Casa de la Luz Hospice - How Can We Help?



www.casahospice.com

"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:

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 needed 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 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 patients and their family.

Anyone can make a referral for hospice care; a physician, family member, friend, or a 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.	How long has Casa been providing hospice care?
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!

Q.	Is Casa's staff specially trained in end-of-life care?
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.

Q.	How satisfied are Casa's patients and families?
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.

Q.	Do you have freestanding inpatient facilities?
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.

Q.	What are Casa's staffing levels?
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.

Q.	Does Casa offer therapies or other activities that can enhance quality of life?
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, message therapy, energy therapies, meditation, and guided imagery.

Q.	Does Casa provide bereavement services for the entire family?
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.

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.	Who is eligible for hospice benefits under Medicare?
A.	Hospice benefits are available to Medicare beneficiaries who: Are certified by their doctor and the hospice medical director as terminally ill and have a life expectancy of six months or less; 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 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.
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 personal 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; and 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, 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.
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 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.
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 is met and certification by physician(s) and hospice team is received.

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", please call 544-9890.