A Closer Look at Hospice Care: Benefits, Coverage, and Choices

Did you know that hospice care has evolved from being a last-days-of-life service to being a holistic approach that can occur in the patient's own home? Gain a wealth of knowledge in this enlightening chat with our special guest, Nikki Inches, LLMSW, and host Attorney Bob Mannor.  Nikki is not only a seasoned elder care navigator but also a dedicated social worker at Mannor Law Group. 

In this episode, Nikki unravels common misconceptions about hospice care, enlightening on how it's no longer just for the final days, but a supportive measure for those with a terminal diagnosis predicted to be within six months.

We don't just stop at explaining what hospice care is, but we take you on a journey of discovery about diverse aspects of this essential service. From exploring the range of medical equipment, medications, and supplies covered, to identifying intriguing differences between for-profit and non-profit hospices. Additionally, we discuss the various benefits and considerations when choosing hospice care including key questions to ask when evaluating what a particular hospice covers. You'll also hear about the additional benefits available for UAW hourly employees with a level five hospice and how it could potentially help bypass the hoops of Medicaid for seven months. Let's navigate this journey of understanding together and ensure the best possible care for our loved ones. Don’t skip this essential conversation!

Transcript

Nikki Inches 0:01

You're listening to Advice From your Advocates, a show where we provide elder law advice to professionals who work with the elderly and their families.

Bob Mannor 0:11

Welcome back to Advice From Your Advocates. I'm excited about today's topic. We're going to talk about hospice. This is a conversation that is very important, but a lot of confusion surrounds hospice, and today we have our very own from Mannor Law Office, Nikki Inches, who is a care navigator and social worker at Mannor Law Group. So hello, Nikki, thanks for coming.

Nikki Inches 0:37

Thanks for having me, Hello everyone.

Bob Mannor 0:39

Nikki has expertise in hospice. She has worked for a hospice organization and I have to say first, I love your name. It's such a rockstar name, Nikki Inches so I can't say that that's one of the reasons why we interviewed you when we saw your resume, but it is a very cool name. So let's talk a little bit about hospice. So I think people have a lot of different ideas about what hospice is and some people have experienced it more recently.

Bob Mannor 1:10

But I remember when I was in my maybe mid-20s, I had a cousin who went on hospice and that was what I believed hospice was for a very long time and it was basically the last few days of life. It was probably a week or less till she passed and she went to a place that was called hospice and they took care of everything. It was very lovely. It was just a way for the family to kind of get their head wrapped around things, to care for the person that was dying and that. That was just a very short term, but it was a place and everything was covered and there was no cost to it. Hospice has changed a lot since then, right?

Nikki Inches 1:50

Yes, absolutely so. Hospice now takes place at your home right, Wherever your home may be.

Bob Mannor 1:56

Whatever that place is, it could be a nursing home, it could be assisted living, could be your daughter's home, it could be anywhere right.

Nikki Inches 2:03

Absolutely. Wherever you are is where your home is and really it did kind of used to be where those last final days of life. But really hospice has so much more to offer for people. They bring in a team of caregivers who are able to help take care of that patient. It's not something that has to be done in the final days of life. The criteria for going on hospice is that if your diagnosis was left untreated, it would be terminal within six months. It doesn't always mean that somebody is gone within six months. It means that when that six months is up we're reevaluating and seeing if we've seen any declines and if so, then we can recertify you for another period.

Bob Mannor 2:45

Absolutely. So we've had clients on hospice for two, three years, sometimes Absolutely, and now I understand. I don't know if this was a change or just kind of a change in attitude, but sometimes dementia can be a qualifier for hospice, and dementia isn't always clear that it's going to lead to death in the next six months, but if it's far enough along, I do believe that that can be a qualifier. Is that accurate?

Nikki Inches 3:10

Absolutely. They're looking at things like do they recognize who their family members are? Do they, are they able to remember to feed themselves? Are they able to dress themselves? They're looking at all of those different pieces and as we progress in that dementia diagnosis or that dementia disease, we're forgetting to do those things, and so that's where hospice steps in.

