Planning Ahead: Learning More about Hospice and Insurance Coverage

Today the temperatures are in the upper 90’s so after my visit with dad I decided it would be an indoor day.  I still have my long “To-Do” list that I have been slowly making my way through.  The next item on my list was to call Hospice and get information.

Dad doesn’t actually need hospice at this time — this is just me being pro-active.  He is in his mid-90’s with early Alzheimer’s disease but no chronic physical condition that would cause him to be “terminal”.  I am just trying to get ahead of the curve on this one because things happened too fast when mom broke her hip.

Mom went from acute issues (broken hip) to serious organ failures to terminal condition and death within 3 weeks.   See “the Emotional Toll of Caregiving“.  This all happened out-of-state and I didn’t know where to turn for help.  I promised myself that with dad I would be better prepared ahead of time.  Therefore now I am trying to learn as much as I can about resources before I need them.

I discussed this with a friend last week.  She used to work for Eldersource and gave me phone numbers for Lifespan and Eldersource.  She also told me to telephone his insurance company to find out if they cover hospice and if they limit which providers he would use.

First I called Lifespan.  I spoke with a woman who explained to me that Lifespan doesn’t actually do Hospice.  What they actually do is refer people to the proper organizations for their needs.  She then referred me to Eldersource and connected me directly.

The lady at Eldersource answered some of my questions.  I asked who actually provides hospice service in this area and she said she would send me a list of hospice providers and some brochures about hospice.

Now when I get her list I will call the agencies listed.  My goal is to visit at least one hospice provider and maybe more.  I want to find out where one gets hospice services.  I prefer to find a stand-alone hospice and not have to work with a nursing home.  I felt “turned off” but the nursing home dad was in last fall and I would very much like to avoid having him go back into a nursing home if I have any control over it.

Instead I want to keep him in his assisted living facility until he is too sick to stay there and then go to a hospice situation.  (His Assisted Living Facility doesn’t allow hospice to take place there because they don’t have nurses around the clock like a nursing home would.)

His physician has told me she considers this to be unrealistic and that he would probably need to go to a nursing home in the future.  But I am stubborn, so will try to do things my way!

I next tried to get information about dad’s health insurance.  I spent awhile trying to get on their web page without success.  Finally I telephoned his benefits office and I learned the web address had changed, as had his login information.  The woman was patient and walked me through creating a new web ID for dad and a new password.  We had to select 5 security questions and choose answers and then I could look up his insurance information.  This all took quite awhile but eventually I got to the listing of his insurance benefits.

I asked about hospice because I didn’t see it listed.  Turns out it was on the very last page that they pay 80% of the cost and the remaining 20% counts towards his “out-of-pocket” expense.  After he spends $1500 out-of-pocket in a year, they would pick up the rest.

The insurance doesn’t limit which facilities are covered as long as they accept Medicare assignment.  I don’t know if that is true of all Medicare eligible people or only those who haven’t chosen “Advantage” plans which often limit which doctors or hospitals one can use.

Anyway, I feel that dad would have the insurance coverage he needs for hospice if he were to enter one.  The issue will come down to whether he meets hospice criteria at the time of the next crisis.  I don’t want to push him towards “end of life” issues if he doesn’t need to worry about them now.  I am just trying to be prepared for the future.  Dad is doing well for a man his age and mental condition.  I would like it to stay that way forever, but I know sooner or later we will hit another medical crisis.  I just hope to be prepared when the time comes.

About letstalkaboutfamily

I am a retired and was the primary caregiver for both my parents before they passed. I have children and grandchildren. This blog is an attempt to connect with other caregivers and share ideas and experiences. I hope you will let me know what worked for you if you had an experience similar to mine. The main issues I am going to talk about are elder care, death and dying, assisted living, family relationships and hoarders and hoarding. Other topics will come up as I address the issues and my relationship with other family members.
This entry was posted in Alzheimer's Disease, Caregiving, Elder Care, Eldercare, Health Care, Health Insurance, Hospice, nursing home and tagged , , , , , . Bookmark the permalink.

