When and who should make a decision about entering hospice?
At any time during a life-limiting illness, it is appropriate to discuss all of a patient's care options, including hospice. Individuals shouldn't hesitate to raise the possibility of hospice with their physician or other healthcare professionals. By law, the decision belongs to the patient. Understandably, most people are uncomfortable with the idea of stopping aggressive efforts to "beat" the disease. Hospice staff, sensitive to these concerns, is available to discuss them with the patient and family.
What will the patient/family have to pay for?
The answer will depend on whether the patient is covered under the Medicare Hospice Benefit, insurance, private pay or charity.
Under the Medicare Hospice Benefit, the patient will most likely NOT be held financially responsible for:
- Drugs/medicine that are related to the terminal illness
- Medical equipment that the hospice approves or orders
- Medical supplies that the hospice approves or orders
- Periodic visits by hospice staff - scheduled according to need
- Hospitalization, IF determined by the hospice team to be necessary for symptom control not possible at home and IF it takes place at a hospital with which St. Thomas Hospice has a contract.
Under the Medicare Hospice Benefit, the patient WILL be held financially responsible for:
- Drugs that are not related to the terminal illness, e.g., blood pressure medication, thyroid pills, etc.
- Private duty aides or caregivers not ordered by hospice.
Under insurance, almost every policy is different. The patient may have to pay a yearly deductible amount (usually $100-$500). The patient may also have a "co-payment" which means that he/she has to pay a certain percentage of the bill (usually 5-25 percent) that the insurance will not pay. Medical equipment and supplies might be covered.
It is important for you and hospice to work together to find out what your insurance policy will cover. If you are not comfortable with your understanding of this important issue, call the hospice office.
Under private pay, the patient WILL be held financially responsible for:
- Drugs/medicine, medical equipment and medical supplies
- Periodic visits by hospice staff - scheduled according to need.
Under charity care, the patient will NOT have to pay for:
- Periodic visits by hospice staff
- Shifts of nurses or aides ordered by Adventist St. Thomas Hospice
Adventist St. Thomas Hospice will issue a monthly statement of charges to private pay patients and a statement of services provided to charity patients.
What specific assistance does hospice provide patients?
A team consisting of a doctor, nurses, social workers, bereavement counselors, home health aides, chaplains and volunteers care for our patients. Each discipline provides assistance based on an area of expertise and an individualized care plan is created for each patient's unique needs.
What if something happens at night?
This is perhaps one of the most worrisome fears of many patients and their families. Adventist St. Thomas Hospice has a nurse on call 24 hours a day, seven days a week for this very reason. You can feel free at any time to call the hospice number (630-856-6990). The phone will be answered by a hospice nurse. If he/she is unable to help you over the phone, a nurse will come to your home.
We do not recommend that the paramedics be called. Once they are involved, they often feel forced to take the patient to a hospital or give more treatment than the patient or family wishes. (Also, the cost is not covered under the Medicare Hospice Benefit.) Please always call the hospice first!
Can our doctor continue to care for the patient?
Yes! The hospice staff firmly believes that the patient's physician should continue to be involved with the hospice patient. Visits can be made either in the doctor's office or by a home visit.
Charges for such visits should be processed in the normal way. That is, the doctor should send his/her bill directly to Medicare or insurance. The hospice does not handle these visits and will not cover fees incurred by such visits. In some instances, Medicare or insurance denies coverage for these visits and so we recommend checking with them regarding coverage before scheduling any such visits.
The Medicare Hospice Benefit will provide a visit by the hospice medical director, if needed, in the absence of the attending physician, or upon staff or family request.
Can we try any further treatments if offered?
Of course. There may be some complications, however. Under Medicare, some treatments are considered "curative" and disqualify a patient from being covered under the Medicare Hospice Benefit. While we support the patient's right to seek whatever treatment he/she wishes, we will most likely have to discharge the patient during the time that such treatments are taking place in order to conform to Medicare law. The patient could then re-enter the hospice after such treatments were completed.
This is another very complicated area, and we suggest that if you have a specific question you call the hospice and talk to one of the staff about it.
How does hospice manage pain?
Hospice believes that emotional and spiritual pain is just as real and in need of attention as physical pain, so it addresses each. Hospice doctors and nurses are up-to-date on the latest therapies for pain and symptom relief. Social Workers, Counselors, and Chaplains are also available to support family members and patients.
Who orders supplies or drugs?
Only a physician can order drugs, so the hospice works closely with your doctor to keep him/her informed about the patient's condition. The hospice nurse is allowed to call a physician's order into a pharmacy.
Upon admission, the Intake Nurse will assess the need for supplies and will order them. From that point on the assigned Nurse will monitor supply usage and will place orders for re-fills and new supplies as needed.
Who delivers or picks up the drugs?
The patient or family is responsible, just as they were prior to being admitted to hospice.
Can I use any pharmacy I want?
If the patient is covered by Medicare, the hospice is responsible for paying for many of the symptom control drugs that may be needed. We have a contract with the Adventist Hinsdale Hospital Pharmacy. They will send bills for covered drugs directly to hospice, and may be able to deliver the medication to you.
If the patient's hospice care is covered by an Insurance policy that includes pharmaceuticals, bills for medication should be processed the same way as was handled prior to hospice services.
Does hospice do anything to make death come sooner?
Hospice neither hastens nor postpones the dying process. Just as doctors and midwives lend support and expertise at the time of birth, the hospice team provides its presence and specialized knowledge during the dying process.
What do we do at the time of death?
Call the hospice (630-856-6990). A hospice nurse will assist you. It is often even more helpful to call when you think death is approaching.
Who will contact the funeral home?
The hospice nurse usually contacts the funeral home to make arrangements to have the body taken to the funeral home.
What about the coroner?
By law, any death that takes place at home in Kane, DuPage or Will counties must be reported to the county coroner. This is usually done by the hospice nurse who has a good working relationship with the various coroners in our area. The family is rarely inconvenienced by this request. Cook county does not require the same procedure.
When and where do we get the death certificate?
The death certificate is issued by the county. Usually the funeral home will arrange to get the information needed for the certificate and will file it with the appropriate government offices. The funeral home will usually arrange to get you as many copies of the certificate as you need. Subsequently, you will have to contact the County Health Department to obtain additional copies. A fee is charged.
Who will arrange to get equipment picked up after a death?
The hospice staff will make the necessary calls for any equipment that the hospice ordered. Arranging for equipment ordered by the family is the family's responsibility, but the hospice staff will be happy to assist when possible.
What about memorials?
The income received as memorials plays a vital role in the hospice's well-being. We appreciate a mention in obituaries, and as a consideration for memorials in lieu of flowers. Memorial envelopes are available for use in funeral homes for those who wish them.
Any individuals sending memorials will receive a thank you from the hospice. In addition, we will send you a listing of those who gave memorials.