What is Hospice Care & Why is it Important?

Hospice supports people near the end of life with compassionate care by:

• 制定專注於每位病人的目標及願望的個人化療護計劃
• 處理症狀及疼痛
• Improving quality of life in the patient’s preferred setting of care
• 鼓勵病人及其家屬充分把握與彼此相處的時間

At VITAS, our care model is inclusive and is designed to meet the unique needs of diverse patients facing a broad array of advanced illnesses, medical conditions, and accompanying symptoms.

Once a patient is deemed eligible for hospice by their physician, the transition can start as soon as they—or the person who is designated to make healthcare decisions on their behalf—agrees to shift from a curative focus and begin hospice services.

Whether you’re a patient, family member, or clinician who treats patients with serious illnesses, having correct information about hospice services can help you make the best decisions about whether hospice care is appropriate.

Table of Contents:

• 安寧療護提供哪些服務？
• What Is Usually Not Included in Hospice Care?
• What Is the Difference Between Hospice and Palliative Care?
• 誰符合接受安寧療護的資格？
• Where Can You Receive Hospice Care?
• How Long Does Hospice Last?
• How Do You Pay for Hospice?
• Begin the Hospice Conversation Early
• What to Ask Your Hospice Provider
• What VITAS Will Do for You in Hospice Care

安寧療護提供哪些服務？

Hospice offers compassionate care to improve the quality of life for seriously ill patients who have a prognosis of six months or less if the disease runs its course as expected.

Because hospice is not a place, patients can remain in their home, whether that is a private home or senior living community such as senior living, memory care, or a nursing home. Services include:

• Clinical symptom and pain management, including medications to help with symptoms.
• Care coordination, including the delivery of home medical equipment and supplies related to the cause of the illness.其中包括淋浴椅、氧氣筒、病床、如廁用品等。
• Training for family members or friends who are the primary caregiver(s).
• An expert, multi-disciplinary team makes regular, scheduled visits to the patient's household. For patients who live in senior living communities and nursing homes, the hospice team works with the facility staff.
• Therapies, including physical and occupational therapy. VITAS also offers respiratory therapy, music therapy, and spiritual and complimentary therapies in many programs.
• Spiritual support and bereavement care.
• Around-the-clock access to a clinical expert who can treat and triage over the phone or via a telehealth visit.
• When medically necessary as per Medicare guidelines, VITAS offers Intensive Comfort Care(R), a higher level of care when patients experience symptom exacerbation. Care is delivered at the patient's bedside in temporary shifts of 8-24 hours until symptoms stabilize.
• Short-term care in an inpatient hospice unit as needed (for patients) or respite care (for caregivers)
• A minimum of 13 months of grief and bereavement support for patients’ loved ones.

What Is Usually Not Included in Hospice Care?

Below are some items that are not included in the hospice benefit:

• Medications unrelated to the patient’s serious illness.
• Emergency room care not arranged by the patient’s hospice care provider.
• Curative treatments intended to heal the patient. If a new curative medication, therapy, or treatment for the patient's serious illness becomes available, they can withdraw from hospice care to receive it.
• Housing or room and board, aside from an inpatient unit hospice stay when medically necessary. The patient and their loved ones remain responsible for their home, assisted living community, or nursing home and related costs such as rent, mortgage, and food.

What Is the Difference Between Hospice and Palliative Care?

Palliative care can occur at any point in life, for any duration, and it can occur in conjunction with curative care.

Hospice is for patients who are not responding to disease-directed treatments and are expected to live six months or less.

Both types of care offer pain and symptom relief with clinical and psychosocial services. Hospice is the only one of these options covered by the Medicare Hospice Benefit (Medicare Part A).

誰符合接受安寧療護的資格？

A patient's physician will determine hospice eligibility based on the patient's prognosis. Hospice becomes an option when curative treatments are no longer effective and the patient has a life expectancy of six months or less as certified by their attending physician and a hospice doctor-either the hospice's medical director or the director's designee. Increased hospitalizations or emergency department visits, typically more than three per year, may be a sign of hospice eligibility.

Diseases that may lead to functional decline and hospice eligibility include:

• 癌症
• Cardiac and circulatory diseases
• Dementia/Alzheimer’s
• End-stage liver or kidney disease
• Respiratory diseases
• Stroke, neurological diseases, ALS (Lou Gehrig’s disease)
• Sepsis and post-sepsis syndrome

Hospice care remains a patient’s choice. Patients can choose to stop receiving hospice services or “revoke” hospice without a physician’s consent. They can then resume curative efforts. If they decide to return to hospice, they can do so as long as they meet eligibility guidelines.

