Understanding when and how to revoke services is crucial in hospice care. This article aims to shed light on revoking hospice services, why it may be necessary, misconceptions surrounding it, and the potential impact when patients or their families decide to restart hospice care.
Defying Misconceptions: Hospice Care and ED Visits
Hospice care is a special kind that helps people who are very sick and close to the end of their lives. It focuses on making them comfortable and peaceful, not curing their illness. Hospice care can be provided at home, in nursing homes, or in hospitals.
Sometimes, a person receiving hospice care may need to go to the Emergency Department (ED) for some reason. For example, they may have a lot of pain, trouble breathing, or a broken device that helps them eat or breathe. You may wonder what happens to their hospice care if they go to the ED. Do they have to stop receiving hospice care? Do they have to pay for the ED visit? Do they have to start a new kind of treatment?
The answer is that it depends. It depends on what the person wants, what the ED doctor thinks, and what the hospice team says. Here are some things you should know:
Going to the ED does not mean that the person has to stop receiving hospice care. Hospice care is a choice that the person makes. They can keep receiving hospice care as long as they want unless they decide to change their mind and try to cure their illness. Hospice care is not a one-way street. The person can always go back to hospice care if they change their mind again.
Going to the ED does not mean the person must pay for the visit. Medicare, Medicaid, and most private insurance plans cover hospice care. The hospice team will pay for the visit if the person goes to the ED for something related to their hospice diagnosis. If the person goes to the ED for something unrelated to their hospice diagnosis, their regular insurance will pay for the visit.
Going to the ED does not mean that the person has to start a new kind of treatment. The ED doctor will try to help the person feel better and manage their symptoms. The ED doctor will also talk to the hospice team and the person’s regular doctor to ensure they are on the same page. The ED doctor will not do anything that goes against the person’s wishes or goals of care. People can always say no to any treatment they do not want.
The most important thing is communicating with the hospice team and the ED staff. If the person needs to go to the ED, call the hospice team first and let them know. They will tell you what to do and how to prepare. They will also contact the ED and tell them that the person is coming. When you get to the ED, tell the staff that the person is receiving hospice care and their wishes. Ask them to talk to the hospice team and the person’s regular doctor before doing anything. This way, everyone can work together to provide the best care for the person.
Hospice care and ED visits do not have to be scary or confusing. They can be part of the person’s journey to a peaceful and dignified end of life. If you keep the person’s wishes and goals in mind, you can defy the misconceptions and make the best decisions for them.
The Need to Revoke Hospice Services
Hospice care is a special kind that helps people who are very sick and close to the end of their lives. It focuses on making them comfortable and peaceful, not curing their illness. Hospice care can be provided at home, in nursing homes, or in hospitals.
Sometimes, a person receiving hospice care may want to stop and try different care. This is called revoking hospice services. Revoking hospice services means that the person no longer wants to receive the benefits of hospice care, such as pain relief, emotional support, and spiritual guidance. It also means that the person will have to pay for medical care not covered by their regular insurance.
There are different reasons why a person may want to revoke hospice services. Some of them are:
The person’s condition improves, and they want to try to cure their illness.
The person wants to try a new treatment that is not compatible with hospice care.
The person is unhappy with the hospice team or the quality of care they receive.
The person changes their mind about their goals of care or their wishes for the end of life.
Revoking hospice services is a personal choice. The person can revoke hospice services at any time, for any reason, without penalty. If they change their mind again, they can also reapply for hospice services at a later time.
However, revoking hospice services is not a decision that should be made lightly. It can have a significant impact on the person’s care journey and their quality of life. Here are some things to consider before revoking hospice services:
Revoking hospice services may cause more pain and suffering for the person and their family. Hospice care provides expert pain and symptom management that may not be available in other settings. Hospice care also provides emotional and spiritual support for the person and their family that can help them cope with the challenges of a severe illness.
Revoking hospice services may not lead to better outcomes for the person. There is no guarantee that a different kind of care or a new treatment will work or improve the person’s condition. Some medicines may cause more harm than good or have serious side effects. Research shows that many people who choose hospice care live longer and have a better quality of life than those who do not.
