If you have a loved one who is very sick and may not get better, you may have heard of hospice care. Hospice care is a special kind that helps dying people feel comfortable and peaceful. It also helps their families cope with the loss and grief. Hospice care can be provided at home, in a hospital, or a facility such as personal care, memory care, or skilled nursing.
Hospice care is not only for the patient but also for the family. It can provide medical services, such as pain relief, symptom management, and wound care. It can also offer emotional and spiritual support, such as counseling, chaplain services, and bereavement care. Hospice care can also provide practical help, such as personal care, housekeeping, and respite care.
Hospice care is covered by Medicare, a health insurance program for people 65 or older, disabled, or with certain diseases. To get hospice care from Medicare, the patient must meet some requirements. One of them is that a doctor must certify that the patient has a terminal illness, which means that if the illness follows its normal course, the patient has less than six months to live.
This article aims to help you understand how to prepare for and navigate the hospice recertification process. Hospice recertification is when a doctor or a nurse practitioner checks if the patient still meets the hospice eligibility criteria for every benefit period. This is important because it ensures that the patient receives the proper care for their condition and that the family gets the support they need.
In this article, you will learn:
What is hospice recertification, and why is it necessary?
How do you prepare for hospice recertification, and what should you expect?
How do you navigate hospice recertification, and what do you do if you face any issues or challenges?
We hope this article will help you and your loved one have a smooth and positive hospice experience.
What is Hospice Recertification?
Hospice recertification is when a doctor or a nurse practitioner checks if your loved one qualifies for hospice care every benefit period. The first benefit period is 90 days, the second is 90 days, and subsequent benefit periods are 60 days each. After each benefit period, your loved one can renew their hospice care for another benefit period if they still meet the eligibility criteria.
Recertification is necessary because it makes sure that your loved one’s condition has not changed significantly since they started hospice care. Sometimes, a patient may get better or worse than expected and may need a different level of care. Recertification also ensures that your loved one receives the best care for their symptoms and comfort.
Recertification works like this:
A few days before the end of each benefit period, the hospice team will contact you to schedule a recertification visit. The visit can occur at your home, hospital, or facility where your loved one stays.
During the visit, the doctor or the nurse practitioner will examine your loved one and ask you some questions about their health, pain, medications, and quality of life. They will also review the medical records and the hospice plan of care that the hospice team has prepared for your loved one. Within a similar time frame, the registered nurse case manager for the loved one will also perform a similar visit for all benefit periods.
Based on the visit, the doctor or the nurse practitioner will decide if your loved one still meets the hospice eligibility criteria. If they do, they will sign a document called a certification of terminal illness, which states that your loved one has a life expectancy of six months or less if the illness follows its normal course. This document will allow your loved one to continue receiving hospice care for another benefit period.
If your loved one does not meet the hospice eligibility criteria, the doctor or the nurse practitioner will explain why and discuss the options with you. You may choose to keep your loved one in hospice care for a short grace period, or you may decide to switch to a different type of care, such as home health care or palliative care. The hospice team will help you with the transition and provide any support you need. Please know that the provider generally does not make this decision during the recertification visit, but after discussing their findings with the registered nurse case manager and the rest of the hospice care team,
How to Prepare for Hospice Recertification?
