Fong Law Group

What Is Hospice Care at Home?

Hospice care is a type of health care that patients with terminally ill conditions rely on at the end of their lives. This type of care focuses on pain management and emotional, spiritual, and familial support for patients nearing the end of their lives.

There are several options for receiving hospice care, including being cared for at home. The type of intimate care a patient receives while in hospice is more conducive to being received at the patient’s home. This becomes a team effort, and it helps to have a peaceful environment when receiving care.

Who Can Benefit From This Type of Care?

Patients with serious illnesses like cancer, heart disease, dementia, kidney failure, or other fatal conditions benefit from hospice care. This type of care can help the patient live a more comfortable life while decreasing the emotional burden of grief for families by preparing them for the loss of their loved one.

When Is Hospice Recommended?

Hospice care should not only be considered by those who have loved ones nearing the end of their lives. While most of these services are generally reserved for people with six months or less to live, early hospice care can be beneficial for patients and their families as well.

You may wish to consider such services in the following cases:

• The patient has a serious decline in their physical well-being
• After a diagnosis of Alzheimer’s disease or dementia
• You have decided to forgo any treatment to improve your physical treatment or care for your illness

Who Makes Up a Hospice Care Team?

Your hospice team can consist of many different types of people. Various professionals and volunteers may be involved in end-of-life care. Some of those you may see on your care team can include:

• Doctors
• Nurses
• Social workers
• Spiritual advisors
• Trained volunteers

Who Pays for Hospice Home Care?

Like any other health care option, these services can quickly become very expensive. Fortunately, there are several ways to cover the cost, including:

Government Programs

If you qualify for government assistance, there may be insurance plans specifically designed to cover the cost of hospice care.

Seniors enrolled in Medicare Part A may qualify for a Medicare hospice care benefit. This benefit program allocates money to pay for such care at home.

For terminally ill patients on Medicaid, hospice care may be covered depending on the state.  

The Department of Veterans Affairs may also provide coverage for these care benefits for seniors who have served our country.

Private Insurance

Check the terms of your insurance policy to determine if your health insurance covers hospice care. Your policy may cover all or part of your hospice care needs.

Options for Uninsured Patients

Even if you do not have health insurance, you may still have coverage options. There are charitable organizations that work with elderly and disabled individuals who need help paying for hospice care services. Hospice care organizations also often have internal departments that work with patients who qualify for this type of care but are indigent or do not have health insurance.

Is In-Home Hospice Right For You?

Making this choice is an important part of your end-of-life care plan. Be sure to gather as much information as you can before deciding whether this type o care is best for you. For example, you may want to consult Medicare’s hospice compare website or CaringInfo.org’s website for other hospice locator tools.

If you have questions about Medicare or Medicaid, contact your elder law attorney to learn more.

Bill Advocates for Seniors Who Seek At-Home Medicaid Care

Seniors who need assistance with everyday activities such as dressing, bathing, and eating are eligible for Medicaid Long-Term Services and Supports (LTSS). Unfortunately, hundreds of thousands of people who qualify for these services – but wish to receive them in their homes or a community setting – end up on extended waiting lists.

In many cases, these seniors then find themselves with no choice but to live in nursing homes or other institutional facilities for months, or even years, if it is the only way they can access the day-to-day support on which they rely.

A piece of legislation focused on meeting the needs of this population of older adults has recently been reintroduced to Congress by U.S. Sen. Bob Casey (D-PA) and U.S. Rep. Debbie Dingell (D-MI).

Aging in Place: When You Want to Live Independently

Living at home as you grow older can have a positive impact on your physical and emotional health, as well as on your wallet. According to one 2022 study, aging in place includes such benefits as the following:

• Maintaining a sense of independence and autonomy in one’s community
• Living in a familiar setting
• Enjoying a more fulfilling social network
• Decreasing feelings of loneliness
• Saving on the cost of long-term care facilities

Where Does the Medicaid Waiver Fit Into HCBS?

Older adults qualifying for Medicaid LTSS who wish to receive services in their home or community generally must wait to be granted a waiver before Medicaid will cover the cost of their home care.

As each state administers its own Medicaid system and waiver program, the wait time can vary depending on where you live. The income and asset thresholds for waiver programs can also differ from state to state, as can the types of home care that are covered.

