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Hospice FAQs

What is hospice and how can it help people?

Hospice is not a place; it is a philosophy of care. Care is usually provided in a patient's home, but can be provided in any environment in which the patient resides, it might be a nursing home, assisted living or a hospice facility. Hospice is the most appropriate treatment option when an individual has made the decision to discontinue curative treatment and when expert symptom management that may include physical, emotional and spiritual support becomes the goal for someone with a life-limiting condition. Caring and comfort, not cure, are the focus of hospice.  

What if someone is not ready to go on hospice and wants to continue receiving curative treatment?

At VNA of Care New England, we customize our services to meet the needs of patients and their loved ones at different points during their illness. We understand and respect these decisions and therefore, offer what is called a Palliative Care Program for those individuals who require home health care services.  

Who provides hospice care?

The patient's needs may change during the different phases of their illness. At certain times more nursing care may be needed, while, at other times, more social work or the expertise of an entire team is beneficial. Hospice care is provided by a team of experts that includes:
  • A physician
  • Registered nurses
  • Home health aides
  • Social workers
  • Spiritual Care Coordinator
  • Trained volunteers
  • Nurse practitioners

Is hospice care only for patients with cancer?

No. Hospice care is actually an appropriate treatment option for many different life-limiting conditions that may include:
  • Cancer
  • Cardiovascular disease
  • Congestive heart failure
  • Alzheimer's disease and other dementias
  • Neurological disease
  • Lou Gehrig's disease (ALS)
  • Parkinson's disease
  • Renal disease
  • Liver disease
  • HIV/AIDS
  • Chronic debilitating infections
  • Multisystem failure

Who is eligible to receive hospice care?

Hospice care is available for patients who have elected to no longer seek curative treatment and have a prognosis of six months or less, as determined by their physician if their disease takes its normal course.

How is hospice care paid for?

Medicare's Hospice Benefit covers hospice costs at 100 percent. Medicaid and most private insurers also cover hospice costs, including medications, medical supplies, and equipment.  

Can I keep my own doctor?

Yes. The hospice team will work with your health care provider to ensure you receive the best possible care. If there comes a time when you or the patient needs a new doctor while receiving hospice care the hospice team can work with you to identify a new doctor you are comfortable with. The VNA of Care New England has three hospice physicians on staff who can also meet your needs if necessary.  

Palliative Care

What is palliative care and how can it help people?

Palliative care focuses on pain relief, stress and other debilitating symptoms of serious illness and may be provided even at the time of diagnosis and while the patient continues to receive curative treatment. The goal of palliative care is to help provide the best possible quality of life for patients and their families while they work to make medical decisions and determine, along with their physician, the best course of treatment that is consistent with their goals and wishes. Palliative care may be provided in the patient's home by VNA of Care New England's home health care program. Learn more about palliative care through CNE and The Conversation Project.
 

Who provides palliative care?

At VNA of Care New England, members of the home care and palliative team including registered nurses, home health aides, and social workers also provide palliative care services, so that if, and when, the patient elects to receive hospice, they are familiar with the staff and have developed a relationship based on trust and mutual understanding.
 

Is palliative care only for patients with cancer?

No. Palliative care is actually an appropriate treatment option for many different life-limiting conditions that may include:
  • Cancer
  • Cardiovascular disease
  • Congestive heart failure
  • Alzheimer's disease and other dementias
  • Neurological disease
  • Lou Gehrig's disease (ALS)
  • Parkinson's disease
  • Renal disease
  • Liver disease
  • HIV/AIDS
  • Chronic debilitating infections
  • Multisystem failure

Who is eligible to receive palliative care?

Palliative care is available for patients who are considered homebound and receiving home health care services from VNA of Care New England.

How to Choose a Home Health Agency

How should I choose a home health care agency?