Bob Mannor 3:35

So I'm going to get right to the misconception that I think a lot of our clients have and a lot of people have, which is, once you go on hospice, everything is covered. And that's just what I believed when I was 25. That was what my experience was. And so what is covered? Because we know that typically the cost of the nursing home is not covered, the cost of the assisted living is not covered, the cost of your mortgage at home or something like that is not covered if you're in your home. And so what is covered under hospice?

Nikki Inches 4:10

So hospice covers 100% of things related to your terminal diagnosis and that includes things such as medical equipment. So if you need a hospital bed, if you need a wheelchair, if you need a walker, if you need oxygen, those things are covered under hospice. Your medications that are related to your diagnosis are covered under hospice.

Bob Mannor 4:30

So no copays or anything like that. No copays like that.

Nikki Inches 4:34

Supplies such as briefs and wipes and bedpads and gloves, those things are all covered under hospice as well.

Bob Mannor 4:42

Now, hospice is covered by Medicare and so that's a really important point because almost everybody had. If you're over 65, you almost certainly have Medicare, so it's a Medicare benefit and it's not I don't believe it's covered under Medicare. So if you have Medicare, whether you have Medicare advantage or Medicare plus a supplement or just Medicare alone, it's covered and there's no cost associated.

Nikki Inches 5:05

Absolutely. Medicare covers it at 100% and if you have one of those supplementals, you actually revert back to your traditional Medicare under hospice.

Bob Mannor 5:12

You do, okay, so even if you're on an advanced program, it converts back to a traditional Medicare program because the insurance company's not paying for anything anymore, right, okay, now talk about hospice, because again, one of the misconceptions that I would have had 30 years ago was that it was hospice, that was just hospice. That's the thing, and my understanding is there's a lot of hospices, even sort of competing against each other.

Understanding Hospice Benefits and Considerations

Nikki Inches 5:44

Absolutely. There are a lot of hospices. They're for profit, they're not for profit. The one thing there aren't very many of anymore, unfortunately, are the hospice houses that you talked about. It sounds like your cousin went to Exactly those, unfortunately, are far and few in between. But you know, all hospices in theory should provide you the same level of care. I would hope that they would Definitely do your research and talk to the different hospice companies.

Bob Mannor 6:13

Well, that's an important point because you can ask them what does this cover? And they do have the freedom to cover different things. Okay, so they have where some hospices might cover and this is not, I don't know of any that do this but in theory that the hospice could cover some level of home care, some number of hours of home care. Most of them do not cover a certain level of hours of unskilled home care, right, and, but that's a possibility that that could be covered, right. So it's important to ask because people just think, okay, well, I was referred to this hospice from the hospital. Realistically it might be owned by the hospital.

Nikki Inches 6:53

Right.

Bob Mannor 6:55

And so it's not a bad idea to maybe check with another hospice and say, okay, what do you cover? But it's a difficult question to ask in that circumstances, where people are talking about hospice and end of life and those types of things, to now say, okay, but what are you going to give me? And I think that's really important to have that conversation.

Nikki Inches 7:13

Absolutely. I think an important piece of that is you know you talked about that home care something that hospice can cover and there are hospices that do is respite stays.

Bob Mannor 7:22

Yes.

Nikki Inches 7:22

Right. So every month for up to five nights we can have the loved one go to a skilled nursing facility and that's covered by hospice, so that the caregivers, the family, can get that break.

Bob Mannor 7:34

And that's a big deal, especially if somebody is is at their home or at their children's home or something like that, and not in a like an independent living, assisted living or nursing home. Because you know what if your daughter is getting married in Tennessee? What if you just need a break for a week? What if you're a spouse? Spouses need breaks, they need to have a time. They need to go visit their granddaughter, they need to go be there for when their grandchild is born or whatever, and so this gives them an opportunity, if they're on hospice, to do that and know that their loved one is going to be cared for during that time period.

Nikki Inches 8:12

Absolutely. It also just gives them that break. When I was in hospice we had some patients that we just had routinely set up every month. They were going to go because that just gave that caregiver that moment to sit down and breathe and they knew that their loved one was coming home. But they were going to get that next break.

