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There's No Place Like HomeArticle submitted by Susan Acocella, General Manager of VITAS Innovative Hospice Care® of Palm Beach. When There's Illness, There's No Place Like Home You know it yourself: faced with life-threatening illness, some 90 percent of patients prefer to remain in their homes, in the bed they know, surrounded by people they love, continuing the routines that make them comfortable. Whether they live in their family home, an adult living facility or a nursing home, they want to age-and die-in place. For terminally ill patients, hospice makes that possible. But what happens when there is a crisis in symptom management: pain, nausea or confusion, for example? Continuous Care puts a trained, skilled clinician at the bedside up to 24 hours a day. It means a hospice patient doesn't have to choose between the comforts of home and the round-the-clock care of hospitalization. Under Continuous Care, additional VITAS staff assist the family or nursing home, on a shift basis, to maintain the patient at home. The Continuous Care staff is in addition to the regular visits of the VITAS hospice team. "Continuous Care means you don't have to send a hospice patient to the emergency room," says Bob Miller, vice president of hospice operations at VITAS Innovative Hospice Care. "When the patient is most vulnerable to confusion or disorientation, Continuous Care keeps her in familiar surroundings. She feels at home and calm." According to Medicare, Medicaid, federal and state regulations, Continuous Care must be limited to brief periods of time to keep a patient comfortable at home; it is not a long-term solution. The patient is reevaluated every 24 hours for his or her continued need for Continuous Care. Medicare, Medicaid and most private health insurance plans provide coverage for all hospice services, including Continuous Care. To be eligible for the Medicare Hospice Benefit, the beneficiary must be diagnosed with six months or less to live. Coverage is all-inclusive, meaning it covers everything related to the patient's terminal diagnosis (physician services, nursing care, home medical equipment and supplies, and medications) as well as counseling, spiritual support and bereavement support for the patient's loved ones-all at no additional cost. Even if a private insurance patient has no Continuous Care benefit, Bob Miller points out, VITAS will try to negotiate with the insurer because of the measurable benefits Continuous Care offers the patient and family. "Continuous Care has been one of the four levels of care authorized under the Medicare Hospice Benefit for more than 20 years," he says. "But only recently have other hospices begun to offer this service at all, let alone as widely as VITAS offers it." Some of the symptoms or problems that might indicate a need for Continuous Care are:
Family may continue to help with the patient's care during Continuous Care if they wish, but they are also encouraged to get rest or respite while the Continuous Care team is on duty. If spiritual or emotional support is needed, the hospice team's chaplain and social worker are available as well. If and when the crisis is resolved and the patient is stable, the Continuous Care team leaves and care of the patient returns to the family or caregiver, with plenty of support from the regular VITAS team of hospice professionals. The patient has been able to remain at home, which is what Continuous Care is all about. What VITAS is about is choices, and most people choose to die at home. Yet the perception persists that hospice means going to-or ending up in-a place. Hospice isn't a place. Hospice is philosophy; it's a way to take care of a patient with a life-limiting illness. And with Continuous Care, VITAS can provide that care wherever the patient calls home. |
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