Frequently Asked Questions

A physician must certify that a hospice patient has an illness and an estimated life expectancy of six months or less if the illness runs its usual course. The patient must agree to hospice care. Generally, most hospice providers accept everyone who meets those criteria, regardless of the patient’s financial situation or insurance coverage. The patient does not have to have family caregivers in the home to receive hospice services.

Hospice is covered by most insurance plans, including Medicare and Medi-Cal, with few out-of-pocket costs to the patient. Tranquil Care staff will work with your insurance company to coordinate coverage. Tranquil Care receives no reimbursement for our bereavement services which are provided free of charge.

The Medicare hospice benefit covers costs related to the terminal illness, including the services of the hospice team, medication, medical equipment, and supplies. Medicare reimburses for different levels of hospice care recognizing sometimes patients require special attention. Medications: The Medicare hospice benefit covers medications needed to treat the patient’s terminal illness. Generally, hospice providers will order medications for you, and the pharmacy will arrange for delivery. Medications for a condition not related to the terminal illness – allergy medication for example – are not covered by the hospice benefit.

Medical supplies: The physician and nurse will work with the family to determine which medical supplies and equipment the patient needs The Tranquil Care Hospice team order the equipment and have it delivered to your home.

No, ambivalence is normal and acceptance is a process. Hospice never takes a person’s hope away. Tranquil Care staff will help patients and their families redefine hope as they begin to accept their death. For example, hope may mean staying well enough to attend an important event or it may mean living and passing without pain. However, the physician must have discussed the prognosis with the patient and the patient must understand and desire Hospice services.

Hospice includes the services of an interdisciplinary team of health care professionals:

• Physicians (the patient’s own physician and the hospice physicians, who are specialist in controlling pain and other symptoms of serious illness) prescribe medications and other methods of pain and symptom control.
• Nurses are experts at maintaining patient comfort. They assess the patient frequently and help family members provide the necessary support.
• Certified nurse assistants provide personal care and help the patient and family with activities of daily living. They also provide companionship and valuable emotional support.
• Social workers coordinate community resources and help the patient and family with non-medical concerns. They can help family members mend damaged relationships, plan for the future and ease other emotional difficulties.
• Chaplains and spiritual counselors help patients and families cope with spiritual questions and concerns at the end of life, either directly or by coordinating services with the patient’s and family’s spiritual advisors.
• Bereavement coordinators help patients and families deal with grief. Grief support services continue for at least one year after the death of a hospice patient.
• Volunteers provide companionship and emotional support and offer help in myriad ways.
• Hospice also provides medications, medical equipment and supplies necessary to promote comfort a home or in other hospice settings.
• Hospice staff is available by phone at all times, 24 hours a day, 365 days a year.

When cure is no longer an option, Hospice provides treatment for comfort reasons. This is called palliative care. If a patient is receiving radiation treatment, we will wait until that course of treatment is completed before admitting the patient to Hospice. Once in the program, if a patient should develop symptoms that would be best managed with radiation, we will work with the radiation oncologist to develop an appropriate treatment plan.

Hospice involves acknowledging that most diseases in their advanced form cannot be cured. It does not mean giving up hope. The focus of hope shifts towards helping the patient achieve quality of life by reaching physical comfort and peace of mind, while helping families adjust to cope with the challenges.  If a patient stabilizes, improves or has a remission, he/she will be “graduated”, or go off the hospice program.

Most hospice patients live at home or in an assisted living, independent living, or skilled nursing facility.

Routine home hospice care covers the services of the interdisciplinary hospice team, medications, and equipment. Other categories of care are available when needed and approved by the interdisciplinary team according to Medicare guidelines.

• Routine: Standard level of care given in the home, long-term care facility, board and care facility, or assisted living facility.  Care includes visits from the hospice nurse, chaplain, social worker, and certified nurses’ aides as well as 24-hour on-call nursing support.
• Inpatient Care: Sometimes pain or symptoms cannot be controlled at home, and the patient is taken to a hospital or other inpatient care center. When the symptoms are under control, the patient returns home. Typically this lasts only a few days.
• Respite Care: Many patients have their caregivers, often family members. When caregivers need a rest from their caregiving responsibilities, patients can stay in a nursing home or hospice residential care center for up to five days. Medicare covers the cost of room and board, as do many other insurance plans.
• Continuous Care: Sometimes a patient has a medical crisis that needs close medical attention. When this happens, we can arrange for inpatient care, or the hospice staff can provide round-the-clock care in the home. When the crisis is over, the patient returns to routine home care. Typically, continuous care lasts a few days until symptoms can be controlled per Medicare Guidelines.

Hospice care does not automatically end after six months. Medicare and most other insurers will continue to pay for hospice care as long as a physician certifies that the patient continues to have a limited life expectancy.

The patient’s primary doctor has to estimate a prognosis of six months or less. This prognosis is his/her best guess but it may not be accurate

Occasionally, the quality of care provided by hospice leads to substantially improved health, and life expectancy exceeds six months. When this happens, the hospice provider will transfer care to a non-hospice care provider. Later, when patients become eligible for hospice, they can re-elect the hospice benefit. There is no penalty for getting better!

When morphine and other pain control medications are administered properly for medical reasons, patients find much-needed relief without getting “high” or resulting in drug dependency. The result is that hospice patients remain more alert and active because they are not exhausted by uncontrolled symptoms.

Hospice recognizes that people are more than a collection of symptoms. People nearing the end of their lives often face enormous emotional and spiritual distress. They are dismayed as their physical abilities begin to fail. They don’t want to be a burden on their families. They worry about how their loved ones will manage without them. Sometimes, they feel deep regret about things they have done or said – or things left undone and unsaid. Hospice professionals and volunteers are trained to be active listeners and to help patients and families work through some of these concerns so that they can find peace and emotional comfort in their final days.