Hospice Care and What it Can Do For You

In this episode, John Ross and Lisa Shoalmire discuss some of the options out in the community that can be of assistance at the right time… for starters, hospice care.

Episode Transcript
Lisa
Hello everyone. Welcome to another edition of Aging Insight. I'm Lisa Shoalmire and I'm here with my partner John Ross and we are Elder Law Attorneys based here in the Ark-La-Tex. The whole purpose of Aging Insight is to make sure you get information that you can use, brought right into your own home. So, we're wanting to provide that to you every week. This week our topic is something that a lot of people run away from.
John
That's true.
Lisa
And talking about the issues of aging and handling the challenges that come with aging, whether those challenges are financial or whether those challenges have to do with where you're gonna live or those challenges are even more basics such as dealing with that chronic or terminal illness. Those are all challenges that if we're blessed with long life, we're all likely to face.
John
That's absolutely right and as you get older and you have more health problems, you have more health needs, more health concerns, as you experience these sort of things, figuring out how to pay for yourself, how to get the care you need, where to get that care from, what is covered by Medicare, what is covered by Medicaid, what is covered by veterans benefits, what're you gonna have to pay for out-of-pocket. All of these questions are flooding in at the same time. And so, one of the keys... We've always said on the program is that you if you wanna stay independent, you wanna live on your own terms, you don't wanna be a burden on others, you wanna avoid going broke, you can do it but you need knowledge. And that knowledge is the key to knowing, when the time comes and you start needing additional care, knowing what options are out there and not just dismissing something because of some misconception you might have. And that's really where we're coming to today.
Lisa
That's right. So, today we wanna talk about one of those resources, one of those options out in our community that can be of assistance at the right time is hospice care. And you know, John, when I say the terms hospice, a lot of folks in the community, or clients, or just even my own family, when you use the word hospice, again, they wanna run away from it, not discuss it, they think that if we're mentioning the 'H' word, then we are... Basically, we've given up, and we're admitting that there's a terminal situation and that's not the way to go. We should fight and we should... But, there are a lot of benefits to hospice care and people just need to know about it.
John
Yeah, I have a friend who is an Elder Law Attorney up in Seattle and he's a very well known up in the northeast and I listened to him speak one time and his position was that hospice benefits, of all of the benefits out there, Medicaid, and Medicare benefits, and home health benefits, and all of the different things that are out there, that hospice was the single number one misused or underused service out there that people just didn't know what was available. And when you start looking at care needs and you say, "Well, I could probably use somebody to come help with some of my meds at home. Maybe I need somebody to do a little... Help me bathe occasionally," or some things like that in the home environment, because I don't wanna have to go to a nursing home just yet.
John
Maybe I'm having some trouble paying for the kind of drugs that I need. Maybe my family is having a hard time coping with the illnesses that I have and I'd like some counseling, some support for them." All of these sort of things and all of those sound like great services. And if I said all of those services came from a palliative care unit, you might say, "Well, John, tell me more about this palliative care unit, that sounds like a great thing." But, if I say all of this is provided by hospice, oh, you should see the look at people's eyes when they're sitting in my office and I say, "Have you considered hospice?" Because you know when they hear that word, Lisa, they're thinking, "John, I cannot believe you just told me I'm gonna die."
Lisa
Yeah. That you've given up on me.
John
They said, "You given up on me and that that's it."
Lisa
Well, that's a big misconception. Hospice... First of all, let's talk about the financials, what pays for hospice care. Because a lot of times people won't even... They think that care is expensive I can't afford it, I'm just gonna dismiss it before we even go any further.
John
Right. And so under your Medicare, under Medicare and your supplemental insurance is coverage for things like home healthcare. So if you have, let's say you've injured yourself and you have a wound and you're at home and you need a nurse to come out and help you dress that wound once or twice a week, Medicare will pay for home health to come out and provide that kind of service, Medicare. Medicare is also what pays for Hospice care. So Hospice care is not gonna cost you anything other than that Medicare premium that's already being deducted out of that social security check that you get.
Lisa
So usually that's the first hurdle, the first thing someone throws up when I mention the term Hospice is well financially that's not... But once we get past that they don't have that excuse not to consider it further, then we really get into the nuts and bolts of what Hospice care can do. And first of all, Hospice care isn't for everyone but Hospice care is not just a benefit for those that are at the very end of life. And, John, some of the requirements for Hospice are that you do have a diagnosis such that death is imminent in six or twelve month time.
