Hospice Care Regulations and Laws

Although advancements in medical care have boosted life expectancies, death is inevitable. While many of us have no idea when our end will come, some terminally ill patients have an idea when they will die. Many choose hospice care to provide comfort in their last days. Hospice care eases their transition from life to death by addressing their needs. These needs include emotional, social, and spiritual.

Hospice care is often provided in a hospice facility or at the patient's home. Care may address the emotional needs of the patient's family and caregivers.

This article focuses on patient rights and federal hospice care laws and regulations.

Understanding Hospice Care

Hospice care is one of two types of patient care available to those with serious or terminal illnesses. Palliative care is also available to patients who suffer from serious or terminal illnesses and works to provide quality-of-life care. Both types of care focus on the needs of patients facing serious illnesses.

One significant difference is that hospice care is for patients who need end-of-life care. Palliative care is for patients at any stage of a serious illness. Hospice focuses on patients with six months or less to live, as documented in the patient's medical record. In contrast, palliative care is often provided along with curative treatment.

Palliative care

Many people think palliative care is synonymous with hospice care, but they are not the same. Palliative care differs from hospice care. Those with serious illnesses such as cancer or HIV/AIDS can receive palliative care. Non-terminal patients can get this level of care at any stage of their serious illness. Palliative care focuses on the patient's quality of life.

During palliative care, patients can develop a plan of care or advance directives with the help of their team. A palliative team may include the following:

• Palliative care physicians and nurses
• Nutritionists (provide dietary advice)
• Social workers
• Clergy

The palliative care team provides emotional and spiritual comfort, symptom management, and care.

Hospice Care

As noted above, hospice care focuses on terminally ill patients with six months or less to live. Hospice care is appropriate when the patient no longer responds to medical treatment. Hospice healthcare professionals provide comfort, like pain medication. They do not attempt to cure the illness.

Hospice Services

Palliative care and hospice care offer similar types of care services.

These services may include the following:

• Medication to manage symptoms and pain, including biologicals
• Medical services
• Medical supplies such as oxygen and catheters
• Speech-language pathology services
• Occupational therapy
• Physical therapy
• Nursing Services
• Medical equipment, like a medical bed or a wheelchair
• Bereavement counseling
• Home care
• Homemaker services

Hospice Care Facility

Hospice care is an interdisciplinary approach to end-of-life care. It is not a specific healthcare facility like a nursing home. Patients often have several choices for receiving hospice care.

These choices include the following:

• At home, with help from home health aides (through a home health agency)
• A traditional nursing home
• Short-term inpatient care at a skilled nursing facility
• An outpatient facility

Patients' Rights During Hospice Care

Hospice patients have the following rights:

• The right to have their property and person treated with respect
• The right to be free from abuse, mistreatment, and neglect, and also to voice grievances if necessary
• Involvement in developing their hospice care plan
• To refuse care or treatment
• To choose their attending physician

Paying For Hospice Care

Hospice care is expensive. Fortunately, those needing end-of-life care have a few options. These options include self-pay, private insurance, Medicare, and, where available, Medicaid.

Medicare is government-funded healthcare for those age 65 and older. It also covers individuals with a disability, ALS, or end-stage renal disease. The Centers for Medicare and Medicaid Services (CMS) a part of the U.S. Department of Health and Human Services (HHS) that administers Medicaid.

Medicare Coverage

Parts of the Social Security Act (including 42 U.S.C., Section 1395d, et seq.) outline the standards for hospice care about Medicare. The Code of Federal Regulations (CFR) establishes more detailed Medicare regulations.

To participate in the Medicare hospice program, healthcare providers must comply with the "conditions of participation." These conditions also form a baseline for state licensure, although some state laws are more stringent.

Conditions of Participation

Conditions of participation are CMS's standards and regulations for healthcare facilities participating in government-funded health insurance programs. These regulations protect patients, public health, and safety.

If the CMS determines a healthcare facility cannot meet a condition of participation, like occupancy requirements, the CMS may consider a waiver, eliminating the consequences thereof.

The conditions of participation for hospice providers, listed in 42 CFR Part 418, are too many to list in their entirety here. The following is a summary of these conditions:

• The medical director must supervise all physician employees and physicians under contract.
• Hospice programs should have an infection control plan. This plan protects hospice patients, their families, and hospice staff from infectious diseases.
• Hospice facilities must develop and maintain an emergency preparedness plan that complies with state, local, and federal law.
• Hospice staff must give the patient or their representative oral and written notice of their rights.
• Hospice registered nurses must complete an initial patient assessment within 48 hours after the patient chooses hospice care. A hospice interdisciplinary group must provide a complete assessment within five calendar days.
• The comprehensive assessment must include data for measuring outcomes and be properly documented in the patient's clinical records.

Medicare's Goals

Overall, Medicare's hospice benefit regulations incorporate the following goals:

• Patients and their family members know of the terminal condition.
• Pain control should be available to patients as needed for the prevention as well as relief of pain.
• Family members and friends should be active in providing support during the death and bereavement process.
• Trained volunteers can provide additional support with whatever the patient needs.

Coverage Details

Medicare-covered hospice care is for patients whose physician certifies they have less than six months to live. Medicare covers two 90-day periods of hospice coverage. If necessary, patients are then eligible for unlimited 60-day benefit periods. Patients can access more benefit periods as long as they remain terminally ill. Patients can change hospice providers once during each benefit period.

Get Help

Navigating complex laws and regulations is challenging, especially if you, a family member, or a loved one is facing a terminal illness. A local, qualified healthcare attorney can guide you through the process during this difficult time.