Understanding What Hospice Care Means

July 1, 2024

When treatment for serious illnesses is causing more side effects than benefits, or when health problems become compounded, then a patient and their family members may begin to wonder about hospice. “We recognized as people consider hospice, it’s highly emotional times,” says medical director for Austin Palliative Care Dr. Kate Tindall. “It might include worries and fears.” But one of the things she hears most often from patients and their families is that they wish they had started sooner. Understanding who qualifies for hospice and what it entails is the first part of deciding what might be best for those with terminal conditions.

What is Hospice Care?

Hospice is meant to care for people who have an anticipated life expectancy of 6 months or less, when there is no cure for their ailment, and the focus of their care shifts to the management of their symptoms and their quality of life. With hospice, the patient’s comfort and dignity become the priority, so treatment of the condition ends and treatment of the symptoms, such as pain management, begins. There are no age restrictions placed around hospice care, meaning any child, adolescent, or adult who has been diagnosed with a terminal illness qualifies for hospice care.

An individual does not need to be bedridden or already in their final days of life in order to receive hospice care. Other common misconceptions about hospice care are that it is designed to cure any illness or prolong life. It is also not meant to hasten death or replace any existing care, such as those already provided by a physician.

Determining When it’s Time for Hospice

Establishing care is most beneficial for the patient and their caregivers when it is taken advantage of earlier rather than later. Hospice can be used for months as long as eligibility has been met. Once there is a significant decline in physical or cognitive function, the goal for treatment should become to help that individual live comfortably and forgo anymore physically debilitating treatments that have been unsuccessful in curing or halting the illness. 

Both individuals and their loved ones who would benefit from initiating hospice care are often unaware of the services or are uncomfortable asking about them. “It’s a hard conversation to have,” says professor of medicine and palliative care at the Duke University School of Medicine David Casarett. “Many people really want to continue aggressive treatment up until the very end.” While many wait for their providers to suggest it, it should be understood that if eligibility for hospice has been met, an individual and their caregivers can initiate hospice care on their own.

Establishing Hospice Care

In order to qualify for hospice care, a physician must certify that the patient is medically eligible, which means that the individual’s life expectancy is 6 months or less. Typically, the referral to hospice starts with the attending physician’s knowledge of that person’s medical history, while eligibility is then confirmed by the hospice physician. A hospice care team consists of professionals who are trained to treat physical, psychological, and the spiritual needs of the individual, while also providing support to family members and caregivers. Care is person-centered, with the importance being placed on the coordination of care, setting clear treatment goals, and communicating with all involved parties.

Receiving Care at Home

Hospice care is generally provided in the person’s home, whether it’s a personal residence or a care facility, such as a nursing home. “When people are close to the end of their lives, going to the hospital does not make them feel better anymore,” explains professor of medicine at the University of California Dr. Carly Zapata. “Because there’s not necessarily something that we can do to address their underlying illness.” Staying at home allows the individual to be around their personal things and close to their loved ones and pets, which can provide them with comfort during the end of their life.

What Does Hospice Care Include?

Hospice includes periodic visits to the patient and their family or caregivers but is available 24-7 if needed. Medication for symptom relief is administered, any medical equipment needed is provided, and toileting and other supplies such as diapers, wipes, wheelchairs, hospital beds are provided. What may surprise some people is that hospice patients may even receive physical and occupational therapy, speech-language pathology services, and dietary counseling.

If needed, short-term inpatient care may be established for those who cannot achieve adequate pain and symptom relief in their home setting. Short-term respite care may also become available to help family caregivers who are experiencing or are at risk for caregiver burnout. Bereavement care, or grief and loss counseling, is also offered to loved ones who may experience anticipatory grief. Grief counseling is available to family members for up to 13 months after the person’s death.

Paying for Hospice

The first step in finding a hospice agency is to search for ones that serve your county. If there are several options available, then it’s recommended to talk to more than one and see which agency will best fit the patient’s needs. Adequate research should be conducted since not all hospice agencies provide physical and occupational therapy. 