John
Yeah. A doctor... In order to qualify for Hospice benefits, a doctor has to certify that you have a disease or illness that could, notice I said "could" and not "will definitely," but could end your life within six months. So you clearly have something that is terminal. Now that doesn't mean that it's going to kill you in six months or that it's gonna kill you next week. In the Hospice world, as people get very close to death, a lot of times they talk about that as actively dying. This is where you're in the last few hours, minutes, maybe a day or two away from it. And often times this is when people... When they think about Hospice, they think about people who are actively dying. And yet if I told you that I have clients that go to church every Sunday, that drive themselves to church every Sunday and yet are receiving benefits under the Hospice program to help with some of those needs that they have in the home and some of these other things, that might surprise you.
John
Just because you have a diagnosis, that you have a disease that could kill you within six months, doesn't mean you're gonna die in six months. In fact, it's not uncommon for people to reach that six month mark and get re-certified for another six months. In fact I've heard stories of people who have received Hospice benefits for two years. In fact, I've even heard stories, and if you talk to some of the Hospice people they will tell you, while not very common, they've even had folks who received Hospice benefits and got better. So it's not for the actively dying, although that seems to be one of the big misconceptions. The other big misconception, Lisa, is I think Hospice originally started out as a program for people with cancer.
Lisa
Sure.
John
And so a lot of times people will say, they'll say, "Well John, my husband has Alzheimer's but he doesn't have cancer so Hospice would not be appropriate," And yet Alzheimer is also a terminal disease and if you're far enough along in it, it might qualify under that six month mark.
Lisa
Well there's still a lot of areas we'd like to talk about with you about Hospice and some of the benefits it can bring into your home and for that loved one that maybe aged or ill, and so stick with us after this break and we'll talk about that.
John
Welcome back to Aging Insight. I'm John Ross, here with Lisa Shoalmire, and today we're talking about a relatively under used program out there that most people have heard of, and that's hospice, and there's lots of different hospices out there. A lot of times people will refer to hospice as an organization. The word hospice just means, a type of care that is covered under Medicare that is for people who have a terminal condition. And again, as we said before the break, it doesn't mean that you're gonna die tomorrow, but there's a number of benefits that can be available under there. There are lots of different hospice organizations, there's private companies that are for-profit, there are non-for-profit companies, but all of these programs are providing services that are paid for under Medicare. And a lot of the things that they can do that you think about, for example having that nurse come out to the house, or that nurse's assistant come out to the house to do some thing's for you. One of the benefits that I think is pretty neat is the respite benefit under hospice.
Lisa
Right, and respite, what we're talking about is respite for that family, for that caregiver, generally speaking. So, the respite benefit for hospice is where the patient, the person who is ill can actually be admitted to a hospital, or another type clinic situation, where they can stay there for up to five days, and that gives the caregiver, who is on the job 24/7 at home, a little break.
John
Yeah, and a lot of times people don't realize the toll that being a caregiver takes on somebody. The average life expectancy of a caregiver is oftentimes less than the life expectancy of the person they're caring for, and that's because the stress is so difficult. Imagine you're taking care of this family member who has late stage Alzheimer's, and that's a round the clock job. They don't sleep on a regular schedule, they're up and down during the night, and you're trying to take care of them and make sure everything's good, and you're doing your best, but you've got a daughter, or a grandchild, who's getting ready to graduate from college, and you're thinking, "There's no way I can take my husband with Alzheimer's down to college station to go to this college graduation, but I just hate to miss it, but I can't really afford $160 a day at the nursing home, so what can I do?"
John
Well, this is where that respite stay, again, a person with late stage Alzheimer's may very well be eligible for hospice care, and if they're covered for hospice care. Then every so often, you're entitled to up to five days worth of respite care at something like a skilled nursing facility, and now you've got a way to get down to that graduation. And you may not have ever realized that that type of benefit was available from hospice.
Lisa
Right, and another one of the benefits that we see from hospice. Hospice is all about improving the quality of life of the individual who is ill. And a lot of times, we live in a wonderful modern age that has some good pharmaceuticals that can help us be pain-free, can pump up our appetites, can make us feel better, less depressed, and so those medications can be obtained through the hospice programs, and oftentimes, those medications can be obtained and you're not falling into that Medicare prescription donut hole, and those medications are provided through that hospice, rather than your prescription benefit.
John
Yeah, so it can be away to get especially pain medicine, or other types of medicines that are there. Earlier, I used the term palliative.
Lisa
That was a pretty fancy word.
John
It's a pretty fancy word, but all that means is taking care of, and palliative care, which is what hospice care is, is taking care of that person in a way that keeps them comfortable and happy. And really one of the last things about hospice here is that they have a huge team of people, and sometimes the benefits that those team members provide can be fantastic. I wanna give you an example or two, of how those team members have impacted lives, but you're gonna have to stick around. We've got one more break, and when we come back from that break, I'm gonna talk to you about those particular issues.
