When faced with the choice of hospice care, most patients and their families focus on whether they’re ready to stop active treatment to focus on quality of life versus quantity of life. The question of health care costs rarely is mentioned.
Hospice is a program that provides medical care and support for patients facing a terminal illness who have chosen to end active treatment (such as chemotherapy for those with cancer) and instead focus on alleviating pain and discomfort.
Hospice agencies provide care for patients at home as well as in hospitals, nursing homes and senior living facilities.
While the decision to choose hospice shouldn’t be based only on cost, patients who enter hospice often remark about the reduced financial burden, says G. Perry Farmer, CEO of Crossroads Hospice in Tulsa, Oklahoma.
The savings can be significant.
Health care costs for cancer patients in hospice were $8,697 lower per patient in the last year of life than patients not in hospice, according to a 2014 study by Brigham and Women’s Hospital in Boston. Here are some other advantages.
Hospice care also prolongs the lives of those who choose it compared with those who don’t. Terminal patients live from 20 days to more than 2 months longer in hospice, according to studies from 2004 through 2010 noted by the National Hospice and Palliative Care Organization in Alexandria, Virginia.
Hospice care also saves on Medicare spending. A 2013 study by the Icahn School of Medicine at Mount Sinai in New York City found Medicare savings ranging from $2,560 to $6,430 per patient, depending on their length of enrollment period before death.
For those on Medicare Part A, hospice covers nursing care costs, doctor services, medication and equipment related to the patient’s terminal illness, with supportive services for the patient and his or her family or caregiver. There are small or no copays or deductibles.
“Hospice is the only 100% Medicare-paid benefit,” Farmer says.
To qualify for Medicare-paid hospice, a physician must certify that the patient has a terminal illness with a life expectancy of 6 months or less, according to Medicare guidelines. The patient must accept palliative care for comfort instead of care to cure an illness and must receive hospice services through a Medicare-approved agency. Medicaid also provides hospice benefits for those who qualify, but coverage varies by state.
“If you are Medicare or Medicaid eligible, hospice really is an A-to-Z inclusive benefit for the family, and they can anticipate not having any out-of-pocket expenses,” says Jonathan Keyserling, senior vice president of the National Hospice and Palliative Care Organization.
Even if patients get better, hospice still will be available to them if their health declines again. And, patients can decide to drop hospice at any time and re-enter later.
Prescription medications are 1 of the biggest areas of cost savings. Hospice covers the cost of all medications for pain and comfort management related to the terminal illness, according to Medicare guidelines. In some cases, hospice patients may need to pay a $5 copay for certain medications, but this isn’t usually the case, Keyserling says.
“Almost anything that can be considered a co-morbidity factor or a contributing factor for either pain, nausea, constipation or anxiety, those medications are also covered,” Farmer says.
Prescription drugs to cure your illness rather than for symptom control or pain relief are not covered, according to Medicare guidelines. Medications and supplements unrelated to the hospice condition, such as calcium supplements or over-the-counter allergy medications, usually aren’t covered through hospice and may need to be paid through a Medicare copay or out of pocket.
Rental costs of durable medical equipment — hospital beds, wheelchairs, walkers, wound dressings and catheters — are included as part of the paid-by-hospice coverage. Without hospice, the patient would need to pay for this equipment or would need to pay a Medicare rental copayment after submitting a doctor’s approval for the equipment, Farmer says.
End-of-life care can be overwhelming, with a patient often seeing multiple health care professionals, says Keyserling. Hospice provides each patient a doctor, nurse, home health aide and social worker, who coordinate the patient’s daily care. Other provided health care professionals include a dietitian, and physical, occupational and speech therapists, according to the Centers for Medicare and Medicaid Services.
Some hospice agencies also offer music therapy, art therapy or pet therapy services, often through volunteer organizations, and are usually free of charge to their hospice patients.
However, if patients need to see a podiatrist, oral surgeon, optometrist or other specialists, they would still need to pay out of pocket for those services, though some may still be partially covered under Medicare. However, the hospice agency may help coordinate with these professionals to visit the hospice patient at home.
Hospice care visits happen on weekdays, but if there’s a weekend emergency, hospice agencies provide 24-hour telephone hotlines. An on-call nurse answers questions and visits the patient if necessary.
Even so, emergency care not related to the terminal illness, such as a broken hip, isn’t covered by hospice.
Being in hospice care may allow seniors to stay in their home versus going into long-term care or assisted living, says Farmer of Crossroads Hospice. Nearly 90% of people over 65 want to stay in their home for as long as possible, according a 2011 survey by the AARP Public Policy Institute.
Hospice care also can be provided to those in a nursing home or assisted living facility, though the cost of nursing homes or assisted living facilities is not covered by hospice.
When Farmer asks seniors to envision their final days, they often express a desire to die peacefully and at home. “No one says they want to be intubated or be in intensive care,” he says.
A 2010 study of cancer patients in hospice by the Mount Sinai School of Medicine found that continuous hospice use leads to a reduction of hospital-based services, including fewer emergency and urgent care visits, and a greater likelihood that a patient will die at home, not in a hospital.
While hospice doesn’t provide live-in care, the services it provides can lessen the strain on caregivers. For example, a hospice home health aide can visit 5 days a week and assist the patient.
Caring for a loved one can be emotionally draining, Keyserling says. Hospice care provides free respite options for caregivers in 2 ways.
Respite volunteers can provide patient-sitting services. If the caregiver needs a break for a short time (a few hours at most), they can do so without having to pay. Otherwise, caregivers who just want to go out to dinner or a movie would need to hire a private home health aide. Most private agencies charge for a minimum of 4 hours for such services. At an average cost of $21 per hour, according to cost data from LongTermCare.gov, that’s an $84 tab for a caregiver.
Hospice also provides a longer-term respite care option — up to 5 consecutive days for the patient in a hospice-approved nursing facility. A small number of hospice agencies now even have their own short-term facilities used for respite care. The entire cost of the stay is covered by hospice. In some cases, there may be a small copay.
Hospice care also includes a social worker on the hospice team. The social worker can help patients and families find additional care and caregiver support services through local and federal programs. They can also help with finalizing burial plans, Farmer says.
In conjunction with a spiritual counselor, social workers may also address the emotional needs of the patient and the family regarding the patient’s eventual death. The patient and the family decide whether to use these services.
Hospice care doesn’t end when the patient dies. Bereavement support for up to 1 year after the patient’s death is available to immediate family members, though there may be a copay for some grief counseling services, according to regulations from the Centers for Medicare and Medicaid Services.
“Folks often don’t consider hospice until they’ve gone through a regimen of very invasive and usually expensive therapies that have proven to be non-beneficial or even distressing to the patient,” Keyserling says. “We want to make sure families know the full range of options they have available to them.”