Who is eligible for hospice?
When an illness is no longer curable, hospice care enables patients to live out their days as fully and comfortably as possible with dignity and respect. Yet the end-of-life journey brings with it emotional and practical burdens that can affect the whole family.
At Nathan Adelson Hospice, we reduce those burdens through the delivery of physical, emotional, social and spiritual care. Even if you understand the advantages of hospice, you may not know if you or your loved one is eligible for hospice care or if your insurance will cover the costs.
Let’s answer these important questions.
What are the medical requirements for hospice?
Hospice is for people who have a limited life expectancy or life-limiting illness.
Patients eligible for hospice care often have recurrent infections, progressive weight loss, changes in cognitive and functional abilities, reduced ability to participate in daily living and deteriorating mental abilities. These complex healthcare needs can burden a patient and family with frequent hospitalizations during a long-term illness.
The main medical requirement for hospice is a physician’s prognosis that their patient has a terminal illness with six months or less to live. This doesn't mean the patient will definitely die during the next six months. There are many factors that determine health decline.
The detailed medical requirements for hospice eligibility are clinical and available on our website here.
In general, patients who are eligible for hospice care are suffering from these illnesses and conditions: heart disease, pulmonary disease, cancer, severe dementia, liver disease, renal disease, stroke, and coma.
Who makes the hospice referral?
While a referral to hospice begins with a physician’s diagnosis, other caregivers may refer a patient to hospice. The list includes physicians, discharge planners, social workers, family members, nursing homes, friends or clergy. Patients are also able to refer themselves.
To discuss a hospice referral, call Nathan Adelson Hospice’s qualified admission personnel at 702.733.0320 to answer any questions you have. Once the staff at Nathan Adelson Hospice receives the referral, they can verify that the patient is eligible for hospice.
Why sign up as soon as possible after the referral and confirmation of eligibility?
It’s important to sign up for hospice care as soon as eligibility is determined. That way, the hospice care team, comprised of physicians, nurses, certified nursing assistants, social workers, specially-trained volunteers, and spiritual care providers can work with the patient’s physician to create the most effective care plan. This allows the care team to begin providing comfort and support as soon as possible and begin to meet the immediate needs of the patient and family.
And since most hospice care takes place wherever the patient calls home, an early start allows for a longer and more comfortable delivery of care.
Will my insurance cover hospice?
Hospice eligibility has slightly different guidelines depending on whether the patient has Medicare, Medicaid or private insurance. The Nathan Adelson Hospice staff can assist in gaining verification that a patient with a life-limiting illness qualifies for hospice care coverage.
Typically, Medicare patients are fully covered for all Nathan Adelson Hospice services related to their terminal illness and have no out of pocket expenses, no deductible, and no copayment. Medicare patients seeking hospice care must have Medicare Part A coverage and expressed a desire to pursue hospice care over curative treatment.
Most private insurance firms follow the federal Medicare hospice guidelines. But, since coverage varies somewhat from firm to firm, the eligibility and benefits must be determined on an individual basis to identify if certain deductibles or copayments apply. To see a list of the private insurance plans Nathan Adelson Hospice accepts, click here and select “How are hospice services paid for?”
For Medicaid patients, the physician must certify the patient has a terminal illness, the patient must agree to accept hospice care by completing an election form, and the physician must state the patient has a reduced life expectancy as indicated by their health condition.
At Nathan Adelson Hospice no one is turned away in their time of need, regardless of their ability to pay. This commitment is made possible by the generous and compassionate support of individuals and corporations who make donations to the Nathan Adelson Hospice Foundation.
How can I make my wishes known?
You’re the one who should decide what is best for you. Make sure your wishes are known by filling out an “Advance Directive” document. If you haven’t made your Advance Directives known, you can visit the free website www.decidingtomorrowtoday.org.
There you can easily download and fill out the Advance Directives Toolkit and the Durable Power of Attorney for healthcare.
Conclusion
Nathan Adelson Hospice has been our community’s trusted partner on the journey of care for over 40 years. We are always available if you have questions about hospice eligibility, insurance requirements or anything else related to a life-limiting illness.
We’re committed to fulfilling our vision that no one ends the journey of life alone, afraid or in pain.
