Identifying Hospice Appropriate Referrals
A referral to Verde Valley Community Hospice can be made by anyone: a family member, friend, nurse, physician or even the individual who is seeking more information about hospice and palliative care. All you need to do is call the Verde Valley Community Hospice office 928.634.1073. Upon receiving the referral, a member of the Hospice Admission Team will contact the referral. In summary, four things are necessary to complete an admission:
- Verde Valley Community Hospice Admission Team meets with the patient/family to explain the hospice benefit.
- The patient meets Medicare eligibility criteria.
- The patient/family agrees with hospice care and the hospice philosophy.
- The Primary Care Physician or Verde Valley Community Hospice Medical Director agrees that hospice services are appropriate and thus orders hospice care
Our goal is to meet with the patient/family within 2-4 hours of receiving the information. The Hospice Team is available to answer questions regarding when a referral is appropriate. When you call the hospice office with a referral, some information will help with the process:
- Your name
- Name of the patient
- Patient contact phone number
- Date of birth and social security number
- Patient’s primary physician’s name and phone number
- Caregiver’s name and contact number
Download a Referral Form
Who Qualifies for Hospice Care?
Any disease process can qualify, and it is the responsibility of the Verde Valley Community Hospice Admission Team to determine eligibility. Various disease processes are eligible including, though not limited to:
- Alzheimer’s (Dementia Type)
- Heart Disease
- Renal Failure (Acute)
- Renal Failure (Chronic)
- Respiratory disease (COPD)
- Neurological disease (Parkinson’s)
- End-stage dementia
- End-stage Kidney disease
- End-stage liver disease
- Decline in clinical status (Previously Failure to Thrive or Debility)
- Stroke (Cerebral Vascular Disease)
General Criteria for Eligibility, along with disease specific criteria, includes a variety of evaluation methods facilitated by the Hospice Admission Team. The Team considers a wide variety of factors including, though not limited to:
- One must have a life-limiting disease process (approximately 6 months or less if the disease process follows its normal course without medical intervention)
- A checklist is used for determining functional performance (Palliative Performance Scale)
- Fall Risk Evaluations
- Daily functional limitations
- Symptoms and changes in symptoms in the past 6 months
- Changes in lifestyle over last 6 months
- Frequent trips to Hospital, ER and/or MD office
General and Specific Evaluation Tools/Criteria Utilized by Hospice Admission Team
Palliative Performance Scale measures:
- Activity level as evidenced by the disease
- Range of self-care
- Ability to ambulate
- Food/fluid intake
- Level of consciousness
- History of falls
- Mental status changes
- Lower extremity weakness or unsteady gait
- Medications (two or more of the following-Diuretics, Laxatives, Narcotics, Psychotropic, Sedatives, Anti-seizure)
- Alternation in bowel and bladder function
- Sensory deficits: Alternation in hearing, eyesight
Functional Limitations and Supportive Symptoms
Who Pays for Hospice?
- Weight loss over last 6 months
- Appetite loss
- Loss of ability to feed self
- Severe weakness
- Loss of ability to bath, dress, take medication, prepare meals, ambulate or toilet
- Increasing levels of fatigue
- Mobility problems, reliance upon assistive devices, such as cane, walker, or wheelchair (may be bedridden)
- Recurrent infections
- Development of Stage III or IV decubitus ulcers (pressure sores)
Hospice is covered by Medicare and most insurance plans, with no put-of-pocket costs for the patient/family.
The Medicare hospice benefit covers costs related to the terminal illness, including the service of the hospice team (nurses, medical social workers/counselors, certified nursing assistants and chaplains), medication, medical equipment and supplies. Medicare reimburses for different levels of hospice care recognizing some individuals require special attention.
- Medication: The Medicare hospice benefit covers medications that are associated with diagnosis and needed to treat the person’s terminal illness. Verde Valley Community Hospice will order the medications for the patient and medications are delivered by the pharmacy to their door. Medications for a condition not related to the terminal illness-allergy medication, for example-are not covered by the hospice benefit.
- Medical Supplies: The physician and hospice nurse will work together with the individual and family to determine which durable medical equipment and biological supplies are needed. These can include equipment like hospital bed, bathroom safety equipment, oxygen and biological supplies like briefs, wound care, etc. Items covered under the Medicare benefit must be related to the hospice diagnosis.
Hospice care does not automatically end after six months. Medicare and most other insurers will continue to pay for the hospice care as long as the patient continues to meet eligibility criteria and the physician supports that the patient continues to have a limited life expectancy.
Occasionally, the quality of care provided by Verde Valley Community Hospice leads to substantially improved health. When this happens, Verde Valley Community Hospice will transfer care to the patient’s primary care physician. Later, if the individual becomes eligible for hospice, they can re-elect the hospice benefit. There is no penalty for getting better!