There are differences in how home health agencies operate and one may meet your needs better than another. When selecting a home health care agency, there are several factors to consider:  

  • Ask your doctor, hospital discharge planner, or social worker what their experience has been with a particular agency
  • Ask friends about their home health care experiences
  • Ask at your local senior or community center what agencies they recommend 
  • Consider how long an agency has been in existence and its history
  • Call the agency directly and ask questions from a representative in the intake department
  • Review the quality measures found on the Medicare.gov website, however, keep in mind this is only one factor to consider when making your choice 

 

Can I choose the home health care agency that I want to receive care from?

If your doctor decides you need home health care, you have the freedom to choose among a list of participating Medicare-certified home health agencies that serve your geographic area to give you the care and services you need. Your choice should be honored by your doctor, hospital discharge planner, or other referring agency. Although you have a say in which agency you use, your choices may be limited by agency availability, or by your insurance coverage. Managed-care plans may require that you receive home health services from agencies they contract with. The discharge plan should also identify any of the home health agencies in which the hospital has a financial interest.

 

Who is eligible for home health care?

VNA of Care New England provides home health care services to adult patients; those who are 18 years of age or older. Those under 18 may also receive home health care services and there are agencies in Rhode Island that specialize in this population.

 

Are there certain criteria to receive home health care?

If you have Medicare, you can use your home health benefits and receive services from a Medicare-certified home health agency if you meet all the following conditions:

  • You must be under the care of a doctor
  • You must need, and your doctor must certify, that you need one or more of the following
    • Intermittent skilled nursing care
    • Physical therapy
    • Speech-language pathology services
    • The continuing need for occupational therapy
  • You must be homebound and your doctor must certify that you are homebound. This means:
    • Leaving your home is not recommended because of your condition
    • Your condition keeps you from leaving home without help, such as a wheelchair or walker, special transportation, or getting help from another person
    • Leaving home takes a considerable and taxing effort
    • A person may leave home for the following reasons:
      • Medical treatment
      • Short, infrequent, absences for non-medical reasons, such as attending religious services
      • Attend adult-day care, however, home health care services are provided in your home

 

Who is not eligible for home health care?

If you need more than part-time or "intermittent" skilled nursing care, you are not eligible for the Medicare home health benefit. To decide whether you're eligible for home health care, Medicare defines part-time or intermittent as "skilled nursing care that's needed or given on fewer than seven days each week or less than eight hours each day over a period of 21 days (or less) with some exceptions in special circumstances." Hour and day limits may be extended in exceptional circumstances when your doctor can predict when your need for care will end. 

 

What services are not covered by Medicare? 24-hour-a-day care at home.

  • Meal preparation or meals delivered to your home
  • Services such as shopping, cleaning, and laundry when this is the only care you need
  • Personal care provided by home health aides, such as bathing, dressing, and using the bathroom when this is the only care you need

 

Will my private insurance or managed care cover the cost of home care services or private pay home care services?

Home health care services are covered under Medicare and most private insurances. Medicare Advantage Plans or other Medicare health plans may require that you get home health services from agencies they contract with. It is best to contact your insurance company directly to determine what services are covered under your plan.  

Grief and Bereavement Support

Am I entitled to feel this sad?

Yes. A personal tragedy has happened and your world has come unglued. The heartbreak caused by the death of a loved one has consequences that you feel in your body, mind and spirit.  

 

Will I always feel this sad?

No. Some days will be worse than others; some will surprise you by their serenity. Healing does not automatically happen because "time heals all wounds." Time, all by itself, simply passes from one moment to the next. But healing is both desirable and possible, depending upon how you invest your time. You are entitled to want to feel better. 

 

When I begin to feel better, why do I feel guilty about feeling better?

Sometimes we worry that we shouldn't recover, because our loved one didn't recover. We feel disloyal or selfish or both. But "creating the new normal" is not disloyal. Life will never be the same again. But it is a healthy thing to recommit to life in its new form(s). Re-entering life does not eliminate the love that we had for the person who died.

 

Am I all alone in this confusion and exhaustion and sorrow?

