Who is eligible for UGC Hospice care?
A very common mistake that people make is that they think UGC Hospice services are only available to cancer patients. The truth of the matter is, we provide our services to clients with any terminal illness. Diagnoses include, but are not limited to:
- Metastatic Malignancies
- Heart Disease (that includes congestive heart failure)
- Kidney Disease
- Liver Disease
- Lung Disease
- Coma and/or Stroke
- Neurological Diseases (Alzheimer's, Parkinson's, Dementia, etc.)
- Lou Gehrig's Disease (ALS)
- Failure of Multiple Organ Systems
- Failure to Thrive (most notably undesired weight loss)
- Senescence - the physical and mental conditions associated with advancing age.
- Debility Unspecified (meaning no specific disease or condition is causing the terminal status)
Is it true that in order to qualify for the Medicare UGC Hospice Benefit you need to have less than 6 months to live?
Another common misinterpretation people make about UGC Hospice is that UGC Hospice care somehow guarantees that a patient has less than 6 months to live.
The summarized answer to this is no. The complex answer is:
When Medicare created the UGC Hospice eligibility guidelines used by Medicare and Medicaid UGC Hospice providers such as ourselves, it included the “six months to live” guideline.
However, due to confusion and concern in the medical community about this guideline, Medicare issued a policy letter to explain and clarify what it meant. We have an excerpt from that letter to help you understand Medicare’s attitude towards this issue. This ideology is also used by Medicaid and generally by private insurers. Please note that the italicizing and underlining of a few sentences has been used by us to indicate points we believe are very important. In its letter to physicians, Medicare said the following. “UGC Hospice care that is covered by Medicare is chosen for specified amounts of time known as election periods. Essentially, a physician may certify a patient for UGC Hospice care coverage for two initial 90-day election periods, followed by an unlimited number of 60-day election periods. Each election period requires that the physician certify a terminal illness. Generally speaking, the hospice benefit is intended primarily for use by clients whose prognosis is terminal, with six months or less of life expectancy. The Medicare program recognizes that terminal illnesses do not have entirely predictable courses. Therefore, the benefit is available for extended periods of time beyond six months provided that proper certification is made at the start of each coverage period. Recognizing that prognoses can be uncertain and may change, Medicare's benefit is not limited in terms of time. UGC Hospice care is available as long as the patient's prognosis meets the law's six month test. This test is a general one. As the governing statute says: The certification of terminal illness of an individual who elects UGC Hospice shall be based on the physician's or medical director's clinical judgment regarding the normal course of the individual's illness. CMS recognizes that making medical prognostication of life expectancy is not always an exact science. Thus, physicians need not be concerned. There is no risk to a physician about certifying an individual for hospice care that he or she believes to be terminally ill.” We believe Medicare makes it very clear that the six months guideline is simply a guideline rather than a requirement. When does UGC Hospice care become appropriate for a person? UGC Hospice care becomes appropriate when a person has a life-terminating illness or condition. The person's physician and the UGC Hospice Medical Director have to make this medical determination together. The person and their family then decide whether he/ she wishes to enter the hospice care program. Informal UGC Hospice Eligibility Questionnaire We have prepared this brief questionnaire that can help determine whether UGC Hospice care is right for you or your loved one. You or your loved one may be eligible if 4 or more of these statements apply to you or your loved one . Please remember that your physician and our Medical Director will make the final decision regarding eligibility of you or your loved one. Please check the following statements as they apply to you or your loved one to see if UGC Hospice care may be appropriate.
- I have begun to feel more tired and weak.
- I experience shortness of breath, even when resting.
- I spend most of the day in bed or in a chair.
- I have noticed an increased weight loss in the past 6 months.
- I call my physician quite often
- I take medications to lessen physical pain.
- I have fallen several times in the past 6 months.
- I have made recurrent trips to the emergency room in the past 6 months.
- I need help from others with daily activities such as: bathing, dressing, eating, cooking, walking, getting out of bed
- My doctor has told me my life expectancy is limited.
If you have checked 4 or more items in this questionnaire, you may want to look into UGC Hospice care by seeking advice of your or your loved one’s primary physician. If you do not have a primary physician, please contact us. We can refer you to our Medical Director who is a Doctor of Internal Medicine as well.