respite care

Friday, March 30, 2007

Respite Care

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.

4
comments:


sali
said…

Respite care was offered to my Father who has a rapid moving form of ALS. The trauma the caregiver has emotionally of watching someone die (i find that odd that you didn’t mention that in your post… and chose instead to use ‘hunting season’ as an anecdotal reason for respite). The rapid decline of someone who a year ago could drive a car, walk and talk. To now being totally bedridden is draining to say the least. To provide the practical side of caregiving and bury your emotions, also calls for a necessary period to gather your perspective and rest your nerves. Respite care is a necessary for caregivers who have to deal with the emotional and physical demands of watching a loved one die.


Anonymous
said…

Though respite is a needed service for some families, it can be limited to 5 days per benefit period. What happens for hospices after providing this level of care for these patients is that families do not want to take them back home.

hospicemom
said…

If you had a patient in respite and the family decided they could not care for them anylonger, the patient would need to go inpatient (related) for discharge planning.

carcharv
said…

I agree with Sali. It is so very hard to witness such a rapid decline in someone you love so dearly. Every fiber of your being aches for your loved one. You wish that you could do more to helping them live longer. Last month my former husband and I just lost our dearest friend to cancer. My ex-husband asked me to go up to our friend's home (widowed for 6 years, also lost his wife to cancer), where I spent the last two weeks of his life, as it turns out, in his home. The past 6 months my former husband and I witnessed a very rapid decline in his health, and we did not know what was happening to him. We literally did not know what he had until the night he died from pancreatic cancer! Needless to say, once his wife died, he had no one to look after him and care for his needs and his last days. I have since realized what a valuable service respite care truly is and how it can help families as they go through this very painful process of saying goodbye.