hospice dying compassion webThe availability of home health and hospice services can help patients re­tain their residence of choice, which is often their own home, but it’s im­portant to have a clear understand­ing of what each benefit entails. Lisa Giovanni, MSN, RN, presi­dent of St. Luke’s Visiting Associa­tion, explains that while both home health services and hospice programs provide medically necessary, intermittent home visits, their focus is quite different. Both services are covered by Medicare and Medicaid and most commercial insurances.

Generally, home health services are provided to patients recovering from an injury, surgery or illness or manag­ing a newly diagnosed, or exasperation of a, chronic disease. To be eligible for services, a physician must or­der the care and certify that the patient requires skilled care and is homebound and therefore unable to receive the care in another setting. For Medicare coverage, the patient needs to meet the Medicare definition of “homebound,” meaning that leaving the home is “dif­ficult and taxing.” For example, the older adult might need help walk, to exit their home, and also requires another person to help them to get in and out of a car, she said.

Home health patients receive skilled nursing care, physical therapy services or both, and as needed, one or more of the following services:

home health aide

medical social work

occupational therapy
speech therapy

The doctor, usually the patient’s family physician, pro­vides the home health agency with an order for services and specifies within that order the care or treatment that the patient needs. Then the nurse or physical therapist who first visits the patient determines the frequency of visits and creates a plan of care that is in­dividualized to each patient.

“Home health care is intermittent and short-term,” Giovanni said. “It might be a couple of visits to teach a patient or family member how to independently care for an intravenous line or a urinary catheter, or it could be a couple of weeks long and include rehabilitation for something like a joint replacement. But it’s not long-term or on­going.”

Hospice services, on the other hand, are designed to provide care for terminally ill patients from the time they begin hospice services through the rest of their life. The hospice team includes physicians, certified nurse practitioners, nurses, hospice aides, volunteers, social workers and chaplains. Hospice focuses on pain management and symptom control, as well as emotion­al, social, and spiritual care, for both the patient and the family. After the patient passes, hospice bereave­ment services continue for a year to help families and loved ones deal with grief and sorrow and assist them through firsts and milestones like holidays, birthdays, and anniversaries.

“Patients who decide to involve hospice earlier, in the last months of life, rather than in the last days of life, are able to reap the benefit of its services because hos­pice not only cares for the patient, but the entire family unit,” she said.

Services can be provided wherever the patient calls home, including the home of a family member, an as­sisted living community, and even a skilled nursing fa­cility. Patients may also receive inpatient care or stay in the St. Luke’s Hospice House when more intense symp­tom management is needed requiring the continuous care of registered nurses 24 hours a day.

“The Hospice House is more of an intensive care unit for symptom management,” Giovanni said. “A patient might go there if they need management of pain or other severe symptoms that are unable to be managed in any other setting.”

To qualify for Medicare / Medicaid hospice services, the patient must have a prognosis of six months or less as verified by two doctors, and no longer be seeking curative treatments. If the patient lives longer than ex­pected and beyond the six-month prognosis, there is a recertification process, so the individual can continue to receive hospice care as long as it is still determined by the physician that the patient’s life expectancy is six months or less. Although rare, some patients have received services for several recertification periods, Giovanni said.

After the patient passes, the family continues to receive bereavement services for a year. Services can include phone calls from bereavement counselors, volunteers, and chaplains, to check on the family’s well-being. Families can also receive bereavement newsletters, and helpful literature, along with attending in-person or virtual support groups. St. Luke’s Hospice hosts an annual luminaria service, as well as several services of remembrance during the year to honor those who have passed away while under the hospice’s care.

“Our hospice team spends their days and their efforts helping patients and their families live every day to the fullest for all of the days that are left,” Giovanni said. “They help patients understand what to expect as death comes closer, but most of all, they really concentrate on helping the patient to achieve whatever goals they have for their final days.”

To learn more, contact St. Luke’s Visiting Nurse Asso­ciation at 484-526-1100 or toll-free at 1-800-211-4788 or visit sluhn.org/vna.

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