Hospice Care Offered by Casa de la Luz Hospice

Frequently Asked Questions | Living Will

"People ask, 'When is the best time to call hospice?'" I say, "sooner rather than later."

� Kaye Andrews

Today, too many Americans die alone and in discomfort. Most people do not want to die by themselves in sterile, impersonal surroundings, hooked up to machines and cut off from family and friends. Instead they prefer to spend their days at home � alert and free of pain � among the people they love. Hospice care makes this possible.

Hospice, from the Latin hospitium, means hospitality. Beginning in Europe in the 12th century, hospices provided lodging and care for weary pilgrims and the dying. Today, hospice is considered the model for quality, compassionate, end of life care. Hospice care is provided by an interdisciplinary team skilled in medical care, pain and symptom management, and emotional and spiritual counseling. Care is offered to the patient, their loved ones and caregivers.

At Casa de la Luz Hospice, we affirm life and believe that death, like birth, is a natural and sacred time of transition. Hospice seeks neither to hasten nor postpone the end of life, but to assist persons to live fully until that time with individuality, dignity and maximum quality of life.

How Does Hospice Care Work?

A person is eligible for hospice care when their physician and the hospice medical director agree that given the nature and progression of their illness, they may have a life expectancy of six months or less. An all-inclusive hospice care benefit is available to eligible persons through the Medicare program (please see Medicare Benefits). Many insurance companies also contract with hospice programs. Hospice services are provided regardless of age, gender, diagnosis, race or religion.

The focus of hospice care is comfort, not cure, and in most cases care is provided in the patient's home. Care is also provided in free-standing hospice facilities, skilled nursing facilities, assisted living facilities and assisted living homes. In order to provide professional and enduring hospice care in the home setting, a (full-time) primary caregiver must be available. Short-term inpatient care is provided should pain or symptoms become too difficult to manage at home, or should the caregiver need respite. In other settings, the hospice team adds essential, professional end of life expertise and services, making regular visits to assess patients' needs and to provide care. Hospice staff are on call 24 hours a day, seven days a week.

The hospice team develops a plan of care focused on the patient's goals, their well-being and needs for pain management and symptom control (please see The "Casa" Team). Among its major responsibilities, the hospice team:

�	coordinates care under the direction of the hospice medical director and the attending physician;
�	manages the patient's pain and/or symptoms;
�	provides nursing and personal care;
�	coaches family and caregivers in the care of the patient;
�	assists the patient and their loved ones with the emotional, spiritual and psychosocial aspects of living with dying;
�	provides comfort medications, medical equipment and supplies;
�	makes short-term inpatient care available should pain or symptoms become too difficult to manage at home, or when a caregiver needs respite;
�	delivers special services like speech and physical therapy when appropriate;
�	provides bereavement care and counseling to surviving family members and friends.

Living in the Sonoran desert, we are reminded that even under the most difficult conditions, life blossoms forth with beauty, color and strength. It is difficult to face the end of one's own or a loved one's life. Yet, those we care for continue to teach us that the end of life may also be filled with simple pleasures, love and laughter, reconciliation and healing, hope and peace.

Should you or a loved one be facing the end of life, Casa de la Luz Hospice would be pleased to offer you our expertise, care and companionship. Please call us at 520-544-9890.

"By focusing first on what's most important to our patients, we can give them the opportunity to live their life while on hospice."

� Lisa Daniels,
Social Worker,
West Team

�Interestingly only 38% of eligible people utilize hospice care; clearly there is room to grow. So I enjoy the opportunity to work alongside the providers in our community sharing the message that hospice is a great option they can present to their patients and families, well before a crisis situation arises.�

� Michael Cassolis,
Physician Relations


Q.	What services are covered under the Medicare Hospice Benefit?
A.	The Medicare Hospice Benefit (the Benefit) covers the following services as long as they relate to the terminal diagnosis and are outlined in the patient's care plan: Physician services for the medical direction of the patient's care, provided by either the patient's attending physician or a physician affiliated with a hospice program; Regular home care visits by registered nurses and licensed practical nurses to monitor the patient's condition and to provide appropriate care and maintain patient comfort; Home health aide and homemaker services such as dressing and bathing that address the patient's personal needs; Chaplain services for the patient and/or loved ones, if desired; Social work and counseling services; Bereavement counseling to help patients and their loved ones with grief and loss; Medical equipment (i.e., hospital beds); Medical supplies (i.e., bandages and catheters); Drugs for symptom control and pain relief; Volunteer support to assist the patient and loved ones; Physical, speech, and occupational therapy, as well as dietary counseling.

