Considerations of Care — Related and Unrelated Diagnoses for a Terminally ill Patient Receiving Hospice Services
Published on December 22, 2023
Updated on July 13, 2024
Published on December 22, 2023
Updated on July 13, 2024
Table of Contents
I understand that navigating the healthcare system, especially when dealing with a terminal illness, can be overwhelming for both patients and their families. It’s essential to have a clear understanding of how diagnoses related to terminal illness and unrelated diagnoses can impact the medications and services covered by a hospice provider in the United States. Let’s delve into this topic and shed some light on these crucial aspects.
Hospice care is a comprehensive and holistic program that focuses on the care, comfort, and quality of life for individuals with serious illnesses approaching the end of their lives. It provides physical, emotional, and spiritual support for the patient and their loved ones. Hospice care aims to manage pain and symptoms, enhance the patient’s well-being, and ensure a peaceful transition.
To qualify for hospice care in the United States, individuals must meet specific criteria primarily set by Medicare. Here are the general requirements:
The specific diagnoses related to the terminal illness, as well as unrelated diagnoses, play a significant role in determining the medications and services covered by a hospice provider.
Here’s how these diagnoses can impact hospice care:
Diagnoses directly related to the terminal illness are the primary factors considered when developing the hospice plan of care. These diagnoses guide the selection of medications, treatments, and interventions to manage symptoms and enhance the patient’s comfort. Here are some key points to understand:
Unrelated diagnoses refer to medical conditions or illnesses not directly connected to the terminal illness. While these diagnoses may not be the primary focus of hospice care, they can still impact the overall plan of care. Consider the following:
Before and during the admission, care should be taken to evaluate the impact of related vs. unrelated diagnosis codes and the effect on the patient related to their comfort, wishes, and desire for a good death. Sometimes, the nurse and family need to advocate for an unrelated diagnosis code to be changed to related for services and medications to be covered, and there are times when a related diagnosis can significantly interfere with the patient’s journey to die the way they want to die as part of dying a good death. Let’s explore the most common areas where care must be taken to do the right thing for the patient!
Please keep in mind that these tips have pros and cons. For example, relating a diagnosis to help with medication costs also means the family will get billed separately if they go to a specialist for that diagnosis/disease. Or if you unrelate something such as ESRD, the patient and family still must bear the cost of whatever they are pursuing in that area.
It’s important to communicate openly and honestly with the hospice team about any unrelated diagnoses and medications the patient may require. The hospice team can work alongside the patient and their family to coordinate care effectively and ensure that all aspects of the patient’s well-being are addressed.
Determining Relatedness to the Terminal Prognosis Process Flow
Frequently Asked Questions About Hospice Care
Top 30 FAQs About Hospice: Everything You Need to Know
Understanding Hospice Care: Is it Too Early to Start Hospice?
What’s the process of getting your loved one on hospice service?
Picking a hospice agency to provide hospice services
National Hospice Locator and Medicare Hospice Compare
Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)
Preparing the patient, family, and caregivers for a “Good Death.”
Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)
The Dying Process and the End of Life
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Gone from My Sight: The Dying Experience
The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death
By Your Side, A Guide for Caring for the Dying at Home
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