I promised last week that I would write something about the different levels of care available through the Medicare Hospice Benefit. Thus, I want to quickly give the basics of hospice respite care. It is, in my mind at least, the most simple or easy to explain level of care.
The Respite Level of Care is offered to any Medicare hospice patient for the express purpose of giving the primary caregiver (usually the family) a break or to allow them to attend to family business. In respite care the hospice admits the patient into a facility for up to five days while the family does whatever the family needs to do. (In my experience, Respite Care is most often used when there is a death in the patient’s family requiring the caregiver to travel for a funeral.)
The hospice has control over where the patient is placed for respite, and the options vary from one hospice to another. Most hospices that have their own inpatient facility, will admit the patient to their facility for the respite care. Most others use local nursing homes. Hospices in states that do not require 24/7 RN care in a nursing home, a Medicare requirement for any respite placement, usually end up having to use a hospital.
Wherever the patient is placed, they are not there because of a need for any specific medical care. Thus, a hospice respite patient that is admitted to the hospital doesn’t actually receive hospital care. They are admitted because the facility is a safe place for the patient to live while the family is unable to care for them. If they are admitted to an acute care facility for a medical condition it is General Inpatient Care, which is the one level of care that I have yet to review. We’ll try to get to that in the next week or two.
While Respite Care is easier to explain than other hospice levels of care, it is possibly the hardest to access. Most hospices don’t try very hard to educate their patients about Respite Care because it is not necessarily good for them financially and is often “abused” by families. The financial problem is that, while the hospice continues to care for the patient, the reimbursement is usually totally signed over to the facility.
The “abuse” problem comes when, in the view of the hospice, the family wants to use this benefit a little too often. There is no real detail about what qualifies someone for respite. Before writing this I looked at the Medicare Conditions of Participation, Medicare Survey Manual, and my Intermediary’s Hospice Manual, the best explanation of who qualifies is “Inpatient respite care is provided to patients whose caregivers need respite.” That forced me to look up the official definition of respite which is:
an interval of rest or relief
That didn’t give me much help either. So, here is the struggle that hospices have. Should Medicare pay the respite care rate because “It’s the first week of deer season and I want to go hunting.”? There is no doubt that there are rural hospices across the south that have to make that judgement every year. It gets even harder when you have families who don’t really want to be taking care of their loved one in the first place. Should respite be used because the family just doesn’t want to care for them? The examples can go on forever, and I would guess that we could fill the comments section of this post with rather amusing respite “needs” that we have had to deal with. The part that isn’t amusing is that I don’t really know the answer to the two examples I have given above. I know how my company would deal with those situations, but it is a gray area where other companies could answer the question differently and still be doing the right thing.
In the end, if you are the caregiver of a hospice patient, this is a benefit that is available to you. If you are getting near the end of your rope, call your hospice and tell them that you need a few days of respite care. It is your right to have it and the hospice’s responsibility to provide it.