As a doctor, you’re there with a patient during some of the most trying times in their life. Deciding if or when they should begin hospice care is one of the most difficult positions to be in.
Take, for instance, the patient with the chronic illness or condition, who isn’t doing well and has been struggling to get to appointments. Their treatments may no longer be providing any type of comfort or medical benefit, and it’s not improving their quality of life. If your patient’s diagnosis is terminal and treatments are no longer providing any relief, it may be time to have a conversation with them about hospice options. At Ardent Hospice & Palliative Care, we focus on alleviating the symptoms and making the patient as comfortable as possible.
If you have a patient who might need to progress into hospice care, there are three things that you, as their doctor, should consider:
1. If a patient still has years to live, we can’t take them on under hospice care.
A chronically sick patient with deteriorating health must still have a prognosis of six months or less to live in order to receive hospice care. This timeframe and prognosis is required by insurance companies and programs, including Medicare.
With Medicare, Medi-Cal, and several other programs, insurance is paid out in benefit periods. For hospice care, that benefit period does not exceed six months. The first benefit period is 90 days and then the second benefit period is 90 days—at each point, the medical director (of the hospice) must check in on the patient to determine if they’re still hospice care appropriate. By the third benefit period the patient is has passed the six-month mark, so the benefit period is reduced to 60 days, and at every 60 days, the director will continue to visit the patient to determine their eligibility. If the six months have passed, and our director decides the patient is no longer hospice appropriate, we are required to discharge them.
If your patient has a chronic or terminal illness, but their expected lifespan is longer than six months, palliative care might be a good option to keep them comfortable until hospice is necessary. Insurance coverage and care varies with palliative care, but it could be a solution depending on the patient’s circumstances.
2. The patient must have a terminal diagnosis.
Even if your patient is elderly and has declining quality of life, if they do not have a chronic illness or condition that’s causing their health issues, they will not be eligible for hospice care. It’s not a hospice qualifier if their health is deteriorating simply because of old age; they have to have a serious illness and concrete diagnosis associated with it.
It might not always be the obvious reason for their diminishing health, but patients will sometimes have a heart condition or other ailment that may justify a six-month prognosis. Some elderly patients might not want to continue with treatments or attend appointments anymore. Instead, they might just want to focus on comfort. However, they must have a diagnosis in order to receive hospice care.
3. You do not have to drop your patient once they’re in hospice care.
Many times, we work with doctors who are apprehensive about dropping their patient once that patient enters into hospice care. Primary physicians do not have to terminate care or contact with their patient. You can still case manage your patient on a monthly basis and stay involved with many aspects of their care.
If you have a patient who may be eligible for hospice services and need a trusted partner in delivering their care, count on Ardent Hospice & Palliative Care to provide comfort to your patient in the time they need it most. Visit us online or call us at (858) 952-1786 for a patient consultation or more information.
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