Revoking hospice services may cause more stress and confusion for the person and their family. Hospice care provides a clear and consistent care plan tailored to the person’s needs and desires. Hospice care also coordinates all the services and equipment that the person needs, such as nurses, doctors, social workers, chaplains, medications, and supplies. Revoking hospice services may mean the person and their family must deal with multiple providers, insurance companies, and bills.
If a person is considering revoking hospice services, they should talk to their hospice team and regular doctor first. They should ask questions and get all the necessary information to make an informed decision. They should also speak to their family and loved ones and share their thoughts and feelings. The hospice team and the regular doctor will respect the person’s choice and help them with the revocation process if they decide to proceed.
When Hospital Admissions Raise Questions
Hospital admissions can be a point of confusion for hospice patients and their caregivers. Sometimes, a person receiving hospice care may need to go to the hospital for some reason. For example, they may have a lot of pain, trouble breathing, or a broken device that helps them eat or breathe. You may wonder what happens to their hospice care if they go to the hospital. Do they have to stop receiving hospice care? Do they have to pay for the hospital stay? Do they have to start a new kind of treatment?
The answer is that it depends. It depends on what the person wants, what the hospital doctor thinks, and what the hospice team says. Here are some things you should know:
Going to the hospital does not mean that the person has to stop receiving hospice care. Hospice care is a choice that the person makes. They can keep receiving hospice care as long as they want unless they decide to change their mind and try to cure their illness. Hospice care is not a one-way street. The person can always go back to hospice care if they change their mind again.
Going to the hospital does not mean the person must pay for the stay. Medicare, Medicaid, and most private insurance plans cover hospice care. If the person goes to the hospital for something related to their hospice diagnosis, the hospice team will pay for the hospital stay. If the person goes to the hospital for something unrelated to their hospice diagnosis, their regular insurance will pay for the hospital stay.
Going to the hospital does not mean the person has to start a new treatment. The hospital doctor will try to help the person feel better and manage their symptoms. The hospital doctor will also talk to the hospice team and the person’s regular doctor to ensure they are on the same page. The hospital doctor will not do anything that goes against the person’s wishes or goals of care. People can always say no to any treatment they do not want.
However, sometimes, the person may need a higher level of care than what hospice can provide at home or in a nursing home. This is called the “General Inpatient” level of hospice care. This level of care is for people who have severe pain or symptoms that cannot be controlled in other settings. The person may need to stay in the hospital or in a hospice facility for a short time until their condition improves. This level of care is also covered by hospice and does not affect the person’s hospice benefits.
But sometimes, the person may not qualify for the “General Inpatient” level of hospice care. This may happen if the person’s pain or symptoms are not severe enough or if the person wants to receive treatments that are not compatible with hospice care. In this case, the person may have to revoke their hospice services if they’re going to stay in the hospital and receive those treatments. This can raise questions about the person’s care journey and the impact of their decision.
If a person is thinking about staying in the hospital and revoking their hospice services, they should talk to their hospice team and their regular doctor first. They should ask questions and get all the necessary information to make an informed decision. They should also talk to their family and loved ones and share their thoughts and feelings. The hospice team and the regular doctor will respect the person’s choice and help them with the revocation process if they decide to proceed.
Common Misunderstandings
Misconceptions about revoking hospice services often stem from a lack of information. It’s vital to debunk these misunderstandings to ensure that patients and their families make informed decisions about their care. We’ll explore some common myths and clarify the reality of revoking hospice services.
Myth: Revoking hospice services is a sign of failure or giving up.
Reality: Revoking hospice services is a personal choice that the person makes based on their changing needs and desires. It does not mean that the person or their family has failed or given up. It simply means that the person wants to try a different kind of care that may suit them better at that moment. The person can constantly reapply for hospice services later if they change their mind again.
Myth: Revoking hospice services is permanent and irreversible.
Reality: Revoking hospice services is not permanent or irreversible. The person can revoke hospice services at any time, for any reason, without penalty. The person can also reapply for hospice services if they meet the eligibility criteria. The person does not have to wait for a certain period or undergo a complicated process to reapply for hospice services.
