Here I will answer a few of the questions we had when we decided to interview hospice. I am sure there are many more – I do not remember all of them. If you have a question, please feel free to send me a note.
Can I keep my own doctor?
In most cases, I believe this is a definitive yes. Many patients have established a wonderful relationship with their physician and have built up a trust in them. The physician must be willing to stay on as the primary care doctor and not all doctors may be willing to do this under hospice. If they are, and if the hospice program is agreeable, then the relationship can be maintained.
Although you may be using your own physician, they will likely be working in tandem with the doctor on staff with hospice. The hospice physician will be kept in the loop with actions regarding all patients.
In some cases when a patient enters hospice, they may still be willing and able to get to the doctor’s office which makes seeing the patient much easier. As disease progresses, there may come a time when leaving the house is no longer comfortable or no longer an option.
At that point, the nurse(s) assigned to the case will be the eyes and ears for the physician, if they are not already doing that. Nurses will keep ongoing notes that get passed along to team members.
If I am receiving feedings via IV (TPN) or via a feeding tube, can I be accepted into the hospice program?
Yes, definitely. Receiving nutrition is considered a basic necessity and is not a curative or life-saving treatment. Remember, the goal of hospice is to keep the patient comfortable and safe at home.
Who administers alternative nutrition?
The patient and/or their caregivers will administer the nutrition. They will be trained by hospice staff in the proper procedure to enable them to feel confident in handling the nutrition supplements as well as any equipment that is necessary.
How much will this cost?
Medicare and private insurers are billed directly from the hospice agency. As stated in a prior post, Medicare will cover hospice at 100%. Private insurers likely do the same but one would have to check with their plan coverage. Other costs that are covered under hospice are: Most medications needed, including some “maintenance medications” a patient may be taken, all wound care supplies, chux pads for beds, diabetic test kits and test papers, diapers for patients who are immobile, nutritional supplements as required for TPN or tube feeding as well as any incidental equipment necessary to operate the machines, oxygen. Also durable medical equipment such as hospital beds, bedside commodes, walkers, and so on. Basically, once a person is under hospice care, there is very little out-of-pocket expense required which can ultimately save patients hundreds of dollars over time.
Further, these items will all be delivered to the patients’ homes, removing the stress of needing to run out and get medicine, equipment, etc.
Personal story: Going home “with hospice” did not change what I was already doing in the way of personal care for George. What it did for me, though, was give me so much peace of mind that I would be fully supported and provided with the necessary assistance needed to keep him comfortable and safe at home. I could feel my blood pressure drop as soon as he agreed to be on hospice.
He was sent home with a PICC line for IV feedings, a drain off his belly, and an open wound/fistula which needed to be kept open. Hospice provided us with everything we needed to handle these things. The nurse would do lab draws weekly as is required for someone receiving TPN nutrition and once the doctor received the results, any changes could be made to the formulation which was delivered weekly from the appointed pharmacy. This included an expensive “ribbon” used to pack his wound which would have cost me over $20 a week to purchase on my own.
I would make a list each week of any supplies that were getting low and relay to either the nurse or to the pharmacy as directed. There were certain items that I still preferred to purchase on my own because I could get higher quantity than hospice was approved for but, overall, there was not a lot I needed to get.