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Conversations on Care Podcast

Understanding the 4 Levels of Hospice

In this episode of Conversations on Care, Open Arms Solutions founder Julie Kollada spoke with Colleen O’Keefe from JourneyCare about what hospice care is, who can benefit from it, and the four different levels of care. Hospice care can be much more complicated than many people assume, so Colleen shared some important information to help you evaluate hospice care options for your loved one.

What is Hospice Care?

Hospice care is a philosophy of care. It’s a Medicare benefit that was created after a lot of grassroots advocacy. It focuses on comfort and caring for patients with terminal illnesses to relieve symptoms and allow them to live with the best possible quality of life for however long they have left. Hospice care is interdisciplinary, and often involves physicians, nurses, social workers, CNAs, and other service providers depending on where you live and the hospice provider you select. It offers support both for the patient and for their family members, who may need training for how best to provide care as well as how to manage their grief and emotions as their loved one nears the end of their life.

Who is Eligible for Hospice Care?

The hospice benefit is available to anyone who has a terminal illness. The biggest one that hospice providers see is cancer, but there are many other types of terminal illnesses that would make someone eligible for hospice care, such as respiratory illnesses, dementia, cardiovascular illnesses, and neurological or movement disorders.

Two physicians need to attest to a six-month prognosis, where if the disease progressed naturally with no intervention, the patient would likely only have that much time left. This doesn’t mean that the patient is actually going to die within six months—and many patients actually improve with hospice care and live for many more months or even years. There are also different criteria for hospice care eligibility based on the type of disease that the patient has. The patient must be in the terminal phase of their disease.

What is Palliative Care?

Palliative care is meant to provide relief of symptoms for individuals with early- or middle-stage chronic illnesses who are still seeking active treatment. It is covered by insurance and the goal is to address symptoms and reduce hospital admissions for people with chronic illnesses by providing care where they are living. Many hospice providers also provide palliative care, so when a person transitions from palliative care to hospice care (if their illness becomes terminal), they can experience seamless continuity of care.

The 4 Levels of Hospice Care

Depending on a patient’s care needs and condition, there are four different types of hospice care that may be provided:

Routine Home Care

The majority (85-90%) of hospice patients are receiving this level of care. The interdisciplinary care is provided to them where they live, which could be their home, a skilled nursing facility, or somewhere else. The team comes to them and helps them manage their symptoms, coordinates their medication and supplies, and gets them the medical equipment they need. The hospice Medicare benefit covers their equipment, medication, and supplies, for both their terminal illness and any comorbidities.

The hospice care team is not at your home 24/7—they visit to manage medications, provide equipment, and train family members on what to do for round-the-clock care. However, you can supplement this hospice care with an hourly or live-in caregiver who will remain by your loved one’s side and advocate for them as well as your whole family.

Continuous Home Care

This care is provided short-term to manage an acute flareup of symptoms or a medical crisis. It can be helpful for patients who do not want to spend any more time in a hospital as well as for those who want to die at home. This care is provided by hospice nurses, registered nurses, and possibly contract nurses depending on the hospice provider.

General Inpatient (GIP) Care

This is short-term 24/7 care for acute uncontrolled symptom management in a hospice facility or a hospital. It can help patients get symptoms like nausea, vomiting, anxiousness, shortness of breath, and so forth under control so they can transition back to where they were living, with a lot of support and helping hands. This type of care can also include training for family members so they can better care for their loved one, who may be in a different condition and need more support.

Respite Care

This benefit allows patients to go to a skilled nursing facility or an inpatient center for up to five days to give their primary caregivers a break. Caregiving can be exhausting and demanding, and these respites allow family members and caregivers to take care of themselves for a few days and recharge.

If you are already working with a trusted physician, do they become part of your hospice team?

Yes, they can. Hospice providers ask physicians upfront (especially if they are referring the patient) how active they want to be in the hospice care team. JourneyCare always asks patients’ primary care physicians (PCPs) how involved they would like to be, and it’s up to each patient, their family, and their doctor.

The Importance of Hospice Care

We have a lot of support when we are brought into the world, and we deserve the same level of support when we leave the world, which is what hospice care aims to provide. It’s an emotional time, and the proper support and care allows families to simply be families rather than primarily being caretakers. You can just be there for your loved one when you have a hospice care provider handling everything for them and coaching you through the process. Many families say after the fact that they wish they would have called hospice earlier, so it’s important to be prepared and find hospice care as soon as your loved one is eligible.

Learn More

To learn more about hospice care or to request care for your loved one in the Chicagoland area, contact JourneyCare. If you’d like to learn more about hourly or live-in caregivers, contact Open Arms Solutions. It would be our privilege to schedule a meeting with your loved one and your family to discuss care needs and answer questions.

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