No, you don't have to be. Some people may push you away. They don't want your grief to be contagious. Or they may not know what to say or what to do. They say nothing. Or (even worse) they say very stupid things that make you wish they had chosen to say nothing instead. But there are also people out there - nearby - who know your territory and can be companions on the journey. That's why the Hospice Program of VNA of Care New England offers Bereavement Support Groups. All of them are open to the public free of charge.  

 

When do these groups meet?

Up to four times a year, seasonally. Each group runs for six sessions of two hours. The winter group always meets in the daytime to avoid night driving. The summer group always meets in the evening. Spring and autumn vary.  

Rehabilitation

What diseases or injuries could require rehabilitative (rehab) therapy at home?

People recovering from surgery, dealing with a chronic illness, or getting better after an injury often need to heal at home. Cardiovascular, also known as CVAs or strokes, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are some common diseases that can be improved by having rehab therapy in your home.

Patients with Parkinson's disease, multiple sclerosis, amputations and paraplegic patients can reap great benefits, live more painlessly and safely in their homes with rehabilitative therapy. Also, broken or fractured bone injuries and joint replacement often require rehab therapy in your home in order to help you mend more quickly.

 

What kind of rehabilitative therapy can I have at home?

You can have physical therapy, occupational therapy and speech therapy in your home. Our rehab therapists will treat you according to your doctor's orders. You can also receive care from one of our social workers and certified nursing assistants if needed. Our team will help you to build strength, conserve energy, find tools to help you adapt and even assist with meals to help you get back to enjoying life. Whatever your challenges are, our experienced rehab therapists and nurses help you find better ways to live at home safely.  
 

How does rehabilitative therapy speed up my recovery process?

VNA of Care New England offers rehab therapy to get you back on your feet, build strength and manage your own day-to-day tasks. Our team will get you the health care you need to live safely at home.

Working with your physician, our team of trained professionals will complete a comprehensive evaluation to determine your health status, and develop an individualized treatment plan to be carried out to achieve successful outcomes. These services include physical therapy, occupational therapy, speech therapy. We can even help with medication and wound care.

Rehab therapists provide individualized exercise programs to strengthen you, instruction on adaptations for your home, and recommendations for equipment to assist you in your home. You will learn what to expect during recovery and what it takes to become healthy, mobile and independent. 

 

How can a physical therapist help me at home?

Physical therapy (or PT) as a home care service brings physical therapists to work with patients to help them achieve independent, functional mobility in the place you prefer: home.  

Some common diagnoses referred for physical therapy include:  

  • Hip and knee replacement surgery
  • Stoke
  • Bone and joint injuries
  • Acute back pain
  • Osteoarthritis
  • Herniated disc
  • Head injury
  • Other conditions and diseases

Our physical therapists will provide instructions in mobility around the home, exercises to strengthen you, and instructions for methods and assistive devices to alleviate your pain. Some of the goals of physical therapy include:  

  • Improved range of motion
  • Prevention of falls
  • Muscle re-education
  • Improved balance and coordination
  • Post-surgery protocols
  • Patient status assessment
  • Teach and train caregivers
  • Falls

 

How can an occupational therapist help me at home?

Occupational therapy (or OT) helps people recover from, or adapt to, a disability and/or illness. Occupational therapists work to develop and carry out individualized treatment plans for each patient. Therapists will provide instruction in techniques to assist you in your activities of daily living, recommend modification to and equipment for your home.

Some of the goals of occupational therapy include plan and implement therapeutic programs, restore physical function, improve level of independence in the safe performance of daily living activities, restore sensory function, and promote strength, coordination and balance.  

 

What would a speech therapist help me with at home?

Speech therapy can improve overall communication and swallowing abilities. Individual treatment plans are designed to:

  • Re-teach speaking
  • Reading or writing
  • Improve auditory comprehension
  • Memory and judgment skills
  • Strengthen oral muscles for speech and swallowing
  • Develop alternative communication systems

Common problems resulting in a referral for speech therapy include:

  • Swallowing
  • Speech intelligibility
  • Auditory and reading comprehension
  • Verbal fluency or word finding
  • Cognitive ability
  • Functional communication
  • Voice disorders

Our therapists will assist you with strategies to help if you have swallowing problems, provide therapy to improve speech and comprehension problems, and assist recovering stroke patients to regain their speech patterns.