Q.	Will the Benefit pay for hospice care in a place other than a personal residence?
A.	Sometimes a patient does not or cannot reside in a private home. The Benefit reimburses for hospice services that are delivered in freestanding hospice facilities, nursing homes and other long-term care facilities. However, the Benefit does not cover expenses for room and board. In some instances, Medicaid may cover these expenses for eligible patients. For benefits available under Medicaid, consult your state Medicaid office.

Q.	Does the Benefit cover continuous care (a special level of hospice care) at home?
A.	Yes. If there is a brief, acute episode that requires additional care to manage pain or acute medical symptoms, nursing care may be covered on a continuous basis to maintain the patient at home. Skilled nursing or home health aide services, or a combination of both may be covered on a 24-hour basis during periods of crisis, but care during these periods must be predominantly nursing care.

Q.	Does the Benefit cover general inpatient care that may be needed as a result of a crisis or an acute episode that cannot be handled in a patient's primary residence?
A.	If a hospice inpatient admission is necessary for the patient, the hospice team will arrange for the patient's stay in a freestanding hospice facility, a nursing home, or other long-term care facility, which is covered by Medicare.

Q.	Is there any relief for loved ones whose responsibility it is to care for the hospice patient?
A.	Caregivers, who are family members or other loved ones responsible for taking care of the hospice patient, may, on occasion, need a break, or respite, from daily caregiving. To give the caregiver relief, respite care may be provided in a Medicare-approved facility such as a freestanding hospice facility, a nursing home or other long-term care facility, which is covered by Medicare for up to five days at a time.

Q.	Is a patient's Medicare coverage forfeited if hospice care is chosen?
A.	Not at all. A patient retains full Medicare coverage for any health care needs not related to the terminal diagnosis, even if the patient elects hospice care. The patient must continue to pay the applicable deductible and coinsurance amounts under the standard Medicare Plan or the co-payment under a Medicare managed care (HMO) plan.

Q.	How long can a patient receive hospice care?
A.	For as long as the physicians continue to recertify the terminal illness, patients can receive hospice care. Two 90-day periods of care are followed by an unlimited number of 60-day periods, as long as the patient remains eligible. Hospice care is provided only to patients who have been certified by their doctor and the hospice medical director as terminally ill with a life expectancy of six months or less.

Q.	What if a patient is enrolled in a Medicare managed care (HMO) plan?
A.	A hospice-eligible patient who is enrolled in a Medicare managed care plan may choose any Medicare-certified hospice provider. Authorization from the managed care plan is not required.

Q.	Why would a patient stop receiving hospice care?
A.	A hospice patient has the right to stop receiving hospice care at any time, for any reason. If the patient chooses to stop hospice care, health care benefits from the standard or managed care Medicare program continue. On occasion, a terminally ill patient's health improves or the patient's illness goes into remission while receiving hospice care. A patient's condition may become stable to the point that the hospice team and physician(s) believe the patient cannot be certified as terminally ill (having a life expectancy of six months or less), and, therefore, is no longer eligible for the Benefit. At any point in time, a patient can return to hospice care, as long as the eligibility criteria are met and certification by physician(s) and hospice team are received.

"We are finding more and more people are open to hearing about hospice and availing themselves or their loved ones of hospice services. As we continue to support our mission, we are actively involved locally, statewide, and nationally."

� Tiana Ronstadt,
Past President,
Casa de la Luz Foundation

The simple and warm-hearted advance directive called "Five Wishes" spells out an individual's desires for end of life care. The form, a living will, was developed by an organization called Aging with Dignity with a grant from the Robert Wood Johnson Foundation.

Most living wills are wordy, confusing and written with legalese. The "Five Wishes" was developed by a hospice worker to help patients and their families plan ahead and cope with death. Five areas are identified and under each wish is a series of options. The directive instructs the signer to choose one of the options or cross out anything with which the signer doesn't agree. Besides these medical areas, also addressed are personal, emotional and spiritual needs. Casa de la Luz Foundation would be pleased to send you a complimentary copy of "Five Wishes."

To receive your copy of "Five Wishes", select here.

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