As awareness of hospice care has grown, so has the number of people in Chicago and elsewhere in the country who are using hospice services. According to the latest Facts and Figures report from the National Hospice and Palliative Care Organization (NHPCO), 1.72 million Medicare beneficiaries enrolled in hospice in 2020 – an increase of 6.8 percent over the previous year.
Without question, this is trending in the right direction. Hospice care brings comfort, dignity and peace as the end draws near, profoundly impacting the lives of patients and their families. We hope more people come to understand that hospice isn’t about giving up hope or hastening death. In actuality, choosing hospice is choosing to make every moment count.
But what qualifies someone for hospice care?
Many people think hospice is only for those in the final hours or days of life, or that services are reserved for cancer patients. Neither is true, yet misconceptions like these persist among residents of Chicago, Illinois. As knowing when to consider hospice care can be of such great benefit, we decided to set the record straight.
Hospice Care Eligibility Guidelines
Most Chicago patients pay nothing out-of-pocket for hospice care. For those who qualify, the full cost of services is typically covered through Medicare, the Illinois Medicaid program or private insurance.
In order to be eligible for hospice coverage, an individual must meet certain criteria. The minimum requirements include:
- A diagnosis of an incurable condition
- An estimated prognosis of six months or less
- A willingness to forgo further curative efforts
Additionally, Medicare only covers hospice care when a Medicare-certified agency provides the necessary services. That’s also the case with Medicaid and most private insurers. However, patients have plenty of options – as reported by the NHPCO, the number of Medicare-certified hospice programs nationwide in 2020 totaled 5,058. And in the Chicago area, dozens of agencies are approved care providers.
Primary Diagnoses for Hospice Patients
A physician’s confirmation of a limited lifespan is a requirement for hospice coverage, but individuals with any serious, life-threatening condition are eligible. Services aren’t limited to those with a specific illness or disease.
That being said, certain diagnoses are more prevalent among Medicare beneficiaries. As per the NHPCO report, the following conditions accounted for largest percentages of hospice patients in 2020:
- Alzheimer’s, dementia and Parkinson’s, at 18.5 percent
- Circulatory and heart diseases at 9.3 percent
- Cancer, at 7.5 percent
- Respiratory conditions, at 6 percent
- Stroke or cerebrovascular accident (CVA), at 5 percent
- Kidney disease, at 1.5 percent
- Severe malnutrition, at 1.3 percent
- COVID-19, at 0.9 percent
Medicare-certified hospice agencies also serve patients facing other life-threatening diseases and conditions. As an example, here at Suncrest of Chicago, we provide care to individuals with:
- HIV/AIDS
- Huntington’s disease
- Liver disease
- Lou Gehrig’s disease (ALS)
- Multiple sclerosis
- Recurrent sepsis
- Refractory autoimmune disease
This list is by no means exhaustive. Like other Medicare-approved hospice care providers, Suncrest of Chicago is ready to meet the needs of patients with any incurable condition.
When to Consider Hospice for a Loved One
As we mentioned above, one of the requirements for hospice coverage is an estimated prognosis of six months or less. This assumes that the patient’s illness follows the expected course – but diseases affect people in different ways, and even the best doctors in Chicago find it difficult to predict how long someone has to live.
With that in mind, families of incurably ill individuals should watch for warning signs that the end of life may be near. Any of the following may suggest that it’s time to consider hospice care:
- Frequent emergency room visits
- Multiple hospitalizations
- Progressive weight loss
- Trouble handling routine tasks
- Confusion or disorientation
- Uncontrollable pain
- Recurring infections
- Unrelenting nausea
- Increasing fatigue
- Difficulty breathing
For individuals diagnosed with dementia, figuring out when hospice care might be appropriate can be tricky, as these disorders often progress rather slowly. However, certain signs are indicative of the end drawing near. Scheduling a hospice consultation is a good idea when a dementia patient:
- Speaks only a few words
- Has problems swallowing food
- Is unable to walk without assistance
- Can’t sit upright without support
- Develops incontinence
- Grows increasingly restless
- Acts angry, agitated or aggressive
Hospice Coverage Isn’t Limited to Six Months
To be eligible for hospice care, an individual must have a life expectancy of six months or less – but that doesn’t mean services aren’t covered past that point. If someone who enters hospice lives longer, here’s what happens:
- A physician conducts an assessment of the patient, and providing their prognosis hasn’t changed, hospice services can continue.
Or:
- After assessing the patient, a physician finds that their condition can no longer be considered terminal and, as such, the individual is discharged.
In the latter situation, the decision to discontinue hospice care isn’t necessarily final. A patient can always resume services later on if their health begins to decline, provided that their life expectancy is estimated to be no more than six months.
Do you believe that a loved one may meet the requirements for hospice care? In Chicago, Suncrest is a trusted source for end-of-life support. To arrange for a free consultation, contact us today.
