Table 4. Common misconceptions about hospice care 30 Misconception Clarification Patients will be discharged from hospice if they do not die within six months.
There used to be a six-month regulation that penalized hospices and patients when a patient lived too long, but it was revised and there is no longer any penalty for an incorrect prognosis if the disease runs its normal course. Medicare does not require a DNR order to enroll in hospice, but it does require that patients pursue palliative, not curative, treatment; individual hospice organizations may require a DNR order before enrolling a patient. Medicare does not require a primary caregiver, but this may be a requirement of some hospice organizations. Most hospice organizations encourage primary physician involvement; the primary physician becomes a part of the team and contributes to the hospice plan of care. Anyone with a life expectancy of less than six months and who chooses a palliative care approach is appropriate for hospice. Most commercial insurance companies have benefits that mimic the Medicare Hospice Benefit; individual hospices vary in their willingness to take uninsured patients. This was once true, but Medicare now covers patients in nursing homes. Patients who want to return to hospice care can be readmitted as long as hospice conditions of participation are met. Anyone (e.g., nurse, social worker, family member, friend) can refer a patient to hospice. Medicare requires that hospice must cover all care related to the terminal illness; individual hospice agencies are allowed to determine whether a specific treatment is palliative (providing symptom relief), which will guide what treatments they are willing to cover. Each insurer has rules defining eligibility for covered services; medical problems unrelated to the terminal illness continue to be covered under regular Medicare insurance. While the patient is enrolled in hospice, most insurance companies, including Medicare, will still cover hospital admissions for unrelated illnesses, as well as for the management of symptoms related to the terminal diagnosis, and respite care. All hospice programs must provide families with bereavement support for up to one year following the death of the patient.
Patients in hospice must have a DNR order.
Patients in hospice must have a primary caregiver. The primary physician must transfer control of his or her patients to hospice. Only patients with cancer are appropriate candidates for hospice. Only Medicare-eligible patients may enroll in hospice. Patients in nursing homes are not eligible for hospice. Patients are not eligible for hospice again if they revoke the hospice benefits. Only physicians can refer patients to hospice. Hospice care precludes patients from being able to receive chemotherapy, blood transfusions, or radiation. Patients who have elected the hospice benefit can no longer access other health insurance benefits.
Patients in hospice cannot be admitted to the hospital.
Hospice care ends when a patient dies.
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Book Code: CA23CME
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