Hospice Care and Alzheimer’s Disease

What is hospice care?

Hospice is a special way of caring for people who are terminally ill, and for their family. This care includes physical care and counseling. Hospice provides palliative or comfort care for an individual at the end-of-life. The primary purpose of hospice care is to manage the pain and other symptoms of the terminal illness, rather than provide treatment for the illness.

How does my loved one become eligible to receive hospice under Medicare?

Medicare covers hospice care if:

  • Your loved one has Medicare Part A;
  • Their physician and a hospice medical director certifies that they are terminally ill, that is, their life expectancy is six months or less, if the illness runs its normal course; and,
  • They choose or elect to receive hospice care and gives up (waives) the right for Medicare to pay for any other services to treat the terminal illness. Instead, Medicare pays the hospice and any related physician expenses. Medicare will continue to pay for your loved one’s care for any services not related to the terminal illness.

Are there guidelines to determine if someone with Alzheimer’s disease is terminally ill?

The National Hospice and Palliative Care Organization has published guidelines to help identify which dementia patients are likely to have a prognosis of six months or less, if the disease runs its normal course. Remember, these are only guidelines to assist doctors in determining whether a patient may be appropriate for hospice care. Some Medicare contractors, that are responsible for paying the hospice claims, have specific rules for payment of hospice for dementia patients.  Some of the criteria that may determine a person’s eligibility:

  • Ability to dress, bathe, and walk without assistance
  • Incontinence
  • Ability to engage in consistently meaningful verbal communication
  • Treatment in the past year for one or more of the following: aspiration pneumonia, UTI, septicemia, pressure ulcers, fever (recurrent after antibiotics), unintentional weight loss, low serum albumin.

What services can my loved one receive from a hospice under Medicare?

Under the hospice benefit, Medicare will pay for your loved one’s:

  • physician’s services
  • nursing services
  • physical, occupational and speech therapy
  • medical social services
  • home health aide and homemaker services
  • counseling services for your wife and your family
  • short-term inpatient care
  • respite care
  • prescription drugs
  • medical appliances and supplies
  • and bereavement counseling for your family.

Where can my loved one receive these services?

Your loved one can receive hospice care at home, in a free-standing hospice facility, or in a hospital or nursing facility. If your loved one is a resident of a nursing facility, Medicare will only pay for the hospice services provided, not for her room and board.

 What will hospice care cost our family?

There will be no deductibles and only limited coinsurance payments for his hospice services. You will have to pay a percent of the cost of a drug or biological. For respite care, there is a coinsurance payment for each respite care day.

How long can my loved one  receive hospice services?

Your loved one may elect to receive benefits for two periods of 90 days each, and an unlimited number of periods of 60 days each. If at any time they change their mind, they can decide to stop receiving hospice care and immediately begin to receive their other Medicare benefits.

For additional information

  • Centers for Medicare and Medicaid Services: cms.hhs.gov
  • Medicare Web site: www.medicare.gov
  • National Hospice and Palliative Care Organization: www.nhpco.org

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