This is a must-read article if you are on Medicare, or a loved one is on Medicare.
Here is something that happened to me earlier this year…
I am sitting by my mother’s bedside in her hospital room. I’m holding her hand, but she doesn’t even know I’m here.
My brother and I have just decided to do hospice care for Mom.
Two weeks before, she was doing great — I even hosted her 99th birthday party. Then I received the call no child wants to get: She had fallen, suffered a stroke and two brain bleeds, and was on her way to the hospital by ambulance.
Several days later, when there was no improvement in her condition, we reluctantly selected hospice care.
Chris, my mother’s new hospice nurse, is now suggesting that we move her to their free-standing hospice facility. It’s a nicer environment for her last days, plus it’s closer to my house. It seems like a logical solution.
I then ask Chris, “Will Medicare pay for the hospice facility?” He assures me that it will. Several minutes later, I repeat the question, and he again says yes. (Thank goodness, I had witnesses both times when I asked.)
The next day, Mom is moved by ambulance to the hospice facility. When my husband and I arrive, Paul, the hospice nurse greets us at my mother’s bedside.
Everything is proceeding smoothly… until we have this conversation about payment.
Paul: Margie, I need you to sign this paper. It explains that Medicare will cover her for two days and then it is private pay.
Margie: That is not what I was told in the hospital. I was told that Medicare will pay for everything.
Paul: You obviously heard wrong. You were upset and didn’t understand.
Margie: I am a national expert in what Medicare covers in the area of long-term care. I definitely know what I heard. Please explain this.
Paul then shows me the paper he wants me to sign. Here are the two paragraphs he is referring to:
General Inpatient Care (GIP): Under this level of care the hospice house provides short term care for acute symptom management much like a hospital setting. An appropriate plan of care including discharge/transfer will be developed on admission. Physician oversight and direct care provided by hospice nurse staff address symptoms such as acute pain, nausea, unresolved vomiting, anxiety and restlessness that cannot be managed in a home type of setting. Once symptoms are managed the patient will be changed to routine level of care for transfer planning.
Routine Care: When a hospice patient’s disease is progressing without the need for acute symptom management, they are considered routine care. If a patient is admitted to hospice house under routine care, transfer planning will begin on admission to the hospice house. Under this level of care the Medicare hospice benefit does not pay for room and board. Room and board is the responsibility of the patient and/or family and is based on ASSETS then INCOME. The hospice house is not a long-term care facility; therefore, the social worker will assist with placement in an AFL/LTC facility or home setting of patient/family choice?
Margie: How much will this care cost each day?
Paul: It depends on her assets and income. That’s all the information I can give you.