Myth: Revoking hospice services means losing all the benefits of hospice care.
Reality: Revoking hospice services means losing some of the benefits of hospice care, but not all of them. The person will no longer receive hospice’s medical care and pain management. The person will also have to pay for medical care not covered by their regular insurance. However, the person can still receive some emotional and spiritual support hospice offers. The hospice team will continue to check on the person and their family and offer counseling and guidance. The hospice team will also help the person and their family with the transition to a different kind of care and with the reapplication process if they decide to return to hospice care.
Returning to Hospice Care
Hospice care is a special kind that helps people who are very sick and close to the end of their lives. Hospice care focuses on making them comfortable and peaceful, not curing their illness. Hospice care can be provided at home, in nursing homes, or in hospitals.
Sometimes, a person who is receiving hospice care may want to start it again after they have stopped it for some reason. This is called restarting hospice care. Restarting hospice care means that the person wants to receive the benefits of hospice care again, such as pain relief, emotional support, and spiritual guidance. Restarting hospice care also means that the person will not receive any medical care that tries to cure or control their illness.
There are different reasons why a person may want to restart hospice care. Some of them are:
The person’s condition gets worse, and they have a short time to live — generally six months or less.
The person tries a different kind of care or a new treatment, but it does not work or causes more problems.
The person is not happy with the other kind of care or the new treatment, and they want to go back to hospice care.
The person changes their mind about their goals of care or their wishes for the end of life.
Restarting hospice care is a personal choice that the person makes. The person can restart hospice care anytime if they meet the eligibility criteria. The person does not have to wait for a certain period or go through a complicated process to restart hospice care.
The Decision to Restart
If a person is considering restarting hospice care, they should talk to their hospice team and regular doctor first. They should ask questions and get all the necessary information to make an informed decision. They should also speak to their family and loved ones and share their thoughts and feelings. The hospice team and the regular doctor will respect the person’s choice and help them with the restarting process if they decide to go ahead with it.
The restarting process is similar to the starting process. The person will need to sign a form that says they want to restart hospice care and they agree to stop any medical care that tries to cure or control their illness. The person will also need to have their hospice doctor and their regular doctor certify that they are terminally ill and have a life expectancy of 6 months or less. The hospice team will then resume providing the services and equipment that the person needs, such as nurses, doctors, social workers, chaplains, medications, and supplies.
Impact on Patients and Families
The decision to revoke and restart hospice services can have a significant impact on the person and their family members. It can affect their emotions, their relationships, and their finances. Here are some things to consider before revoking and restarting hospice services:
Revoking and restarting hospice services may cause more stress and confusion for the person and their family. Hospice care provides a clear and consistent care plan tailored to the person’s needs and desires. Hospice care also coordinates all the services and equipment that the person needs, such as nurses, doctors, social workers, chaplains, medications, and supplies. Revoking and restarting hospice services may mean that the person and their family have to deal with multiple providers, insurance companies, and bills.
Revoking and restarting hospice services may cause more pain and suffering for the person and their family. Hospice care provides expert pain and symptom management that may not be available in other settings. Hospice care also provides emotional and spiritual support for the person and their family that can help them cope with the challenges of a severe illness. Revoking and restarting hospice services may mean that the person and their family lose some of the benefits of hospice care for a while and then have to adjust to them again.
Revoking and restarting hospice services may not lead to better outcomes for the person. There is no guarantee that a different kind of care or a new treatment will work or improve the person’s condition. Some medicines may cause more harm than good or have serious side effects. Research shows that many people who choose hospice care live longer and have a better quality of life than those who do not.
If a person and their family decide to revoke and restart hospice services, they should seek support from their healthcare providers and their loved ones. They should also look for resources to help them with their emotional and practical decisions, such as counseling, support groups, financial assistance, and legal advice. They should remember that they are not alone and that they can always change their mind again if they want to.
Preventing Hospice Revocations: Considerations for Hospice Staff
As hospice staff, you play a vital role in preventing hospice revocations. You can identify high-risk cases during the admission process and take steps to ensure that these patients receive the care they need without revocation.
