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"Hail
Guest. Not only the door, but the heart of the owner is open to
you."
Inscribed over the threshold of an ancient hospice in
Assisi
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:
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coordinates care under the direction of the hospice medical
director and the attending physician;
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manages the patient's pain and/or symptoms;
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provides nursing and personal care;
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coaches family and caregivers in the care of the patient;
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assists the patient and their loved ones with the emotional,
spiritual and psychosocial aspects of living with dying;
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provides needed medications, medical equipment and supplies;
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makes
short-term inpatient care available should pain or symptoms
become too difficult to manage at home, or when a caregiver
needs respite;
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delivers special services like speech and physical therapy
when appropriate;
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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 do not hesitate to call on us.
Casa de la Luz Hospice provides care for people who have any
type of terminal illness that is no longer responding to
curative treatment. When a disease prognosis is measured
in months, not years. When medical treatments cannot cure
a disease, Casa's team of professionals can do a great deal to
control pain, provide medical, spiritual, and emotional comfort
to patient and their families.
Anyone can make a referral for hospice care; a physician, family
member, friend, or neighbor. Once a referral is made, an
admissions nurse will schedule a visit with the patient and
family to assess the best care options. Our care can begin
that day.
When selecting a hospice
provider, it is important to know that not all hospices are
alike. If, after reading this, you want us to provide your
care, please be sure to specifically ask for Casa de la Luz
Hospice.
The expertise and over 30
years experience of the two founders, Lynette Jaramillo and
Agnes Poore, RN, have resulted in the creation of an
award-winning company that upholds standards of quality
performance that far exceed state and federal requirements.
| Q.
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How long has Casa
been providing hospice care?
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| A. |
Founded in 1998, Casa de
la Luz Hospice has served the Tucson community for eight years, and is
locally owned and operated. Services are available 24 hours a day,
365 days a year. Hospice is our only business!
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| Q.
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Is Casa's staff
specially trained in end-of-life care?
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| A. |
As of 2005, over 50% of
Casa de la Luz Hospice nurses have been certified in Hospice and
Palliative Care. Our program has three hospice physicians on staff who
have special expertise in palliative (comfort) and end-of-life care. In
fact, because of our recognized expertise in end-of-life care, we work
with University Medical Center to provide training for third-year
medical residents.
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| Q.
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How satisfied are Casa's
patients and families?
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| A. |
In written surveys, 98%
of our families give a rating of "very satisfied" to describe their
overall experience with Casa de la Luz Hospice.
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| Q.
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Do you have freestanding
inpatient facilities?
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| A. |
Yes. We have two hospice
facilities specially designed to enhance the end-of-life experience for
patients who require close medical monitoring. Kanmar Place is
Tucson's only residential hospice home, where the emphasis is on quality
of life and where residents can live until they die. Our Inpatient
Unit is a short-term alternative to home care when pain, symptoms, or
family situations cannot be adequately addressed in the patient's home.
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| Q.
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What are Casa's staffing
levels?
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| A. |
Our inpatient unit has a
one-to-three staffing ratio, and our standard for home hospice care is
one nurse for every 10 patients. Our physicians are very accessible to
patients and family members and actually make house calls. Home care
nurses generally schedule daytime visits, but additional nursing staff
are available around the clock for phone consultations or for patient
needs that require additional home visits.
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| Q.
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Does Casa offer
therapies or other activities that can enhance quality
of life?
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| A. |
People approaching the
end of life have taught us that pain is rarely purely physical, nor is
it best treated by medications alone. A holistic approach to care is
offered that considers the whole person - body, mind, and spirit.
Complementary therapies are provided by professional Casa staff and
trained Casa volunteers, and includes therapeutic music, massage
therapy, energy therapies, meditation, and guided imagery.
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| Q.
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Does Casa provide
bereavement services for the entire family?
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| A. |
Yes. Casa provides a
comprehensive range of free grief support services for up to 13 months,
through our support groups, Healing Journeys seminars, and our Grief
Recovery Program.
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Surprisingly, many people do not realize that there is an
all-inclusive hospice care benefit available to Americans
through the Medicare program. Since 1983, the Medicare
Hospice Benefit has enabled millions of terminally ill Americans
and their families to receive quality end-of-life care that
provides comfort, compassion, and dignity.
What is the Medicare Hospice Benefit?
As
you may know, the Medicare program consists primarily of two
parts:
Part A - often described as Hospital Insurance
Part B - known as Supplementary Medical
Insurance.
Hospice care is available as a benefit under Medicare Part A.
The Medicare Hospice Benefit is designed to meet the unique
needs of those who have a terminal illness, providing them and
their loved ones with special support and services not otherwise
covered by Medicare. Under the Medicare Hospice Benefit,
beneficiaries elect to receive non-curative treatment and
services for their terminal illness by waiving the standard
Medicare benefits for treatment of a terminal illness.
However, the beneficiary may continue to access standard
Medicare benefits for treatment of conditions unrelated to the
terminal illness. For more information about Medicare
health plans or to receive a Medicare handbook, call
1-800-MEDICARE (1-800-633-4227).
| Q.
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Who is eligible for hospice benefits under Medicare?
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| A. |
Hospice benefits are available to Medicare beneficiaries
who:
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Are certified by their doctor and the hospice
medical director as terminally ill and have a life
expectancy of six months or less;
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Sign a statement choosing hospice care using the
Medicare Hospice Benefit, rather than curative
treatment and standard Medicare covered benefits for
their terminal illness; and
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Enroll in a Medicare-approved hospice program.
It is important to note that Medicare will continue to
pay for covered benefits for any health problems that
are not related to the terminal illness.
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| Q.
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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:
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Physician services for the medical direction of the
patient's care, provided by either the patient's
personal physician or a physician affiliated with a
hospice program;
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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;
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Home health aide and homemaker services such as
dressing and bathing that address the patient's
personal needs;
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Chaplain services for the patient and/or loved ones,
if desired;
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Social work and counseling services;
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Bereavement counseling to help patients and their
loved ones with grief and loss;
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Medical equipment (i.e., hospital beds);
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Medical supplies (i.e., bandages and catheters);
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Drugs for symptom control and pain relief;
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Volunteer support to assist the patient and loved
ones;
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Physical, speech, and occupational therapy; and
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Dietary counseling.
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| Q.
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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, hospitals, and 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.
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Does the Benefit cover continuous care (a special level
of hospice care) at home?
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| 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.
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| Q.
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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.
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| Q.
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Is there any relief for loved ones whose responsibility
it is to care for the hospice patient?
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| A. |
Caregivers, who are family members or other loved one's
responsible for taking care of the hospice patient, may,
on occasion, need a break, or respite, from daily care
giving. To give the caregiver relief, respite care
may be provided in a Medicare-approved facility such as
a freestanding hospice facility, a hospital, a nursing
home or other long-term care facility, which is covered
by Medicare for up to five days at a time.
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| Q.
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Is a patient's Medicare coverage forfeited if hospice
care is chosen?
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| 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.
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| Q.
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How long can a patient receive hospice care?
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| 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.
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| Q.
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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.
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| Q.
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Why would a patient stop receiving hospice care?
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| 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 is met and certification by
physician(s) and hospice team is received. |
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The simple and
warm-hearted advanced 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, submit your
request below:
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