How does my hospice provider get my medical records?
Copies of pertinent medical records are sent from the physician’s office to the hospice agency. Every hospice agency has procedures and staff who make this part of starting hospice easy and quick. A phone call by you to your physician, telling them you have chosen a specific hospice, can help sometimes to speed up the process. However, leave it to the hospice to complete the process. You have enough to do caring for yourself and your loved one at this point in the journey.
Can I keep my physician?
Yes you can; however, every hospice has a Medical Director who can collaborate with your physician or assume care. Often, these Medical Directors will make home visits. You need to check with your hospice about home visits prior to signing papers. If home visits are important to you, choose a hospice that offers this service. The Medical Director of a hospice agency is available 24/7 and can be a great help with care after hours and on the weekends when it may be hard to speak with your physician. All you have to remember is that you only need to call the hospice from now on. The hospice staff contacts the physician for you. They can provide important information to the physician to assist in making medical decisions.
If I already have medical equipment, can I keep that equipment?
It depends on the policies of your hospice. Often the hospice can make arrangements to keep the equipment and not require that it be replaced by equipment from a company with which the hospice usually works. This is an excellent customer service policy. If having to change equipment is going to be uncomfortable or difficult ( i.e. changing hospital beds), you might want to reconsider and choose a hospice willing to allow you to keep the equipment you have in place. Each hospice will tell you what equipment they will pay for and what equipment might continue to be your financial responsibility.
If medical equipment is recommended, the hospice agency will arrange for delivery and set up. Not all equipment is covered under hospice insurance or the Medicare Hospice Benefit. The hospice agency will provide you in writing a list of what is covered and what is not. If you are a Veteran, they will inquire with the VA Hospital to see if they can provide equipment. The company that delivers the equipment will teach you how to use it. The hospice staff can also review this with you. The medical equipment company should come frequently to check the equipment to make sure it is operating properly. Confirm with your hospice whether they want you to call them or the medical equipment company if there are problems with the equipment.
Are medications and supplies paid for by the hospice?
Some medications and supplies are covered but not all of them. The hospice is required to provide you with a written list of medications and supplies that they will cover. Just as with medical equipment, not all medications and supplies are covered. The hospice might even make suggestions of medications that are no longer needed or recommended. Often, stopping medications makes you or your loved one feel better. Don’t worry; no changes are made unless approved by a physician.
Can I change hospices?
Yes you can. Sometimes, the hospice you choose is not a good fit, despite the care you took in choosing it. You may not be happy with the care, the staff that come into your home, or their responsiveness to your concerns. It might be that the staff aren’t available when it is convenient for you. Sometimes personalities clash and the hospice agency is unable or unwilling to make a change in staff assignments. A call to the hospice Program Director is the first place to start. If you are still unsatisfied, you can contact another hospice and arrange for a transfer from one hospice to another. The new hospice should come out and make a home visit first, and then contact your current hospice for you. A representative from your current hospice will provide you with a document for signature to make the transfer effective that day. Medical records should be provided from the first hospice to the new one.
Why am I being discharged?
The hospice agency is required to discharge patients that get better and no longer qualify for care based on Medicare Hospice Guidelines. The government is very strict, and hospices take this seriously. Every hospice is happy when they have patients who improve and can be discharged from hospice care. This can be scary, similar to graduating from high school and moving out on your own. If discharge from hospice care is warranted, the hospice will work with you and develop a plan that will make the transition easier. You can ask for recommendations for extra help that you may need, but you may have to cover that cost. If hospice care is needed again, it is no problem to re-start care.
How long can I receive hospice care?
It depends on your circumstances and the policies of your hospice. This is not an easy answer. Although Medicare has specific guidelines, each hospice interprets the guidelines differently. In general, patients must be certified by the medical director as needing continued hospice services after the first 3 months, and then every 2 months after that. A nurse practitioner or the medical director is required to come to the house and personally assess the patient prior to signing the Medicare papers. Even though the words “ 6 months or less” are often associated with hospice, an individual can stay on hospice as long as there is documented continued need and physical decline as determined by the hospice nurse and/or medical director. This situation can be extremely stressful and the uncertainty very difficult for families who have become very dependent on the support from the hospice staff. A hospice with outstanding customer service will always let you know in advance if there is any question or thought that there is a pending discharge and will help find community resources to assist with caregiving.
Can someone receive hospice and home health?
Patients do not usually qualify for both types of services. If the home health agency is providing services for a diagnosis unrelated to the hospice diagnosis, they might continue care; but this is not very common.
Can I pay for therapy myself if it is not covered under hospice? 
Yes, but you must get permission from your hospice prior to starting any additional medical services or therapy. The hospice is responsible for overseeing and coordinating all medical care, and it is important for them to be kept informed.
Why can’t I continue with dialysis and be on hospice? 
Similar to home health, you may be allowed to continue dialysis but only if the reason you are receiving dialysis is unrelated to your hospice diagnosis. This might occur if you have chronic kidney disease and then develop cancer. Your hospice or palliative care team will help you navigate making these decisions.