 

How can a therapist help me with pain control?

In the first few days at home after joint replacement surgery, patients will often experience more pain than they expected. Rehab therapists can help control your pain by advising the use of therapies such as ice or heat to improve pain control. For other pain issues, your therapist may use ultrasound.

 

If I have a joint replacement, approximately how long will it be before I return to my regular routine?

After you have been discharged from the hospital, your doctor may order a few weeks of rehab therapy in your home. Generally, you will have three to four weeks of rehab therapy at home. At that point, you may be ready for outpatient rehab therapy. In all, it may be six weeks or more before you are able to return to normal activities. With minimally-invasive surgery, some surgeons are finding that patients can be discharged in as few as one day, with a significantly faster return to normal activities and less post-operative pain.  

 

How can rehab therapy at home help improve my congestive heart failure or chronic obstructive pulmonary disease?

Our therapists will also recommend ways to modify your home and decide what equipment will help you continue to live at home safely. Occupational therapists can help with meal planning to stick with a low salt diet, and teach you how to conserve energy during daily activities. Together, physical and occupational therapists can help you continue to live an active vibrant life.  

Remote Monitoring

How does the remote monitoring system work?

  • Patients can have vital signs such as weight, blood pressure and pulse rate monitored at home by utilizing the easy-to-use equipment that comes with the remote monitoring unit. Also, each day, the remote monitor asks specific questions about the patient's illness and provides useful tips and education.
  • Readings and responses are transmitted to specially trained nurses. 
  • The nurse may receive an alert if there are changes outside of normal parameters, specific to the individual patient. 

 

What is the process if there is an alert?

  • Our nurse checks the patient's history and then contacts the patient to review medications, diet, or other changes. 
  • After talking with the patient, the nurse may schedule a nursing visit or contact the patient's physician for further instructions.

 

What are the benefits to the patient?

  • Daily monitoring
  • Better understanding and management of their health condition
  • Ongoing education and support

 

In what geographical locations is remote monitoring available?

VNA of Care New England serves patients throughout Rhode Island, except Block Island or Aquidneck Island. 

 

What health conditions are currently eligible to use remote monitoring?

  • Acute MI (heart attack) 
  • Asthma 
  • COPD 
  • Diabetes 
  • Heart failure 
  • Hypertension (high blood pressure) 
  • Aftercare cardiac surgery 
  • Pneumonia 

 

Will my physician know about remote monitoring?

Yes. Your physician will know that you are receiving remote monitoring services and VNA of Care New England will provide him or her with periodic reports to let him or her know your status. Physicians with patients who have received remote monitoring have been very happy with the program. They recognize the value in their patients learning more about their disease and appropriate self-management.

Physicians also appreciate that remote monitoring can help to prevent emergency room visits and hospitalizations through early detection of potentially harmful changes in a patient's condition.

 

Does remote monitoring replace the nurse?

No, remote monitoring is used to complement in-home nursing care. Patients still receive nursing visits and any other services appropriate to their specific home care needs.

 

What if patients want to stay in someone else's home while they are recovering? Can the remote monitoring equipment be used there?  

Yes, the equipment can be used anywhere there is a power source.

 

What does telemonitoring cost?

There is no charge to the patient for remote monitoring services.

 

How do I find out more about remote monitoring?

If you are hospitalized and chose VNA of Care New England as your home care provider of choice, you may be asked about remote monitoring before you are discharged from the hospital. If you have one of the conditions currently eligible to use remote monitoring and it was not discussed with you at the hospital, you may inquire with your VNA of Care New England home care nurse.

 

I have questions, who should I call?

Call VNA of Care New England at (401) 737-6050 and ask to speak with the triage nurse.