Preparing for hospice recertification can help you and your loved one to have a smooth and positive experience. Here are some tips on how to get ready for the recertification visit:
Gather relevant information about your loved one’s medical history, symptoms, treatments, care goals, preferences, and quality of life. You can use a notebook, a folder, or a digital device to store and organize the information. Some examples of information you may need are:
The diagnosis and prognosis of your loved one’s terminal illness
The medications and treatments your loved one is taking or receiving
The symptoms and problems your loved one is facing, such as pain, nausea, anxiety, or depression
The goals and wishes of your loved one for their end-of-life care, such as where they want to die, who they want to be with, or what they want to do
The preferences and needs of your loved one for their comfort and dignity, such as food, music, spiritual practices, or personal care
The quality of life and well-being of your loved one, such as their physical, emotional, social, and spiritual health
Document any changes or declines in your loved one’s condition using hospice scales or other tools. Hospice scales are simple tools that help measure and monitor your loved one’s symptoms and quality of life. Some examples of hospice scales are (don’t fret as the hospice typically completes these registered nurse case manager):
The Edmonton Symptom Assessment System (ESAS), which rates your loved one’s severity of pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath from 0 (none) to 10 (worst possible)
The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp), which measures your loved one’s sense of meaning, peace, faith, and overall spiritual well-being from 0 (not at all) to 4 (very much)
Communicate with the hospice team by attending meetings, asking questions, expressing concerns, or seeking support. The hospice team is there to help you and your loved one through the recertification process and beyond. You can communicate with them by:
Attending the care plan meetings, which are regular meetings where the hospice team reviews and updates the plan of care for your loved one
Asking questions, such as what to expect from the recertification visit, how to deal with any challenges or difficulties, or how to access any resources or services
Expressing concerns, such as if you notice any changes or problems in your loved one’s condition, if you have any doubts or worries about the recertification outcome, or if you have any complaints or suggestions about the hospice care
Seeking support, such as if you need any emotional, spiritual, or practical help or if you want to connect with other family members or caregivers who are going through the same situation
How to Navigate Hospice Recertification?
Navigating hospice recertification can be challenging and stressful, but it can also be rewarding and satisfying. Here are some steps to help you complete a successful recertification visit and deal with any issues or scenarios that may arise:
Schedule an appointment in advance. The hospice team will contact you a few days before the end of each benefit period to schedule a recertification visit. Try to arrange a time and place that is convenient and comfortable for you and your loved one. If possible, have other family members or caregivers present during the visit to provide support and input.
Prepare for questions or challenges from the physician or nurse practitioner. The doctor or the nurse practitioner who performs the recertification visit may ask questions or challenge you on some aspects of your loved one’s condition or care. They may do this to verify the accuracy and validity of the information you provide or to explore other options or perspectives. Be ready to answer their questions honestly and confidently and to explain your reasons and evidence for your views and choices. Do not hesitate to ask for clarification or more information if you feel unsure or uncomfortable.
Review documentation carefully. Before signing the certification of terminal illness, review the document carefully and check for any errors or inconsistencies. If you notice anything incorrect or unclear, point it out to the doctor or the nurse practitioner and ask for a correction or an explanation. If you agree with the document, sign it and keep a copy for your records.
Provide feedback or suggestions. After the recertification visit, you may have feedback or suggestions for the hospice team, the doctor, or the nurse practitioner. You may want to express your appreciation, gratitude, or satisfaction, or you may want to share your concerns, complaints, or dissatisfaction. You may also have some ideas or requests for improving or changing the hospice care or the recertification process. You can communicate your feedback or suggestions by phone, email, letter, or in person. The hospice team will appreciate your input and try to address your needs and expectations.
Some common issues or scenarios that may arise during recertification visits are:
Denial of eligibility due to unrealistic expectations. Sometimes, the doctor or the nurse practitioner may deny your loved one’s eligibility for hospice care because they think that your loved one’s condition is not terminal or that they have more than six months to live. This may happen because they have different opinions or criteria than your loved one’s regular doctor or have not seen your loved one’s decline or deterioration. This can be very frustrating and upsetting for you and your loved one, especially if you have been receiving hospice care for a long time and have built a trusting relationship with the hospice team. If this happens, you can try to:
Ask for a second opinion from another doctor or nurse practitioner, preferably someone who knows your loved one well and has seen their progress and prognosis.
Provide more evidence or documentation of your loved one’s terminal illness, such as medical records, test results, hospice scales, or letters from other healthcare providers.
