The vast majority of Cleveland patients who qualify for hospice care receive services at home or wherever they happen to reside. People who are seriously ill and nearing the end of life generally prefer to be in a familiar setting, and hospice care at home makes that possible.
However, sometimes a patient’s symptoms cannot be managed at home. In these cases, a nurse or healthcare provider may advise moving to the in-patient level of hospice care. Services are then provided at a local hospital or a dedicated facility, with the goal of stabilizing the patient so that they can once again receive care at home.
The question is, who pays for in-patient hospice care in Cleveland? Will you be left to foot the bill if a loved one on hospice requires this level of assistance?
If they’re on Medicare, the answer may be no. Read on to learn more.
Medicare Requirements for In-Patient Hospice Care
The basic Medicare requirements for hospice eligibility apply to all levels of care, including the in-patient level. For services to be covered under Medicare, a patient must meet these criteria:
- Their life expectancy is six months or less, as certified by a doctor.
- They’re choosing comfort care instead of further curative treatments.
If someone on hospice happens to live longer than six months, their Medicare coverage doesn’t end. Providing that a physician recertifies that the patient is terminally ill, they can continue to receive care services through Medicare for an unlimited period of time.
In regards to in-patient hospice care, Medicare has an additional requirement. For services to be covered, a patient must be experiencing symptoms that are unmanageable at home, as determined by the hospice team.
Medicare and In-Patient Hospice Care
The members of the hospice team — the patient’s own physician as well as a hospice doctor, registered nurses, social workers, home health aides and other specialists – make every effort to manage symptoms in the home environment. To that end, changes in medication or the care protocol can often work to keep a patient comfortable at home.
At times, though, symptoms may escalate and become impossible to manage in the home setting. In that event, the Medicare hospice benefit allows for in-patient care at a Cleveland hospital or a local facility, but only if arranged by the hospice provider. People can’t simply opt for in-patient hospice care, as Medicare may not cover the costs if this level of assistance isn’t medically necessary.
When is in-patient hospice care indicated? Your loved one may need to receive care services outside of the home if they experience any of the following:
- Pervasive pain
- Uncontrollable nausea
- Respiratory distress
- Wounds requiring complex care
- Pathological fractures
- Insuppressible seizures
In the situations listed above, Medicare typically covers the full cost of in-patient hospice services. But, this list isn’t exhaustive – issues like the need for intravenous medication that requires continuous monitoring or minor procedures to improve patient comfort may also be covered by Medicare when arranged for by the hospice team.
In-Patient Hospice Care Services
The Medicare hospice benefit offer comprehensive coverage to Cleveland patients in need. As such, if your loved one has to spend any time at a local hospital or care facility, everything they require should be covered. This includes all of the medications, medical supplies and equipment they need and visits from members of the hospice team.
If your loved one should require in-patient hospice care services, the team will keep a close watch on their symptoms and adjust the plan of care to keep them comfortable. After a few days, your loved one will hopefully be stable enough to return to hospice care at home.
What if that’s not the case? How long will Medicare pay for in-patient hospice care?
Fortunately, there’s no time limit – as long as your loved one requires intensive symptom relief related to the hospice diagnosis, Medicare will cover the cost of in-patient care. The goal will still be to get their symptoms under control so that they can go back home, but your loved one can receive around-the-clock attention and assistance for as long a period as necessary.
Medicare Hospice Coverage
Medicare may cover both hospice care at home and in-patient care services. Continuous home care, with members of the team providing 24-hour assistance, may also be covered in the event of a health crisis. And, caregivers of Cleveland patients can take advantage of respite care, getting a break from their regular responsibilities while their loved one stays at an in-patient facility for up to five days.
The fact that Medicare may cover all of these services is a relief to many people, but some patients and their families encounter issues with their coverage. The best way for you to avoid this is to work with a Cleveland hospice provider who will handle Medicare billing on your behalf. Here at Suncrest, we know the ins and outs of the Medicare hospice benefit, and our team is standing by to help in any way they can.
For more information on the Suncrest Care Team in Cleveland, Ohio, or to discuss at-home hospice care with a friendly and knowledgeable professional, contact us today.