Identifying High-Risk Cases
High-risk cases are those patients who are more likely to revoke hospice services due to various factors. Some of these factors are:
The patient has a diagnosis that is unpredictable or has a potential for improvement, such as cancer, heart failure, or dementia.
The patient has a history of frequent hospitalizations or emergency department visits.
The patient has unrealistic expectations or a lack of understanding of their prognosis or hospice care.
The patient has a strong desire to pursue aggressive or experimental treatments.
The patient has family members or caregivers who are unsupportive or conflicted about hospice care.
The patient has cultural or religious beliefs that are incompatible with hospice care.
To identify high-risk cases, you can use various tools and methods, such as:
Screening tools that assess the patient’s eligibility, preferences, and care goals, such as the Palliative Performance Scale, the Surprise Question, or the Goals of Care Conversation Guide.
Communication skills that elicit the patient’s values, beliefs, and fears, such as open-ended questions, active listening, and empathic responses.
Documentation tools that record the patient’s risk factors, concerns, and interventions, such as the Hospice Revocation Risk Assessment Tool, the Hospice Revocation Prevention Plan, or the Hospice Revocation Tracking Form.
By identifying high-risk cases, you can provide more focused and individualized care to these patients and address their needs and concerns promptly and effectively.
Strategies for Preventing Revocations
Certain strategies can be put in place to prevent hospice revocations. These strategies help identify patients at high risk for revocation and take measures to provide the appropriate level of care, reducing the need for revocation. Some of these strategies are:
Educating the patient and their family about their diagnosis, prognosis, and hospice care, using clear and simple language, visual aids, and teach-back techniques.
Exploring the patient’s goals of care and aligning them with the hospice philosophy, using motivational interviewing, shared decision-making, and advance care planning.
Building trust and rapport with the patient and their family, using regular visits, phone calls, and letters, and expressing empathy, compassion, and respect.
Collaborating with the hospice team and the patient’s primary care provider, using interdisciplinary meetings, care coordination, and case management.
Providing adequate pain and symptom management, using evidence-based guidelines, standardized tools, and timely interventions.
Offering emotional and spiritual support, using counseling, support groups, and chaplain services.
Addressing cultural and religious diversity, using cultural competence, interpreter services, and community resources.
Anticipating and preventing crises, using risk assessment, contingency planning, and crisis intervention.
Implementing these strategies can prevent hospice revocations and provide continuous, quality care to your patients and their families. It can also enhance your professional satisfaction and reduce your stress and burnout.
Conclusion
Hospice care is a particular type of care that helps people with terminal illnesses and a life expectancy of six months or less. It focuses on relieving pain and other symptoms and providing emotional and spiritual support to the patients and their families. Hospice care can be provided at home, in nursing homes, or in hospitals.
Sometimes, a person receiving hospice care may decide to stop it and try a different type of care. This is called revoking hospice services. Revoking hospice services means that the person no longer wants to receive the benefits of hospice care, such as pain relief, emotional support, and spiritual guidance. It also means that the person will have to pay for medical care not covered by their regular insurance.
Revoking hospice services is a personal choice. The person can revoke hospice services at any time, for any reason, without penalty. If they change their mind again, they can also reapply for hospice services at a later time.
However, revoking hospice services is not a decision that should be made lightly. It can significantly impact the person’s care journey and quality of life. It can also cause more pain and suffering, stress and confusion, uncertainty, and regret for the person and their family.
Therefore, it is essential to prevent hospice revocations as much as possible. To prevent hospice revocations, healthcare providers can identify high-risk cases during the admission process and take steps to ensure that these patients receive the care they need without revocation. They can also use various strategies: educating, exploring, building, collaborating, providing, offering, addressing, and anticipating.
Healthcare providers can provide continuous and quality care to their patients and families by preventing hospice revocations. They can also enhance their professional satisfaction and reduce their stress and burnout.
Hospice care is a valuable and compassionate service that can help people facing the end of life. By understanding and preventing hospice revocations, healthcare providers can ensure that their patients and their families receive the best care possible.