Where Can You Receive Hospice Care?

Hospice is a service provided by a team of experts that comes to the patient in the place they prefer to receive end-of-life care. This means patients can remain surrounded by the faces and things they know and love:

• In a private home
• In a senior living community
• 在療養院

When medically necessary, short–term treatment in an inpatient unit is available for some hospice patients.

How Long Does Hospice Last?

There is no limit to the amount of time a patient can receive hospice care. Although hospice is for patients who have six months or less to live according to a physician, the patient’s stay can be extended when necessary.

Eligible patients benefit most from hospice services if they are referred early in their end-of-life journey. In surveys, family members often say, "We wish we had known about hospice sooner."

How Do You Pay for Hospice?

多數安寧療護病人無需支付自付費用。 Medicare Part A covers up to 100% of the cost of hospice care related to a hospice-eligible patient’s illness, with no deductible or copayment.

私人或僱主提供的健康保險則可能不同。請向您的保險公司查詢安寧療護資格、承保內容、自付費用等詳情。 Medicaid provides hospice coverage, but specific services and eligibility criteria vary by state.

Begin the Hospice Conversation Early

Hospice care provides the most meaningful improvement to the patient’s quality of life when it begins sooner in their disease process rather than later.

VITAS recommends end-of-life care conversations begin as soon as a serious diagnosis is made.透過與家人、醫師或設施人員及早展開有關他們療護目標及偏好的持續討論，病人可確保在他們希望的時間獲得希望的療護。

Physicians can help patients understand their options and identify their preferences during advance care planning sessions and goals-of-care consultations.這些關於聯邦醫療保險費用報銷的討論可形成醫療照護事前指示，這是一種具有醫療約束力的文件，指出該如何治療病人、在什麼情況下應對病人進行復甦術、誰可代替病人做出醫療決定等事項。

凡是18歲以上的人都應該準備一份醫療照護事前指示，以便當他們無法表達自己的意思時仍能維持對於自身護理的掌控。醫療照護事前指示包括生前遺囑、持久／醫療授權書、「五個願望」文件、維持生命治療的醫囑及其他重要文件。

Questions to Ask Your Hospice Provider

When considering hospice care for yourself or a loved one, understanding a potential provider's capabilities, history, and philosophy will enable you to make a more confident care decision.以下問題可釐清服務提供者是否適合病人：

• 安寧療護費用將如何支付？ Does the provider accept Medicare, Medicaid, VA benefits, and private insurance?
• 提供哪種療護層級​​​​​​​？ How often will care team members visit the patient at home?
• 病入的住院程序為何？最快可何時展開照護？
• 如果出現緊急狀況或嚴重症狀發作時，會如何處理？服務提供者是否提供全天候支援？
• 服務提供者能否處理居家照護的複雜症狀？他們對於呼吸道疾病、失智症、癌症、心臟病、敗血症、愛滋病等疾病能否提供專業服務？
• Is population-specific care available for veterans, LGBTQ+ patients, religious minorities, etc.? Can the provider accommodate and honor specific religious or cultural traditions?

What VITAS Will Do for You in Hospice Care

VITAS秉持「病人及家屬第一」的核心理念提供服務。VITAS的每項服務都為了病人、家屬、照顧者能獲得充分的支持而設；在病人生命最艱難但最關鍵的時刻能提升他們的生活品質，處理症狀及疼痛，並確保病人在這期間可獲得舒適與尊嚴。

Once a patient is ready to consider hospice care, VITAS can typically conduct an eligibility assessment within 24 hours and, if appropriate, begin an immediate transition to our services. We can take on new patients day or night, even on holidays and weekends.

這種隨時待命的服務方式正是我們整個療護模式的最佳寫照。對於病人、家屬、照顧者的臨床支援僅需一通電話，服務就來。

A VITAS interdisciplinary care team is assigned to each patient, working from an individualized care plan built around the patient’s unique needs, goals, and preferences.

Members of the team-including a physician, nurse, aide, social worker, chaplain, bereavement counselor, and other specialists-will visit routinely to manage the patient's clinical, psychosocial, and spiritual symptoms.探訪次數將視每位病人及家屬的需求而定。

Upon the patient’s death, spiritual staff and other members of the care team can be present to assist with end-of-life rituals, funeral home arrangements, and the challenges of grieving.

For at least 13 months after the patient’s death, VITAS bereavement specialists continue to help the family navigate their loss with personal check-ins, grief support groups, and other practical measures.