These are among the main reasons why you may want to consult with your elder law attorney, who knows the rules and regulations specific to the state where you reside.

Home and Community Based Services (HCBS) Access Act

The Home and Community Based Services (HCBS) Access Act, originally introduced in 2021, seeks to secure for these seniors a real choice between receiving care at home or in an institution.

A one-page PDF summary of the HBCS Access Act outlines six specific steps that the proposed legislation is designed to provide:

• Enhanced Medicaid funding for HCBS
• Grant funding for states that would develop their capacity to serve individuals who prefer to receive home care
• Resources for states meant to ensure professional caregivers have stable jobs and wages
• A stronger workforce in home care
• Training for family caregivers
• Improved methods for evaluating the quality of HCBS

According to a 2021 report from Justice in Aging, 25 of the 50 states spend twice as much on institutional care as on HCBS for seniors and people with disabilities.

In addition to seniors eligible for Medicaid LTSS, many people with disabilities would benefit from the legislation if it is passed.

Support From Others

Sixteen U.S. representatives are co-sponsoring the HCBS Access Act, and numerous advocacy organizations for older adults have endorsed the legislation as well.

“I’m helping introduce the HCBS Access Act, which expands Medicaid HCBS funding that will help ensure Americans don’t have unnecessary delays in accessing the care they need,” U.S. Sen. Jeanne Shaheen (D-NH), one co-sponsor, said in a news release about the Act. "This bill is an important investment not only in the accessibility of care, but also in creating better jobs for home care workers and support for family caregivers.”

Earlier this year, Sen. Casey and Rep. Dingell also reintroduced a related bill, the Better Care Better Jobs Act. The goals of this legislation are to boost funding for HCBS, make millions more individuals on Medicaid eligible for these services, and create new jobs for home care workers.

Because Medicaid can be such a complex system to navigate, be sure to consider consulting with your elder law attorney.

Study: Certain Social Risks May Cause Early Death in Seniors

Using survey data from more than 8,000 adults aged 65 and older, researchers have identified eight social factors that may lead to early death in older adults.

As part of the study, researchers from Massachusetts General Hospital and the University of California, San Francisco, developed a tool called the Social Frailty Index to examine factors that predict mortality, including age, gender, and medical conditions, as well as social characteristics.

The findings have applications in clinical, population health, and research settings. Clinicians may be able to use the index to help their older patients participate in advanced care planning. The index also helps identify at-risk seniors who could benefit from changes to their social interactions that could extend their lives.

8 Social Characteristics Shared by Study Participants Who Died Prematurely

Following 8,250 seniors for four years, the research team discovered that 22 percent of the group died within four years of their baseline interview.

The participants who died prematurely had the following eight social characteristics in common:

1. Poor neighborhood cleanliness
2. Low perceived control over their financial situation
3. Meeting with children less than yearly
4. Not working for a salary
5. Not being active with children
6. Not volunteering
7. Feeling isolated
8. Being treated with less courtesy or respect

Why Are the Social Frailty Index Findings Important for Older Adults?

The Social Frailty Index reveals the potential impact of healthy social connections on seniors’ physical health, according to the study’s authors. These findings, they state, are significant because medical providers previously had not accounted for these characteristics. Health care providers taking these findings into account may be able to give patients a complete care management plan.

“We often overemphasize the importance of medical conditions when thinking about longevity,” Sachin J. Shah, the study’s lead researcher, said in a news release. “This research demonstrates that our social lives are as important as medical conditions.”

The data collected from the study also helps predict the likelihood that a senior can safely and comfortably age in place. Solid social connections correlate with the ability of older adults to live independently.

Failure to consider social factors can lead to more significant inequities. For example, one of the authors states, Medicare penalizes hospital readmissions. Because of the expense of rehospitalization, some hospitals may refuse to admit Medicare recipients. Omitting risk factors creates a more significant barrier to proper treatment for marginalized groups. Patients can therefore avoid rehospitalizations if clinicians recognize and account for social factors when assessing a patient’s risk factors.

What Can Seniors Take From the Study?

This study’s findings suggest that friends, family, and community can help you live a longer and happier life. Armed with the knowledge from this study, seniors and their caretakers can structure their lives to address the eight social factors listed above.

This study also provides older adults and caregivers with the language to address these conditions with doctors, estate planners, geriatric care managers, and other family members to help ensure their needs get met.