Hospice is a medicare benefit that all Medicare enrollees qualify for, but it may also be covered through private insurance and by Medicaid in almost every state. Military families may receive hospice through Tricare, while veterans with the Veterans Health Administration Standard Medical Benefits Package are also eligible for hospice. Hospice agencies will also accept individual self-pay, while there are also non-profit organizations that provide hospice services free of charge.

Discontinuing Hospice Care

Though it is uncommon, if a patient does improve or their condition stabilizes, they may no longer meet medical eligibility for hospice. If this happens, the patient is discharged from the program. Another situation that sometimes arises is when a person elects to try a curative therapy, such as a clinical study for a new medication or procedure. In order to do that, the patient must withdraw from hospice through what is called revocation. Both children and veterans are exempt from being disqualified from hospice care if they choose to also pursue curative treatments. Any person may always re-enroll in hospice care at any time as long as they meet the medical eligibility.

Opting for Palliative Care

Individuals with chronic conditions or life-threatening illnesses may opt for palliative care, which doesn’t require people to stop their treatments. Palliative care is a combination of treatment and comfort care and can be an important bridge to hospice care if patients become eligible. Because transitioning to hospice care can be an emotional choice, palliative care providers often help patients prepare for that. Many people avoid palliative care because they think it is equal to giving up and that death is imminent, but studies show that for many, palliative care allows them to live longer, happier lives. This is due to the benefits of symptom management and spiritual support.

Insureyouknow.org

While hospice care can be difficult to accept, it can provide people with the best quality of life possible in their final days, as well as provide their loved ones with valued support. With Insureyouknow.org, you may keep track of all medical and financial records in one easy-to-review place so that you may focus on caring for your loved one, your family, and yourself during this period of their care.

Legal and Financial Planning for Those with Alzheimer’s and Their Caregivers

November 1, 2023

If you or a loved one is diagnosed with Alzheimer’s or dementia, then there are certain things that you will need to plan for legally and financially. An estimated 6 million Americans have Alzheimer’s, and it is currently the seventh leading cause of death in the United States. Alzheimer’s is a brain disorder that slowly decreases memory and thinking skills, while dementia involves a loss of cognitive functioning; both cause more and more difficulty for an individual to perform the most simple tasks. Though a diagnosis can be scary, the right planning can help individuals and their families feel more at ease.

Putting Legal Documentation in Place

Christopher Berry, Founder and Planner at The Elder Care Firm, recommends three main disability documents that should be in place.

First, there needs to be a financial power of attorney, a document that designates someone to make all financial decisions once an individual is unable to do so for themselves. If an individual lacks a trusted loved one to make financial decisions, then designating a financial attorney or bank is an option.

The next document that needs to be in place is the medical power of attorney that designates someone to make medical decisions for an individual. In many cases, it may be appropriate to appoint the same person to be the financial and medical power of attorney, as long as that person is well-trusted by the individual. In the event that something happens to the original power of attorney(s), successor (or back-up) agents for power of attorney(s) should also be designated.

The last document is the personal care plan, which instructs the financial and medical power of attorney(s) on how best to care for the individual in need. For instance, those entrusted to the care of an individual will need to make sure they sign medical records release forms at all doctor’s offices; copies of the power of attorney or living will should also be given to healthcare providers.

These three documents provide a foundation to make decisions for the individual diagnosed with Alzheimer’s or dementia when they no longer can themselves. It’s ideal to include the individual in these conversations in the early stages of their diagnosis, so that they may be a part of the decision-making process and appoint people that they will feel most comfortable with during their care.

How to Pay for Long-Term Care

Since Alzheimer’s is a progressive disease, the level of care an individual needs will increase over time. Care costs may include medical treatment, medical equipment, modifications to living areas, and full-time residential care services.

The first thing a family can do is to use their own personal funds for care expenses. It’s important for families to remember that they will also pay in their time, as many children of loved ones with Alzheimer’s or dementia will become the main caregivers. It may be wise to meet with a financial planner or sit down with other family members, such as your spouse and siblings, to determine how long some of you may be able to forgo work in order to provide full time care.

