Hospice Care: Comfort, Dignity, and Support for the Whole Family.
If your loved one is suffering from a serious illness, you might be wondering what happens next. The hospice program provides patients with the care that is as comfortable as possible, while at the same time providing guidance, education and emotional support to families.
Compassionate, comfort focused hospice services are available in Los Angeles County and nearby communities in Southern California through Canestro Care Hospice. Our interdisciplinary team ensures each patient, family, carer and attending physician are included in the development of a care plan tailored to the patient’s need, values, culture and wishes.
If you don’t know what to do next, you don’t have to make the decision without your family. We have the staff to answer your questions, examine the situation and let you know about the admission process.
What is Hospice Care?
Hospice is specialized care for someone who has a terminal illness who elects to receive care for comfort and the quality of life rather than care focused on curing the terminal illness and the associated conditions.
Hospice is not a particular location. Typically carried out wherever the patient calls home, such as:
A private residence
An assisted living community
A board and care home
A facility or institution that provides continuous care to the elderly and sick by nurses.
If appropriate, another contracted care setting:
The aim of hospice is to treat pain and other symptoms, maintain the patient’s dignity, and ensure that the patient and family spend as much time together as possible.
When is it time for a Family to think about Hospice Care?
For a family, hospice might be a consideration when the disease is rapidly advancing, or when the treatment is causing more pain than comfort. Hospice may also be a good choice for the patient who wishes to stay at home and not be admitted to the hospital again and again.
Indications that it may be time to consider hospice services might include:
Regular hospitalizations or visits to ERs
A worsening of pain, shortness of breath, agitation, nausea or other troublesome symptoms.
Weight loss, weakness or loss of appetite.
This increased sleep or bed time will lead to more restful sleep.
Stumbling, having trouble walking around, bathing, dressing, eating or using the restroom.
Second infections or other complications
Deterioration of memory, communication or recognition of people
Patients’ refusal of treatment that would prolong life is motivated by a desire to end the treatment for the purpose of controlling their illness.
No need to wait for a problem. A meaningful and timely hospice conversation can provide the patient and family time to learn about their choices and get support.
What persons can qualify for Hospice Care?
Medicare hospice benefit: If the hospice physician and patient’s attending physician (if the patient has one) certify that the patient has a terminal illness and is likely to live for six months or less if the illness runs its normal course, the patient may qualify. The patient must also sign up for hospice care and forgo any form of Medicare covered treatment that is meant to cure the terminal disease and any related conditions and be instead offered comfort focused care.
Eligibility depends on the overall clinical situation of the patient and not just the diagnosis. The evaluation of a hospice includes disease progression, functional decline, symptoms, hospitalizations, nutritional changes etc. and other clinical factors.
Factors that can contribute to hospice admission include:
Cancer
Alzheimer’s and other dementias.
Advanced heart failure and heart disease.
Chronic long-term lung conditions such as chronic obstructive pulmonary disease (COPD)
Patients with stroke and other neurological diseases
Amyotrophic lateral sclerosis (ALS)
End stage kidney disease
The end stage of liver disease.
HIV/AIDS
Other advanced or life limiting illnesses.
Canestro Care Hospice can evaluate a referral and work with the patient’s doctors to determine if they qualify for hospice.
How Does Hospice Care Work?
The first step of hospice care is a conversation and clinical evaluation. When the patient is a candidate and agrees to hospice, the team at Canestro Care Hospice prepares a detailed treatment plan and creates a care plan for each patient.
The plan is tailored to the patient’s diagnosis, symptoms, medications, personal goals, cultural preferences, spiritual wishes, caregiver needs and desired place of care. It is reviewed and updated when the patient’s condition becomes different.
Patients and caregivers are scheduled to receive visits in accordance with the plan of care and have access to hospice clinical support 24/7/365. The frequency of visits as well as services will depend on the needs of the patient and the level of services required.
What services can Canestro Care Hospice offer you?
Services are guided by the hospice plan of care and might include:
Treatment for pain and symptoms.
The diagnosis is based on the nursing visits and clinical assessments.
Hospice plan of care has to be under the control of a physician.
Care from hospice aides to assist with personal care.
Medical social services
Spiritual care in line with the patient’s preferences
Providing counseling to patients and families as well as emotional support.
Caregiver education & guidance
Medications related to the terminal illness and related conditions
Hospice diagnosis medicine supplies and equipment.
Short term inpatient care (medically indicated for symptom management)
Short term inpatient respite care (with eligibility criteria)
Bereavement support for loved ones after a patient’s death
The services, frequency of visits, medication, supplies and equipment will be based on the Individual Plan of care developed and the clinical needs of the patient.
Who is involved in the Hospice Care Team?
Hospice has an interdisciplinary approach. The care team can consist of:
A doctor of the hospice or medical director
The attending physician of the patient’s choice
Registered nurses and Licensed Vocational Nurses
Hospice aides
Medical social workers
Chaplains or spiritual care counsellors
Bereavement professionals
Trained volunteers and other care professionals
The team meets regularly and collaborates to provide care for the patient’s physical, emotional, social and spiritual health. Family caregivers continue to be a valuable group in the care team, and the hospice team educates and supports the family members to feel better prepared.
Let’s examine the four levels of hospice care.
There are 4 levels of hospice care that Medicare recognizes. This level is appropriate based on patient’s condition and clinical needs.
Routine Home Care
The most typical type of hospice care is routine home care. The patient is provided regular hospice services and family, caregivers or facility staff render day to day care.
