Hospice may well be both the most generous and the least used Medicare benefit. Hospice care is available to anyone whose disease, in its usual course, will end in death within six months. But in 2020 the median time on hospice was 18 days, with wide variation by disease type. [footnote: 24 Code of Federal Regulations 418.22; www.nhpco.org/wp-content/uploads/NHPCO-Facts-Figures-2022.pdf]
What Hospice Covers
Hospice care does not replace hospital, skilled nursing or assisted living facility or home health care. It supplements this care with attention to relief of symptoms; to physical, emotional and spiritual care of the person and counseling for their family during hospice and for up to 13 months after death. Inpatient care for respite or to address breakthrough pain or symptoms of a condition other than the one which brought the person to hospice are provided with a 5% copay for respite. Prescription drugs have a $5 copay.
Entering Hospice Care
To enter hospice, the person must agree to forego pursing treatment and cure of whatever disease or condition occasioned hospice eligibility, [footnote: 42 Code of Federal Regulations 418.24]. There are discussions about changing this to allow people to continue dialysis.
Leaving Hospice Care
People can decide to leave hospice. We do see people who are frail and failing to thrive enter hospice and, being strengthened, leave hospice. We also see people who have lived beyond two consecutive six-month hospice periods. Those people need to meet with a doctor in person no more than 30 days before beginning a third hospice period. Hospice regulations and hospice practice differ: it can be very difficult to secure a second six-month period.
Elder law attorney, Terry Garrett, CELA, is a member of the National Academy of Elder Law Attorneys and is an Approved Guardianship Attorney. She assists people in elder law, estate and special needs planning, guardianship and settling estates. She graduated with honors from Cornell University. She was on the Dean’s List at Wharton Business School. She earned her J.D. at Columbia Law School, receiving the Parker Award and a Mellon Fellowship.
