Home Care and Hospice

Question 1

Provide a definition of home care.

Answer 1

Home care is “the provision of equipment and services to the patient in the home for the purpose of restoring and maintaining his or her maximal level of comfort, function, and health.”

Question 2

List the considerations for providing home care.

Answer 2

• Services can be provided in the home
• Safety
• Patient autonomy
• Transportation barriers
• Expected outcomes
• Cost-effectiveness

Question 3

Provide the Medicare definition for “homebound.”

Answer 3

Patients are able to leave the home infrequently for short durations to attend to:

• outpt medical care
• religious services
• adult day programs

Question 4

Indicate Medicare’s new timelines for home health care face-to-face encounters.

Answer 4

• Purpose is to affirm the role of the physician as the person who orders home health care based on examination of the patient which must:
• -> Occur within 90 days prior to the start of home health care, or within the 30 days after the start of care
• If ordering home health care for a new condition that was not evident during a recent visit, the certifying physician must see the patient within 30 days
• FTF can be done by non-physician practitioner (NPP) but a physician must still order and certify the plan of care.

Question 5

State the benefit periods for Medicare coverage of hospice care.

Answer 5

• Covers palliative and support services for beneficiaries who have a life expectancy of 6 months or less if the terminal disease with which they have been diagnosed follows a normal course
• Agree to forgo curative treatment for the terminal illness (DNR not needed)
• Two physicians certify initially
• *The first hospice benefit period is 90 days
• If illness continues to engender the likelihood of death within 6 months, the patient can be recertified for another 90 days
• After the second 90-day period, the patient can be recertified for an unlimited number of 60-day periods, as long as he or she continues to have a life expectancy of 6 months or less

Question 6

List members of the team Medicare allows for hospice care.

Answer 6

• Medical Director (24/7)
• Skilled Nursing (24/7)
• Chaplain
• Aide
• Social worker
• Durable medical equipment company
• Pharmacist