Continuous Home Care
During a short medical emergency, intensive home care may be available, as it permits intensive nursing care to be provided at home to control acute symptoms. It’s only available if certain Medicare conditions are fulfilled.
General Inpatient Care
If the pain or other symptoms are not well-controlled at the present location, general inpatient hospice care might be considered. This is temporary assistance in a suitable contracted care home until symptoms have been controlled.
Inpatient Respite Care
Inpatient respite care is for an unpaid carer to have some respite. If the Medicare standards are satisfied, the patient may continue to be admitted for up to five days at a time to an approved facility.
Where does Hospice care take place?
When possible Canestro Care Hospice can provide care to the patient. Hospice care is often provided in the comfort and familiarity of the patient’s own home. Assisted living communities, board and care homes, nursing homes and other residential environments may also be used to coordinate care.
The Canestro hospice team collaborates with the staff at the facility to coordinate the hospice plan of care when a patient is residing in the facility. The hospice services are not intended as an alternative to the facility’s room, board, and normal custodial care.
Subject to the availability of services, Canestro Care Hospice provides services to patients and families throughout Los Angeles County and adjacent areas of Southern California, including Van Nuys, the San Fernando Valley, Los Angeles, Glendale, Burbank, Pasadena, Santa Clarita and others.
The length of hospice care varies from patient to patient.
The six month projection is a guideline and not a cut-off time. Medicare will continue to cover hospice services for a patient after the six month limit if the patient is acceptable to Medicare and the hospice physician certifies the terminal prognosis for each benefit period.
Patients may feel better or stabilize, and go home without hospice. A patient can also end hospice at any time to try to cure the terminal illness. Hospice care can be again chosen if eligibility is met at a later time.
Does Medicare Pay for Hospice Care?
Medicare Part A will pay for hospice care for Medicare beneficiaries who qualify for the Medicare hospice benefit and receive care from a Medicare certified hospice provider.
The hospice team, treatment for symptom and pain management, and medical devices and supplies as part of the plan of care are typically covered by the hospice team when it comes to terminal care and related conditions. Patients may have a copayment of up to $5 for each outpatient covered prescription for pain and symptom management under Original Medicare and may be charged 5 percent of the Medicare approved amount for respite care provided while admitted to an inpatient facility.
Some private insurance plans, Medicaid and Medicare Advantage plans also may cover hospice care. Coverage and patient responsibility will differ, but the Canestro Care Hospice team will be able to assist in an in-depth review of available benefits prior to admission.
What is NOT covered by the Medicare Hospice Benefit?
Typically, the Medicare hospice benefit will not pay for:
Treatment that would cure the terminal disease and other illnesses/conditions following hospice selection
Medications, equipment or services that are not directly related to the terminal illness or related terminal conditions as part of the hospice benefit
Unscheduled emergency room, inpatient hospital or ambulance services for the terminal illness;
An assisted living facility, nursing home or residential home where someone lives with a private family doctor.
Care for the terminal illness from another provider that was not arranged by the elected hospice
All patients should inform their hospice team before going to emergency, hospital, ambulance or other services for terminal illness care. Care unrelated to the terminal illness can still be covered by the other Medicare benefits, with the normal coverage rules and cost sharing.
What’s the difference between Hospice and Palliative Care?
Hospice and palliative care help maintain comfort, manage symptoms and enhance quality of life. The main difference involves eligibility and the goals of treatment.
Palliative care can be given at any point during the course of a serious illness and may be used in conjunction with treatment that is aimed at curing or controlling the illness. Hospice care is typically for a patient who has a life expectancy of 6 months or less and chooses comfort care rather than treatment for the terminal illness and conditions.
Canestro Care Hospice offers hospice care. We do not have a stand alone palliative care program.
May the patient keep his or her own doctor while the patient is receiving hospice services?
Yes. The attending medical professional can be an OMP that is qualified by Medicare. The physician, nurse practitioner or physician assistant may be a patient’s choice of OMP who is qualified by Medicare. The attending professional may continue to provide care, as long as the hospice physician and interdisciplinary team are coordinating care.
Is it possible for a patient to get out of hospice care?
Yes. Hospice is an option that you make yourself. The hospice election can be rescinded at any time by a patient or designee. Medicare also allows a patient to switch hospice providers. Once hospice has been discontinued and the patient re-evaluates and qualifies again, they can choose to use hospice once again.
Here are some questions you should ask your hospice provider.
It’s important to select a hospice. Consider asking:
Does the hospice have a valid Medicare certification and license?
What is the turn-around time for the hospice’s evaluation of a referral?
Are there support services available 365 days a year, 24 hours a day?
What do you do with urgent symptoms outside of business hours?
Who will visit and how will we know how often they are coming?
What will happen to the medications, medical equipment and supplies?
What assistance does the hospice offer to the family caregiver?
How are cultural, language and spiritual preferences respected?
What supports are there for family and friends who have lost a loved one?
How does the hospice communicate with a hospital, doctor, nursing home or assisted living center?
Why Families choose Canestro Care Hospice
At Canestro Care Hospice, each patient is treated as an individual, not just a diagnosis. Listening, communicating and creating care that is focused on the patient and family value.
We are dedicated to providing comfort, dignity and reliable assistance to patients and families throughout Los Angeles County and other communities in Southern California. Whether you have your first conversation with us, or we are continuing our care for you and your family, we are here to help you to feel informed, supported and not alone.
Talk With Canestro Care Hospice
If you think someone you love may benefit from hospice care, call Canestro Care Hospice at (844) 978-2100. A member of our team can answer your questions, explain hospice eligibility and help you request a hospice evaluation.