When personal funds get low or forgoing work for a period of time becomes difficult, long-term care insurance can be a lifesaver. The key to relying on long-term care insurance though is that it needs to be set up ahead of the Alzheimer’s or dementia diagnoses, so considering these plans as one ages may be smart.

Veterans can make use of the veterans benefit, or non-service-connected pension, which is sometimes called the aid and attendance benefit. This benefit can help pay for long-term care of both veterans and their spouses.

Finally, an individual aged 65 or older can receive Medicare, while those that qualify for Medicaid can receive assistance for the cost of a nursing home. If someone’s income is too high to receive Medicaid, then the spenddown is one strategy to know; under spenddown, an individual may subtract their non-covered medical expenses and cost sharing (including Medicare premiums and deductibles) from their available income. With the spenddown, a person’s income may be lowered enough for them to qualify for Medicaid.

Minimizing Risk Factors During Care

Research published recently in the journal Alzheimer’s & Dementia found that nearly half of patients with Alzheimer’s and dementia will experience a serious fall in their own home. Author Safiyyah Okoye, who was at John Hopkins University when the study was conducted, recommends minimizing risks such as these by safeguarding homes early on in diagnoses. “Examining the multiple factors, including environmental ones like a person’s home or neighborhood, is necessary to inform fall-risk screening, caregiver education and support, and prevention strategies for this high-risk population of older adults,” she states.

The good news is that since the progression of Alzheimer’s is often slow, families have plenty of time to modify the home for increased safety.

In addition to fall prevention modifications, other safety measures may include installing warning bells on doors to signal when they’re opened, putting down pressure-sensitive mats to alert when someone has moved, and using night lights throughout the home. Coats, wallets, and keys should also be kept out of sight, because at some point, leaving the home alone and driving will no longer be safe. Conversations about these safety measures, such as when an individual will have to stop driving, are ones that caregivers should have early on with their loved ones. Including individuals in their future planning while they are still cognitively sound will help both them and their caregivers feel more comfortable with the journey ahead.

Insureyouknow.org

It’s important to remember that even though receiving an Alzheimer’s or dementia diagnosis can be devastating, it is not the end. People with Alzheimer’s can thrive for many years before independent functioning becomes difficult. Both patients and caregivers will feel more calm through planning ahead. Insureyouknow.org can help caregivers stay organized by storing all of their important documents in one place, such as financial records, estate planning documentation, insurance policies, and detailed care plans. Above all, there is hope for those with Alzheimer’s; research is happening every day for potential therapies and future treatments.

Medicare Will Cover Shingles Vaccine in 2023

December 27, 2022

Starting in January 2023, Medicare will cover the cost of the shingles vaccine, Shingrix.

The Centers for Disease Control and Prevention (CDC) recommends adults 50 years and older get two doses of Shingrix two to six months apart to prevent complications from the disease shingles. Shingrix is more than 90 percent effective in preventing illness, according to the CDC. But for many people on Medicare, it had been unaffordable at more than $200 for the shot regimen.

The Inflation Reduction Act of 2022 aims to reduce the cost of some drugs and close this barrier to good healthcare. As of January 2023, all vaccinations covered under Medicare part D that are approved and recommended by the Centers for Medicare and Medicaid and the CDC will be covered without a copay. So, no cost-sharing will be associated with the administration of Shingrix, as well as flu shots; tetanus, diphtheria, and pertussis vaccines; and COVID-19 vaccines.

What is “shingles”?

Shingles is an invasive, painful outbreak of rash or blisters on the skin that can damage your vision or hearing, make you lose hair, and cause long-term nerve pain. It is caused by the varicella-zoster virus—the same virus that erupts in chickenpox. After you have chickenpox, the virus stays in your body. It may not result in problems for many years, but as you get older, the virus may reappear as shingles.

Is shingles contagious?

Shingles is not contagious. But you can catch chickenpox from someone with shingles. If you’ve never had chickenpox or the chickenpox vaccine, try to stay away from anyone who has shingles. If you have shingles, try to stay away from anyone who has not had chickenpox or the chickenpox vaccine, or anyone who might have a weak immune system.

