Hospice Care by Mitigare
Information and Practical Advice on Signing Up for Hospice Care
Where is hospice?
Hospice is not a place but a philosophy of care for persons with terminal illnesses. Hospice care is most often delivered in the home of the patient. Hospice care can also be delivered in a nursing home or other institution chosen by the patient and their family.
Who is eligible for hospice?
Persons with a terminal diagnosis of an illness with a prognosis of six months or less, and who have decided not to continue to pursue curative treatments, are eligible for hospice care. That diagnosis can come from the family physician or, if that is not available, the hospice doctors can make the diagnosis determining eligibility.
How do I “sign up” for hospice?
Hospice intakes are scheduled from Monday to Saturday. The intake visit includes the medical director, a hospice nurse and the hospice social worker. It generally takes 24 to 48 hours to schedule everyone to be able to come together as the hospice team is also tending to their regular jobs and obligations. It is important that you begin to plan and arrange for the patient’s intake before there is a crisis.
When should I call hospice?
Call hospice before you have a medical emergency. Hospice care is best delivered in a planned and expected manner. The hospice medical team can help you anticipate and plan for events as a disease progresses, eliminating the need for emergency visits. Maintaining minimum stress for the patient and the caregivers is part of the program that hospice is trying to deliver.
Who provides the care for hospice patients?
Family members, or hired caregivers paid for by the patient/family, provide most of the day-to-day care of hospice patients. Hospice team members will help the family and caregivers learn how to care for the patient at home and will make regular visits to manage the patient's care. Team members also provide routine psychological, emotional and spiritual support for the patient, family and caregivers. Mitigare does not provide staff to stay with patients and families around the clock except in extraordinary circumstances.
What happens at the intake visit?
It takes 24 to 48 hours to arrange the intake visit. The intake procedure involves the medical director, a hospice nurse and a social worker. Please call Mitigare and schedule the intake examination before you have an emergency. Intake visits are not scheduled on Sundays. Often intake exams are scheduled after 6 pm.
If the patient has emergency needs, such as pain and symptom management, the hospice doctor will address the immediate medical needs, and the intake appointment will be scheduled for a different day.
At the time of the intake examination, the doctor and nurse will review with the patient and family the medical history and the diagnosis of the patient’s illness. They will examine the patient and determine their current condition in order to devise a health care plan appropriate for that patient. If there is a need for home medical equipment, the doctor will prepare the equipment order. The social worker will discuss with the patient and/or primary care taker the financial obligations. If a patient has limited resources, the social worker will help determine what is feasible for the family using a standard sliding scale evaluation as commonly used by other medical institutions.
Who are these hospice team members and how often do they visit?
The hospice team includes a doctor, nurse, social worker and a volunteer. In addition, a bereavement specialist (thanotologist) remains involved with the family during the illness and afterwards. Members visit on varying schedules according to the needs and wishes of the patient and family. The hospice nurse is the case manager and will often visit several times a week. The nurse remains in constant contact with the Medical Director. The nurse will monitor responses to medication changes and will offer support as the patient's condition worsens. The social worker visits will vary depending on the specific needs or wishes of the patient and family. Volunteers may be available to provide friendly visits, additional support for family members and/or respite for the regular caregivers. Hospice staff is available 24 hours-a-day for phone consultation and/or unscheduled visits should a specific need arise. The goal of all these people is to help support the patient and family in their decisions and in achieving their goals during this sacred part of the life cycle.
Why is Hospice not "Emergency Care"?
Mitigare does everything possible to keep hospice care from being emergency care. It is important that people try to anticipate needs and help the hospice team provide care in a planned and comfortable way for its patients. The hospice team can help you anticipate events and advise you of the likely progression of an illness so the patient and caregivers are not feeling unnecessary anxiety as the disease follows its natural course.
What if there is an emergency after I am enrolled in hospice?
Hospice takes all steps possible to avoid emergencies by anticipating changes in condition before they occur. However, once you are a hospice patient, emergency service is available 24/7.
The hospice team will inform you of likely “paths” an illness will take and help you have available basic medicines that may be needed immediately to counteract new symptoms or pain. Once a patient is in hospice, they will have a phone number to call if there is an urgent need.
Do you call 911 when a hospice patient is dying?
The patient/family always has the right to call 911 for emergency medical assistance, but most hospice patients sign a Do Not Resuscitate (DNR) order saying they do not want anyone to attempt to revive them when their heart stops beating or when they stop breathing. Unless shown the DNR, paramedics are legally bound to do everything they can to save the patient's life and get them to the Emergency Room. Unless the hospital ER knows the patient has a DNR, those doctors may also do all they can to save the patient. Generally, families involved in hospice, do not call 911 when the patient is dying.
What does Mitigare charge for its services?
Hospice care is delivered by a team that may include a doctor, a nurse, a social worker, a thanatologist (expert in the psycho-social aspects of dying) and a hospice volunteer. Services are delivered on an economic sliding scale so that anyone, regardless of ability to pay, can have hospice. Hospice charges for the medical team visits and for home care medical equipment. Mitigare has a Patient Assistance Fund that allows us to serve anyone regardless of their ability to pay. The Mitigare social worker will work with you to find a plan that fits your budget.
When do I pay?
The patient is responsible for paying the intake fees at the time of intake. The Mitigare social worker will help determine what that amount will be at the time of intake.
Patients will be billed and expected to pay weekly.
Mitigare cannot accept credit card payments at this time.
If the patient has medical insurance, the patients will pay directly to Mitigare and Mitigare will help with the collection of insurance.