8 Responses to Planning Ahead: Learning More about Hospice and Insurance Coverage

  1. Terre Mirsch says:

    You are wise to explore your options for hospice care before your father is in need of the care. Too often, people delay conversations and avoid seeking this information until a crisis occurs. Making decisions during a crisis is much more stressful for all involved and as you are experiencing, navigating the healthcare system is not easy!

    Questions about how hospice is paid for are not uncommon. Medicare covers hospice care at 100% under the Medicare Hospice benefit. Hospice services including the care and support of an interdisciplinary team (nursing, social work, spiritual care, hospice aides, therapists, and volunteers), medications related to the illness for which one is receiving hospice care, durable medical equipment and supplies, and bereavement care. Additionally, respite care is available for up to five consecutive days at a time for caregiver relief. Inpatient hospice care or continuous home care is available during short times of medical crisis. Typically, beneficiaries of Medicare Advantage plans will access the Medicare Hospice Benefit. It sounds as if the insurance plan your father has may also cover residential hospice care, which will be a wonderful benefit to have.

    You are asking great questions! Doing your homework now will make the decision making much easier when the time comes.

    • Thanks, Terre, The reason I am concerned with payment is that I have no way to care for dad at home. My apartment is too small and dad’s assisted living facility doesn’t permit hospice. I need to find out more about the on site care places and how they are paid. I am still not convinced the insurance and Medicare cover the on site hospice because the insurance rep just said it covers whatever Medicare covers. That is why I need to know more before we hit any crisis. When dad was in the hospital I had almost no time to find a place for him to go. I am sure they would push me to the same nursing home again if I don’t know what my choices are.

      • Terre Mirsch says:

        I understand your concern and encourage you to explore this further. Medicare does not cover the room and board services of a residential hospice (sometimes referred to as a hospice house) other than during a short term medical crisis. They will, however, reimburse the hospice for services at a routine home care rate, just as if the services were provided in his or your home. Some residential hospices accept this as full payment; others require payment for room and board (covers meals, linen and housekeeping, and 24 hour nursing care); some have sliding scale rates for payment based on a financial assessment. Every residential hospice is a bit different. I am hopeful that you will find a hospice in your area that will meet you and your father’s needs.

  2. terry1954 says:

    i wish medicare would pay for respite care for me as a caregiver, but i was told that since he is my brother, they help with nothing. that is sad to me, because i could use a break myself of at least a couple of days. my brother is on original medicare with no supplemental insurance

    • Terry, I don’t understand the Medicare rules. It seems to me like it shouldn’t matter if he is your brother but I have no idea how they decide. Everyone needs respite! I hope you can keep finding ways to get at least some time for yourself.

    • Terre Mirsch says:

      Insurance coverage guidelines are very hard to navigate! I am unfamiliar with respite coverage guidelines under Medicare except under the hospice benefit. The Medicare Hospice Benefit provides for respite care up to five consecutive days on an occasional basis. The purpose is one of caregiver relief and it does not matter what the relationship of the caregiver is to the patient. I find that our ability to give caregivers a break from time to time, allows them opportunity to reenergize and renew. Of course, all caregivers need a break from time to time- not just caregivers of those receiving hospice care. Perhaps someday other healthcare benefits will mirror the hospice benefit in this regard.

      • Thank you for adding these details for me. We pay for dad’s assisted living now and could pay the same or more for the hospice if we had to. I know the nursing home cost $11,000 per month when he was there and Medicare wouldn’t pay because he didn’t need an hour per day of skilled nursing. Dad is living off savings now and will continue to until he runs out. Assisted living is much cheaper than a nursing home so his money will last much longer where he is. I know also that some of the local hospice houses work with volunteers and donations but I haven’t called them yet. This afternoon I got the list of phone numbers to call, so soon I will call the ones I have heard the most about.

        Another reason I want to know as much as possible in advance is that I go south for several months in the snowy part of winter and leave dad in his assisted living. I have companions visit him 4 times a week and my son goes on Sunday. In an emergency I would return home but it would be good if I know what I want for him if things happen in a hurry as they usually do! It is hard to predict what dad will be like in 6 to 9 months, but thankfully so far he seems to be doing very well.

        Thanks again for your input on this topic.

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