Who is at risk for shingles?

Anyone who has had chickenpox is at risk of getting shingles. More than 99 percent of Americans born before 1980 have had chickenpox, even if they don’t remember it. The risk of contracting shingles increases as you get older; shingles is most common in people over 50. People with weakened immune systems are at higher risk of getting shingles. About one out of every three people in the United States will develop shingles during their lifetime. It is rare, but possible, to get shingles more than once.

What are the symptoms of shingles?

Early signs of shingles include burning or shooting pain and tingling or itching. It is usually on one side of the body or face. The pain can be mild to severe.

One to 14 days later, you will get a rash. It consists of blisters that typically scab over in 7 to 10 days. The rash is usually a single stripe around either the left or the right side of the body. In other cases, the rash occurs on one side of the face. In rare cases (usually among people with weakened immune systems), the rash may be more widespread and look like a chickenpox rash. Some people may also have other symptoms, including fever, headache, chills, and an upset stomach.

What are some complications caused by shingles?

• Postherpetic neuralgia (PHN) is the most common complication of shingles. It causes severe pain in the areas where you had the shingles rash. It usually gets better in a few weeks or months, but some people can have pain from PHN for many years, and it can interfere with daily life.
• Temporary or permanent vision loss can happen if shingles affects your eye.
• Hearing or balance problems are possible if you have shingles within or near your ear. You may also have temporary or permanent weakness in the muscles on that side of your face.
• Very rarely, shingles can also lead to pneumonia, brain inflammation (encephalitis), or death.

How is shingles diagnosed?

Usually, your healthcare provider can diagnose shingles by taking your medical history, looking at your rash, and after scraping off tissue from the rash or swabbing some fluid from the blisters, sending the sample to a lab for testing.

How can shingles be treated?

There is no cure for shingles. Antiviral medicines may help make the attack shorter and less severe. They may also help prevent PHN. Recommended medicines are most effective if you can take them within three days after the rash appears. Pain relievers may also help with the pain. A cool washcloth, calamine lotion, and oatmeal baths may help relieve some of the itching associated with shingles.

InsureYouKnow.org

If you are at risk of getting shingles, contact your healthcare provider or pharmacist to schedule a Shingrix shot early in 2023, even if you are not covered by Medicare. Shingrix is also covered by most health insurance plans so check with your insurance provider to see if the vaccine is included in your plan.

At insureyouknow.org, record the date of your first shot and set a reminder for your second shot two to six months later. You’ll be off to a great start in preventing the pain and possible side effects of shingles in 2023.

Medicare Enrollment: Open Until December 7

October 28, 2021

Medicare is a national health insurance program administered by the federal government for people 65 or older. You’re first eligible to sign up for Medicare three months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or Amyotrophic lateral sclerosis (ALS)—also known as Lou Gehrig’s disease. 

From October 15 through December 7 every year, depending on your circumstances, you are allowed to enroll in or switch to another Medicare Advantage plan or Medicare Part D prescription drug plan, or to drop your plan and return to Original Medicare. View a complete list of Medicare enrollment dates.

If you qualify for Medicare coverage or know someone who may need your help to learn about Medicare, coverage options, and how to apply, keep reading for a quick course in Medicare Basics.

Medicare Basics

Medicare and Medicare-approved private insurance companies offer the following options for you to get health care coverage:

• Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

• Part B (Medical Insurance): Helps cover:
  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
  • Many preventive services (like screenings, shots, or vaccines, and yearly “wellness” visits)

• Part C (Medicare Advantage): Medicare-approved private insurance companies that provide all Part A and Part B services and may provide prescription drug coverage and other supplemental benefits.

• Part D  (Prescription Drug Coverage): Medicare-approved private insurance companies that provide outpatient prescription drug coverage.

