your community.

VETERANS ADMINISTRATION

NATIONAL ASSOCIATION FOR HOME CARE

More on hospices

Administration on Aging's handout on hospice (MS Word document)