What is hospice?
Hospice services are a Medicare entitlement for any person in the end stage of an illness. While hospice originally was for patients with end-stage cancer diagnoses, over the past 30 years hospice services have expanded and are now available to any person in the end stages of any illness, including any form of cancer, Alzheimer's, HIV disease, and decline in health.
How do I qualify?
A doctor must certify that, should the disease take its natural course and all aggressive treatments cease, the patient would have a life expectancy of six months or less. The patient or representative must give consent to waive all aggressive treatment related to the primary diagnosis and replace it with active symptom management. This is a benefit available to every person on Medicare and Medicaid, and most private insurances now include hospice reimbursements. The hospice bills Medicare (or other insurance) directly, usually at no cost to the patient.
What if I live longer than six months?
An eligible patient is not limited to a six-month time frame to receive hospice services. Once admitted into hospice services, the patient is re-evaluated at the end of each certification period (the first two certification periods last 90 days each, followed by an unlimited number of 60-day benefit periods).
What services are provided?
Medicare states that hospice services are to include regular visits from a hospice nurse, social worker, chaplain, and nursing aide. Hospice services may be provided at the patient's private or assisted living residence, nursing home, or hospital. You can find federal laws on hospice services and regulations at the Hospice Patients Alliance Web site (see the link below).
What are advance directives? Are they the same as living wills?
Yes. The term “advance directive” is the legal name for the document commonly called a “living will.” An advance directive allows a person to state specifically the kind of care and treatment he or she would want to receive if he or she were unable to make those decisions due to incompetence or incapacity. It expresses a person's specific instructions, definitions, and/or limitations to the type of health care that he or she would want to receive. A person may also designate a health care representative (“health care proxy”) in an advance directive.
What is a health care representative?
The health care representative is a person you select to participate in discussions with your health care providers and make decisions for you in accordance with what he or she knows of your wishes. A person can choose anyone over the age of 18 who is not the patient's health care provider to enforce his or her health care wishes. You select the health care proxy in the living will.
How do I prepare an advance directive?
An advance directive must be executed by a person (the “declarant”) when the declarant is competent. It must be signed by the declarant and witnessed by any two people over the age of 18. The only person who may not serve as a witness to the signing of the advance directive is the person designated as the declarant's health care representative.
A person seeking legal advice about preparing an advance directive should be encouraged to make his or her wishes known to anybody who may assume a role in his or her health care decision-making, in order to avoid unnecessary confusion or misunderstanding when the patient can no longer express him- or herself. The advance directive should also be discussed with and copies provided to members of the patient's family, other possible caregivers, the patient's doctor, and/or a lawyer.
When does the advance directive take effect?
An advance directive takes effect when at least two physicians determine that a patient is medically incompetent or incapacitated. If a patient regains capacity or competence, the patient's wishes override the advance directive.
How do I make changes to an advance directive that is lready in effect?
You may make changes to an existing advance directive at any time, as long as you are of sound mind, using the same procedure described above.
What does an advance directive look like?
You can view an example of an advance directive form for New Jersey residents on this Web site. Your health care provider or legal representative can also give you a form.
This article originally appeared in the January-February 2005 issue of Looking Out for Your Legal Rights ®. |
