Hospice vs. Home Health

Originally published in the Lincoln Tribune, July 8, 2008

Q: My mother has had home health services with her diabetes. Now she has been diagnosed with cancer, and her doctor is recommending hospice. What is the difference between hospice and home health?

A: Home health is for patients whose conditions are expected to improve. Hospice cares for those with serious illnesses whose health is declining. Home health is designed to help a homebound patient reach a certain level of improvement. For example, a diabetes patient like your mother might need help learning to manage her insulin levels by herself. As she becomes more independent, the number of home health visits would decrease until she is discharged. Hospice, entering the scene of a more serious disease like cancer, is designed to increase the number of visits as the patient's condition worsens.

Just as the missions of home health and hospice organizations differ, there are significant operational differences as well. Home health focuses its attentions on the patient. By contrast, hospice is not only focused on the patient's needs, but also supports and educates the patient's family caregivers.

The two entities are also paid for differently. Medicare, Medicaid, Workers' Compensation, and private health plans all have home health benefits, but they are limited to the duration of the patient's recovery or improvement to a certain level. These benefits cover a portion of the expenses. For example, only 80% of the cost of durable medical equipment (DME) is covered, and medications are the individual's responsibility.

Hospice patients also receive Medicare, Medicaid and insurance benefits, but they are more inclusive. These benefits would pay for the entire cost of the DME and medications related to the patient's illness. About 95% of hospice patients are covered by Medicare, Medicaid or insurance. However, if you are in the remaining 5%, don't despair: few hospices will turn away a patient for an inability to pay. If you are concerned about payment issues, ask the hospice admissions professional about your options. Many hospices, including mine, maintain specially donated funds for the care of patients without other resources.

If you are concerned about a loved one, please send your questions to asklinda@pchcv.org. See you next week!

Mom's fears, Dad's decline

Originally published in the Lincoln Tribune, July 1, 2008

Q: I read your column about the family where the father-in-law was declining and the mother-in-law was close to a breakdown [see June 17 Tribune]. I am in a similar situation with my parents. Dad is in bad shape, although in OK spirits, but Mom is in denial. She panics every time someone talks about him getting worse. What should I do?

A: First of all, thank you for trying to improve the family's situation. It can be hard to ask for help when you have tried to deal with their problems—his health, her fears—by yourself. You are doing the right thing. Our palliative care team may be able to help both of them, perhaps your mother even more than your dad.

It sounds like you need to deal with her before anything else. She is grappling with one of the biggest fears adults can have—losing her husband. The cornerstone of her world is crumbling. Try to be as gentle with her as you can, even though she may say irrational things or try to argue with you.

I might try a different way to begin the discussion. Look for a time when she is the least stressed. Tell her, "We have all been so wrapped up in Dad's situation, I don't think we're taking care of ourselves. I have been thinking about getting us some help." When she asks what kind, tell her you believe a consultation with a palliative care clinician might help both of you understand your dad's needs. The consultation will help you identify specific services that can help you enjoy time with your father, instead of having to be his nurses. Should hospice be an option for your dad's condition, the team of nurses, nurse assistants, counselors, and more can help take care of the many tasks that may be difficult for the two of you. Emphasize how the consultation with a palliative care physician or your nurse practitioner can help relieve the burden on both of you.

Is your mother concerned about healthcare costs? I would also mention that palliative care consultations are reimbursed by most all insurance plans, including Medicare. Financial relief can also be a powerful motivator.

I wish you all the best in your conversation with your mother. Remember to be gentle above all else.

If you have a question for me, please email me at asklinda@pchcv.org. Until next week, be kind to one another!

The hospice admission process

Originally published in the Lincoln Tribune, June 24, 2008

Q: What happens during the hospice admission process? I have been thinking about calling on behalf of my mother.

A: A hospice admission is much like being admitted to the hospital, except the office comes to your home. When you call about obtaining hospice services, ask for the admissions office. An admissions professional will ask many questions about your mother's situation. If Mom is appropriate for hospice, he will call her doctor to obtain an order for services. He will then set an appointment with the two of you to conduct the admission.

Each hospice has a unique way of presenting the admissions information, but the process is generally the same. The admitting nurse or social worker often begins with a discussion of the patient's rights. Every patient has the right to receive appropriate and professional care, to be fully informed about their care, and to have their health information kept private, to name a few. A discussion of the specific services your mother needs might come next.

Be prepared to speak frankly with the admissions person. Depending on your situation, the conversation may take some time. Try not to rush through your answers. Voice the concerns you may have about your mother's care. If your mother and family decision-makers are in agreement about beginning hospice, the admissions professional will present the necessary forms to authorize services.

Once the forms are complete, your mother is officially a hospice patient. Depending on which services she has chosen, she will soon meet her nurse and social worker. The nurse is usually the first to visit. She will assess your mother's physical, mental, and emotional status. The care team will then develop your mother's personal plan of care. Some of the first tasks she may attend to are conducting a head-to-toe assessment of your mother's condition, reviewing her prescriptions, and ordering any necessary medical equipment. Afterward, your mother's care team will visit on a regular schedule, or an as-needed basis if more frequent visits are required.

Readers, don't be afraid to send questions about your loved ones to asklinda@pchcv.org; your name and email will be kept completely confidential. See you next week!