Bob Mannor 8:30

And so the general thing with hospice is it's good for six months, right, but it's not meaning it's six months. And don't take that when they say six months, Don't say, oh well, I don't know what we're going to do in six months, because under many circumstances they'll be able to renew that for an additional six months. Absolutely Okay. Something that we talk about frequently and is not well known except in the long-term care industry is level five hospice. So what does that mean? Level five hospice?

Nikki Inches 9:03

So level five hospice is a benefit that was given to a lot of the UAW hourly employees. It is a benefit through their Blue Cross that will pay for up to 210 days room and board in a skilled nursing facility. So the Medicare portion will cover the hospice care itself. And their fifth level benefit is covered by their Blue Cross and so they oftentimes don't have any kind of copays or out of pockets with that.

Bob Mannor 9:33

Yeah, which is amazing. So I want to put that in context a little bit. First of all, if you weren't a retiree or a spouse of a retiree from UAW, you probably don't have this. I'm not aware of anybody that has it. That wasn't UAW, it was a very specifically negotiated by the UAW and so if you were salary, if you didn't work, if you weren't UAW, you probably don't have it. Can't hurt to ask right, absolutely. I always tell people ask, sure, check it out.

Bob Mannor 10:01

But the other thing is, why is it so such an important benefit? Well, if somebody needs that level of care, basically 24 hour care around here, that's going to be a licensed nursing home. Now there's different prices for things like assisted livings and independent livings and memory cares, but when it comes to licensed nursing homes, they're going to range from typically about 10,000 up to about $15,000 a month and even if we get Medicaid you're going to have a small copay. But with the hospice you're not going to have a copay. So it's a great benefit for seven months basically, so 210 days which is basically seven months.

Nikki Inches 10:44

Occasionally there's a small copay in there, out of pocket maximum type of thing, but typically that's very nominal.

Bob Mannor 10:51

So there could be a copay, but frequently there's not and regardless it is still now you don't have to do the things necessary to get Medicaid. So most of the listeners will know that we help people get Medicaid at Manor Law Group and that we usually can protect most, if not all, of the assets in order to qualify for Medicaid. But even to do that, I say that we can do it. We can protect you, especially if you're married. But even if you're single, we can protect assets and still qualify for Medicaid. But you have to jump through some hoops and sometimes those hoops require moving money around and things like that. And if we don't have to do that for seven months, that's a big plus, absolutely. What else about hospice do you want people to know about?

Nikki Inches 11:38

So I think it's important to note that it's not kind of. The conception is that hospice comes in, everything ends, we stop your medications. People go on comfort meds, but that's not necessarily the case. So, for instance, if you admit to hospice for something that is not kidney or renal related and you've been on dialysis, you can continue that dialysis. You don't have to stop that.

Bob Mannor 12:04

That's really interesting.

Nikki Inches 12:05

Yeah, also, you don't have to have a DNR in place to be on hospice.

Bob Mannor 12:11

Is that right?

Nikki Inches 12:12

Absolutely. A person can say I'm not ready to make that decision yet and as time goes on, you will end up back at the hospital. You know through that and that's the end of what hospice is trying to avoid. But it's not a requirement that you have that to be on hospice.

Bob Mannor 12:28

Those are really good tips because those are. The DNR thing is something I didn't know. And then even being on dialysis and still being on hospice until you told me that a few weeks ago, I didn't realize that that was an option. So that's really important that they. I think what you're saying, if I can recap it, is that you can still be treated for other things that aren't the reason you're on hospice, absolutely so hospice is going to identify the reason you're on hospice and you can continue care for the other things that aren't that thing.

Nikki Inches 13:01

Absolutely.

Bob Mannor 13:01

So if you're on, for example, for dementia and you get and you're on dialysis, you could stay on dialysis. Yeah, that's very interesting. Well, thank you, nikki. This has been very informative. I think that I hope a lot of people listen to this and pass it on to others. To encourage other people to listen to hospice is such an important benefit it's. You know, we don't want to take it too lightly, but we don't want to make it so that we don't get on it because we're confused about it. So this was really good information. I hope you have passed this along to your friends and family and co-workers so that they can get a better understanding of hospice. So thank you for joining us for advice from your advocates, and don't forget to subscribe.

Nikki Inches 13:45

Thanks for listening. To learn more,