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Q: Last week, a friend was glowing about the hospice care her mother is receiving, and she said that hospice has been caring for her for more than eight months! I thought hospice care was only for six months, so I guess I need more information. How long can someone receive hospice care and how does the hospice decide? Any information would be helpful, thank you, and I enjoy reading your column.

– Jolene M.

A: Jolene, thank you for your question, we are so glad you are appreciating Life’s End in the Missoulian. You are not alone; many people don’t understand the Hospice Medicare Benefit. The beauty of it is, hospice is much more available than people think and we frequently hear families wishing that they had received hospice care sooner, “if they had only known.”

There are three parts to your question, so let’s break them down. It will be important to define the Hospice Medicare Benefit, what it pays for and how qualification is determined.

The Hospice Medicare Benefit was established in 1982. Before this, hospice in Missoula was provided by a grassroots team of medical professionals and community members volunteering their time to care for people at the end of life. Fortunately, Congress recognized that people receiving hospice care experienced improved quality of life and were able to stay at home – rather than being transported to often unwanted and always costly hospital stays. This is how, and why, the Hospice Medicare Benefit (Medicare Part A) was enacted. This specialized part of Medicare is commonly referred to as “comfort care” or “palliative care” and is defined as non-curative care for individuals with a terminal illness.

In fact, you cannot access both parts of Medicare at the same time – individuals must chose either curative or comfort/palliative care. Fortunately, you can alternate between the two if you would like. For example, if I were diagnosed with a terminal illness and wanted to discontinue curative treatment, I would elect hospice and Part A to receive comfort care for myself, and for my family, in my own home. If, however, there were new treatments that became available to me, I could elect to revoke hospice care and re-elect coverage under Part B for curative care.

While traditional medical teams are familiar, an interdisciplinary hospice team is quite exceptional. Hospice is required by Medicare to provide an entire team dedicated to each individual’s unique needs. This team is comprised of the following professionals: physician, nurse, nurse’s aide, homemaker, chaplain, social worker, pharmacist, volunteers, office staff, contracted professionals such as occupational therapist, physical therapist, podiatrist and nutritionist. Some hospices also choose to offer additional services at no charge, such as massage therapist, music therapist, music thanatologist and specialty counselors. Medicare also requires that hospices cover the cost of all of the following, as long as they are related to the terminal illness: medications, medical equipment needed in the home and medical supplies. Uniquely, hospice is designed to provide care for the entire family as well; through ongoing education, counseling, and support. For example, bereavement care for the family continues 13 months after their loved one has passed, as support for grief and other life matters. Realistically, there is no other well-rounded, holistic care program available through Medicare like hospice.

Finally, how qualification for hospice care is determined. Facing our own mortality is always a difficult thing. In that way, choosing hospice care is a very personal and often labored decision. Your health care team may suggest hospice, you may decide it is worth investigating, or perhaps a close friend or family member with experience offers advice. Ultimately, whether you qualify for hospice care or not, the decision to receive hospice care is yours. Medicare has clear guidelines for determining if someone qualifies for the Hospice Benefit. The same goes for private insurance, which usually follows Medicare guidelines. (Individuals, wishing to privately pay for hospice care, can ignore all of these guidelines and pay out of pocket at any time.)

Part of this qualification process requires two physicians to attest they “would not be surprised, if the terminal illness runs its natural course, that the patient passes within the next 6 months.” This is where the six-month diagnosis comes into play. Obviously, physicians are not omniscient and cannot know to the day the course of any disease or when someone will die. Therefore, once Medicare or insurance qualifications are met and supported by a doctor, hospice care can continue indefinitely until someone passes away – or until they no longer qualify. Hospices are required to regularly re-certify individuals, and to strictly follow the guidelines set by Medicare and private insurance at all times.

So you can see, it is a complicated system for an amazing service. If this has piqued your interest in hospice, you are invited to attend this month’s Community Conversation on Death and Dying, where Dr. Brad Ihrig will speak about his experience providing international hospice care in Mongolia, on Thursday from 6 to 8 p.m. at The Loft of Missoula.

If you have a question you would like to submit to Life’s End, email and we will respond via email or in this column.

Maurika Wells is administrator of Hospice of Missoula.

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