John
Welcome back to Aging Insight. And today, Lisa and I are talking about hospice benefits. And we've talked about that there's a medical care benefit there, there's a respite benefit, that there's some prescription drug benefits, all within this hospice. But one of the big things, and one of the most valuable things, is that the team of people that a Hospice agency brings to the table.
Lisa
To your door step.
John
To your door step.
Lisa
Yeah. [chuckle]
John
Yeah, that's exactly right. And not just medical professionals like nurses, and doctors, but also things like social workers, chaplains. And a lot of times, these folks can identify problems long before they ever become problems. And I'll give you an example, we had a husband and wife, and the the wife had Alzheimer's. The husband, unfortunately, had cancer. And he was at the very end of his life, and as so many people had done, they waited until the very end, and they brought in the hospice people. And one of the things the social worker said was "Well, by the way, have you all thought about what you're gonna do for this surviving spouse after... 'Cause Mom has Alzheimer's, she can't take care of herself. And when Dad dies, there's not going to be a caregiver. And maybe you should do some things, maybe put some plans together." And They were actually able to get with us, and we jumped into action to put some things together so that the surviving spouse would be taken care of, long after that gentleman passed.
John
Now, all of that happened within a couple of days. And frankly, if it had been probably one day later, we wouldn't have been able to complete that task. I guess my point with that is, goes back to with all of those resources, and all of the knowledge and benefits that those people can provide, don't wait until the last minute.
Lisa
Well, John, another benefit of hospice that a lot of folks are not aware of, is that hospice benefits and hospice services can also brought into a nursing home, or skilled nursing facility for your family member. And a lot of folks think that if your family member is a resident at the nursing facility, then hospice is not available. But that's really not true, and what's great about bringing hospice into the nursing facility is now we just have that many more eyeballs on that patient to make sure they're getting the highest and best care. And they're as comfortable and as well taken care of as they can be. I've seen families who didn't realize that was a benefit, and when they brought hospice into the nursing facility, their loved one just got all that much more care. And it's a difficult time, but lot's of support.
John
Right. I guess that our main point today with this topic is that when it comes to hospice care, again, it is truly an underutilized service. It doesn't cost you anything because it's already being paid for by your Medicare premiums. It can be a tool that keeps you out of a nursing home. What do we always say, Lisa? That our clients always tell us that they don't want to go to a nursing home. Well, if you want to avoid a nursing home, don't forget that there may be benefits from hospice that can do that.
Lisa
That can help you and your family keep you at home.
John
That's right, and people will say "Well, I don't wanna be a burden on my friends and family." And here, where you've got this team of social workers, nurses, chaplains, CNAs and all of these different people that they can bring in to help, that does alleviate the burden. That respite stay benefit alleviates that burden so that you're not becoming a burden on others. And of course, again, whether if you're on Medicare, this is paid for by Medicare, if you're on Medicaid, hospice is paid for by Medicaid. So you're not out of pocket, and since you're not out of pocket for these things, if you didn't have that, you might be paying for that person to come to the home to help bathe you or to do those tasks. And so, preserving those precious assets by utilizing every service that you can get your hands on, that's really the key.
Lisa
Well, and the bottomline here is hospice is designed to help support that patient to have that quality of life, and often times people put off utilizing hospice way too long, and I can't tell you how many times I've heard from clients and their families that they wish they had started utilizing hospice much earlier, because the person that is on the service, got to feeling better because of they got their medications just right, and it really gave them a quality of life during that period that they can enjoy with their families.
John
Yeah, and my last little point on this, and this is probably the one to keep in mind. Let's say you sign up for some hospice benefits, but you're just not happy with it. Quit. Stop. Just because you've made a decision to take some hospice benefits, doesn't mean that you're just washing your hands of life and that there's no going back. And if you decide "Well, you know what? Hospice is not right. I'd be better off with home health or paying for some care, or maybe some other form," that's fine. So, again, use the tools that are out there the best way you can. And you've got to know what those tools are, and of course, that's the point of this program. That's why you've been watching, it's so that you can learn what those benefits are and know that they're available even sometimes when you don't think they're available. Don't just believe rumors out there. Get the real knowledge, get the benefits that you need to take care of yourself.
Lisa
Yeah, so we've completed another episode of Aging Insight, but we're here every week on KLFI. And you could also go to the KLFI website, if you missed last week's episode, you can hit that website and you can get a replay right there. And you can catch us on the radio every Saturday at noon on 107.1 or you can call in with your questions.
John
Yeah, that's a live call-in radio. So if you have a question, call us. You can also find us on the internet at aginginsight.com, on Facebook, and you can follow me on Twitter at txkelderlaw. And until next time, we'll see you.
Lisa
Goodbye.

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