• Medicare Supplemental Insurance (Medigap): Extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. Policies are standardized, and in most states named by letters, like Plan G or Plan K. The benefits in each lettered plan are the same, no matter which insurance company sells it.
  • You need both Part A and Part B to buy a Medigap policy.
  • Some Medigap policies offer coverage when you travel outside the United States.
  • Generally, Medigap policies don’t cover long-term care (like care in a nursing home), vision, dental, hearing aids, private-duty nursing, or prescription drugs.
  • If you’re under 65, you might not be able to buy a Medigap policy, or you may have to pay more.
  • Medigap policies are standardized, and in most states named by letters, like Plan G or Plan K. The benefits in each lettered plan are the same, no matter which insurance company sells it.
  • Find a Medigap policy that works for you.

Medicare Options

When you first sign up for Medicare and during open enrollment periods, you can choose one of the following two ways to get your Medicare coverage.

• Original Medicare (Includes Part A and Part B)
  • With Original Medicare, you can go to any doctor or hospital that takes Medicare, anywhere in the United States. Find providers that work with Medicare.
  • Join a separate Medicare drug plan (Part D) to get drug coverage. If you choose Original Medicare and want to add drug coverage, you can join a separate Medicare drug plan. Medicare drug coverage is optional. It’s available to everyone with Medicare.
  • If you have other insurance you also may have other coverage, like employer or union, military, or veterans’ benefits, learn how Original Medicare works with your other coverage.

• Medicare Advantage (Part C)
  • Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
  • In most cases, you’ll need to use doctors who are in the plan’s network.
  • Plans may have lower out-of-pocket costs than Original Medicare.
  • Plans may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.
  • Most Medicare Advantage Plans include Part D coverage.
  • Below are the most common types of Medicare Advantage Plans:
  • Health Maintenance Organization (HMO) Plans  
  • Preferred Provider Organization (PPO) PlansPrivate Fee-for-Service (PFFS) PlansSpecial Needs Plans (SNPs)
  • Find a Medicare Advantage Plan for 2022.

Medicare Costs

Generally, you pay a monthly premium for Medicare coverage and part of the costs each time you get a covered service. There’s no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage, like a Medicare Supplement Insurance. Get Medicare costs for current premium rates.

Health Insurance Assistance

Contact your local State Health Insurance Assistance Program (SHIP) to get free personalized health insurance counseling. SHIPs aren’t connected to any insurance company or health plan.

Sign Up Process

When you’re ready, contact Social Security to sign up for Medicare coverage:

• Apply online (at Social Security): This is the easiest and fastest way to sign up and get any financial help you may need. You’ll need to create your secure my Social Security account to sign up for Medicare or apply for Social Security benefits online.
• Call 1-800-772-1213. TTY users can call 1-800-325-0778.
• Contact your local Social Security office.
• If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.
  

Note: Medicare provides your coverage, but you’ll sign up through Social Security (or the Railroad Retirement Board) because they need to see if you’re eligible for Medicare, including whether you (or another qualifying person) paid Medicare taxes long enough to get Part A without having to pay a monthly premium. They also process requests to sign up for Part B for Medicare.

InsureYouKnow.org

After you’ve met all the requirements to apply for Medicare coverage, have made your choices, and have signed up online, keep track of your decisions and copies of your Medicare, Medigap, and Medicare Advantage Plan membership information at insureyouknow.org.

Retirees Face the Rising Cost of Living

August 14, 2021

Have you noticed this year that your grocery bill has been rising and the price of gas is higher each time you fill up at the pump? You also may have been shocked by sticker prices on new and used cars and trucks resulting from inflation in recent months.  

Consumer Price Index

On July 11, 2021, the Labor Department reported its consumer price index (CPI) rose 5.4 percent in July from a year earlier, in line with June’s figure and matching the largest jump since August 2008. White House officials are cautiously optimistic that the current increase in prices will be transitory, citing a continued drop in forward prices for lumber and other goods that experienced sharp increases because of supply chain bottlenecks. Steel capacity also had risen substantially over the past few months, they said.

The Federal Reserve has been keeping a close eye on inflation reports since it’s the central bank’s job to maximize employment and keep prices stable. Chairman Jerome Powell and other officials acknowledge the recent acceleration in prices but believe that the inflation is “transitory” and that prices won’t continue to increase at their current pace for too long.

