Advocacy Group on New Medicare Hospice Law: “An Issue that Must be Closely Watched”

Hospice is “a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments, explains the Hospice Foundation of America.

For families with a loved one currently receiving Hospice care, a new law is under debate and analysis by some advocacy groups. At the very least, they are keeping a close watch on the real-world effect of the law.

The new Medicare Home Health Face-to-Face Requirement is a condition of receiving payment for hospice services. “A physician must order Medicare home health services and must certify a patient’s eligibility for the benefit,” according to Center for Medicare and Medicaid Services (CMS). Moreover, “[before certifying] a patient’s eligibility for the home health benefit . . . [he or she] . . . must document . . . a face-to-face encounter with the patient.”

Why did Congress enact this law? Will the administrative burdens be worthy of debate? The rationale appears to have been; “[to ensure] that the orders and certification for home health services are based on a physician’s current knowledge of the patient’s clinical condition.” What remains unclear is whether Congress is trying to prevent some sort of perceived abuse of the Hospice process, whether Congress perceived physicians as lacking in diligence in this regard, or if it is a means to ensure money is not wasted.

Some groups ARE raising questions. For example, an article recently was published by CMS, entitled, “New Hospice Face-to-Face Requirement: Help or Hindrance?” The group expresses hope that the law will encourage more physician involvement, but also concern that “caring for hospice patients in their third and subsequent certification periods . . . [might become more] . . . difficult and potentially more expensive for providers than caring for patients in their first and second certification periods.” The group ends its article by noting it will continue to watch the issue, so that Medicare beneficiaries who are nearing the end of their lives will not bear any unintended burdens or care shortcomings as a result of this new law.

Image: Sura Nualpradid / FreeDigitalPhotos.net

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Considering Home Care? Read this First!

Making the decision to hire a home care service to provide care for your loved one is an important decision and can, at the same time, be very difficult. If an illness or recovery from surgery requires nursing care or physical therapy, a physician may order skilled home care services that provide both skilled providers and personal aides. Your decision is then based on the obvious medical determinations made by the doctor. But what if you as the family caregiver must determine the extent of care needed without the help of a doctor?

Each home care situation is unique. In the beginning, family or friends step in to help with simple tasks and support for aging seniors who want to stay in their homes. As long term care needs progress, more time is required to manage those needs. Physical and mental conditions change with aging making usually routine hygiene and daily living activities difficult for an aging individual. Even with the healthiest of seniors, the ability to drive a car, shop for groceries or do general housekeeping eventually needs to be relinquished to the responsibility of another person.

In one example, Karen, would stop by her parents' home on her way to work every morning and again on her way home from work in the evening. She checked in the morning to see that they were up and ready for the day and Karen would take a shopping list for things they needed. In the evening she delivered the needed items she had purchased during her lunch break and sometimes she fixed a meal when one was not prepared by her mother. This worked well until Karen began to notice her father did not shave or dress during the day and both parents were forgetting their medications. Karen felt more time and supervision was needed in their care but with her own family and job, she could not do it. Non-medical or personal home care services would be a good option for Karen to consider.

Before starting your search for a non-medical or personal home care company, determine what the care needs are and how much time each week will be required for assistance from the company. You may want to consult with the family physician and other family members as well as experienced social workers or care managers to determine needs. Most home care companies, as well, will help you do an assessment at no charge. With your care needs in hand, you are ready to begin your search.

The National Association for Home Care & Hospice (http://www.nahc.org/home.html) gives the following guidelines and checklist in searching for a home care company.

• How long has this provider been serving the community?
• Does this provider supply literature explaining its services, eligibility requirements, fees, and funding sources? Many providers furnish their home care clients with a detailed "Patient Bill of Rights" that outlines the rights and responsibilities of the providers, clients, and family caregivers alike.
• How does this provider select and train its employees? Does it protect its workers with written personnel policies and malpractice insurance? Does it protect clients from theft or abuse by bonding its employees?
• Does this provider assign supervisors to oversee the quality of care clients are receiving in their homes? If so, how often do these individuals make visits? Who can the client and his or her family members call with questions or complaints? How does the company follow up on and resolve problems?
• What are the financial procedures of this provider? Does the provider furnish written statements explaining all of the costs and payment plan options associated with home care?
• What procedures does this provider have in place to handle emergencies? Are its caregivers available on notice?
• How does this provider ensure client confidentiality?

If a home care company has not previously been recommended to you, ask for a list of previous clients and call for their experience with this provider.

Following up on these guidelines can help you determine the quality of personal care that is given. Many states license non-medical home care companies and require both legal and health standards to be maintained.
Read about individual home care companies in your area on the National Care Planning Council's website www.longtermcarelink.net. Photographer: photostock Evan H. Farr on Google +