Appeal the decision to the hospice agency or the Medicare program, following the instructions and procedures that they provide.
Disagreement over goals of care. Sometimes, the doctor or the nurse practitioner may disagree with you or your loved one over the care goals for your loved one. They may suggest or recommend a different type or level of care, such as curative treatment, aggressive intervention, or hospitalization. They may do this because they think that your loved one’s condition can improve or stabilize or that they can benefit from other options or services. This can be very confusing and stressful for you and your loved one, especially if you have already decided on your loved one’s preferences and wishes for their end-of-life care. If this happens, you can try to:
Explain your loved one’s goals and wishes clearly and respectfully and why they are important and meaningful for them.
Listen to the doctor’s or the nurse practitioner’s reasons and arguments for their suggestions or recommendations, and try to understand their perspective and intentions.
Negotiate and compromise with the doctor or nurse practitioner to find a compromise or a solution that works for both parties.
Seek mediation or arbitration from a third party, such as a hospice social worker, a chaplain, or an ethics committee, who can help resolve the conflict and facilitate communication.
Emotional distress. Recertification visits can be emotionally distressing for you and your loved one, as they can remind you of the reality and severity of your loved one’s illness and the uncertainty and finality of their future. You and your loved one may experience various emotions, such as sadness, anger, fear, guilt, or denial. These emotions are normal and natural and can affect your mood, behavior, and well-being. If you feel emotionally distressed, you can try to:
Express your emotions healthily and constructively, such as talking, writing, crying, or praying.
Seek support from your family, friends, or other caregivers who can listen to you, comfort you, and help you cope.
Reach out to the hospice team, especially the counselor, the chaplain, or the bereavement coordinator, who can provide you with professional and compassionate guidance and assistance.
Engage in self-care activities, such as eating, sleeping, exercising, relaxing, or doing something you enjoy or find meaningful.
Some resources or strategies to cope with stress or grief related to recertification visits are:
Hospice and Palliative Care Network of Pennsylvania (HPCNPA). This statewide organization promotes and supports hospice and palliative care in Pennsylvania. It offers information, education, advocacy, and resources for patients, families, and hospice and palliative care providers.
National Hospice and Palliative Care Organization (NHPCO). This national organization represents and serves hospice and palliative care programs and professionals in the United States. It provides leadership, advocacy, education, and quality hospice and palliative care standards. It also offers a variety of resources and services for patients, families, and caregivers, such as a helpline, a directory, a newsletter, and a grief center.
Hospice Foundation of America (HFA). This is a national organization that provides education and support for those who cope with terminal illness, death, and grief. It offers programs, publications, videos, and webinars on topics related to hospice care, end-of-life issues, and grief. It also hosts an annual Living With Grief program, a free educational event addressing a specific aspect of grief and loss.
GriefShare is a network of support groups that helps people who are grieving the loss of a loved one. It offers a 13-week program that features weekly meetings, video seminars, group discussions, and personal workbooks. It also provides daily emails, online resources, and a 24/7 hotline.
Conclusion
In this article, we have learned about hospice recertification and eligibility and how to prepare for and navigate the recertification process. We have also learned about some common issues or scenarios that may arise during recertification visits and some resources or strategies to cope with stress or grief related to recertification visits.
This article aimed to help you understand how hospice recertification and eligibility work and how they affect you and your loved one. We hope this article has provided valuable and relevant information and made you feel more confident and comfortable with the recertification process.
Recertification is a normal and necessary part of hospice care that can help ensure quality care for terminally ill patients and their families. It can help verify that your loved one still meets the hospice eligibility criteria and receives the best care for their symptoms and comfort. Recertification can also help you and your loved one communicate your goals and wishes and plan for the future.
If you have any questions or concerns about hospice recertification and eligibility or need support or assistance, please do not hesitate to contact your hospice team. They are always ready and willing to help you and your loved one and make your hospice experience as smooth and positive as possible.