As one of the most-cited inflation gauges, the CPI measures changes in how much American consumers pay for everyday goods and services including groceries, gasoline, clothes, restaurant meals, haircuts, concerts, and automobiles.

The CPI and other price measures have been on the rise in 2021 in large part because of a comeback in consumer spending and U.S. gross domestic product (GDP) as COVID restrictions eased.

Economic activity as measured by GDP rose at an annualized rate of 6.5 percent in the second quarter as Americans frequented restaurants, took summer vacations, and resumed other activities that COVID-19 had hindered.

Consumer Spending

Consumer spending, bolstered by the nationwide rollout of vaccines, jumped 11.8 percent during the three months ending June 30, the second-fastest rate since 1952.

At the same time, the pent-up demand for travel, retail, and restaurants has left many businesses scrambling to keep up and led to several setbacks on the supply side of the U.S. economy.

Employers who have struggled to find workers have hiked pay or offered signing bonuses to help fill the record 10.1 million job openings across the economy at the end of June. The leisure and hospitality sector, which includes restaurants, bars, and hotels, has one of the highest levels of job openings at more than 1.6 million.

But instead of absorbing higher labor and material costs, some businesses have begun to pass on the impact of higher wages to their consumers.

Inflation and Retirees

Higher prices take a significant toll on retirees. Social Security benefits rise only once a year. “Those with modest Social Security benefits are the ones who really have trouble,” reports Mary Johnson, Social Security and Medicare policy analyst at The Senior Citizens League, a non-partisan advocacy group. “Other retirees have had to tap more of their savings than they had planned because the Social Security benefit didn’t keep up with 2021’s hot inflation,” she says.

Inflation could prompt largest Social Security cost-of-living adjustment in decades. Retirees could see a 6.1 percent  bump to their Social Security benefits in 2022. That would be the biggest increase since 1983, according to The Senior Citizens League, which calculated the figure.

The Social Security Administration typically announces the amount of the annual cost of living adjustment (COLA), if any, in October. The increase in benefits typically goes into effect in January.

You might not see all the increase in your benefit payment. If your Medicare Part B premiums are deducted from your Social Security (as is the case with 70 percent of Part B enrollees), a Medicare rate increase could offset all or part of the COLA.

The Social Security COLA for 2021 was 1.3 percent. For many retirees, that meant just $20 more per month. Over the years, the increases have led to a loss of buying power for seniors, according to research from The Senior Citizens League.

The amount your Social Security check will increase will be based on a combination of your underlying benefit and the Social Security COLA.  Assuming the Social Security COLA  is at the 6.1 percent level for 2022, and you are receiving the maximum Social Security benefit of $3,895, you would get an additional $237.60 per month. This would mean an increase of $2,851.14 per year. 

The jump in benefits will be a bit more modest for those receiving the average Social Security benefit in 2021. Social Security benefits averaged just $1,543 per month in 2021. Again, assuming a 6.1 percent Social Security COLA, you could see your retirement benefits increase by $94.12 per month. When living on a fixed income, an additional $1,129.48 can go a long way.

If you are still working, make sure you have other retirement income to help maintain your standard of living. Even at the maximum Social Security benefit, you will have a tough time keeping your standard of living on Social Security alone. Work with a trusted financial planner to help determine the optimal time to claim your Social Security  benefits and to set up a monthly payment schedule.

Currently, 69 million Americans are collecting Social Security benefits. So, a significant increase in the COLA to Social Security will be significant for the budgets of many retirees. Before the announcement is made in October, the Today show offers hints to help you save money at the grocery store, including keeping track of your grocery spending, taking inventory of what you already have and using it, and meal planning to reduce food waste and save on your food bill.

Smart shoppers will also watch for sales, comparison shop, and consider buying useful, non-perishable items in bulk and even making use of an extra freezer whenever possible. When it comes to saving money, cheap and healthy can go hand in hand.

InsureYouKnow.org

If you currently collect Social Security benefits or plan to in 2022, you can track at insureyouknow.org your monthly spending patterns, file copies of your Social Security and Medicare statements, as well as savings accounts you may have set up for vacations, rainy days, or emergency contingency plans.