Hospice Care / Palliative CareSchedule Consultation
Hospice Care / Palliative Care
Hospice provides support and assistance for terminally ill patients and their families who would like the focus of their care to be on Comfort and the Quality of Life rather than on prolonging life by any means available. Terminal illness is usually defined as a condition that will result in the patient’s death within a six month period of time. However, since some individuals survive longer than expected, hospice can continue to support the patient and family beyond six months as long as the patient remains terminally ill.
The hospice team is composed of a nurse, social worker, aides, volunteers, and clergy. The team helps hospice patients and their families identify needs and form a plan of care to meet those needs. As a patient’s condition changes the plan is care is constantly adjusted to meet those changes. Hospice will arrange for any medical equipment, including oxygen, which a patient needs. While hospice provides support and assistance, they cannot routinely supply 24/7 assistance. Hospice patients need primary caregivers from family, friends, or private duty help, or any combination of these; hospice services supplement these primary caregivers.
Hospice care is normally provided in someone’s home, but, when this is not possible, it can also be provided in personal care homes, assisted living residences and nursing homes. If the patient becomes bed confined in a personal care home or an assisted living residence, there may be a need for family, friends, or private duty help to fill in gaps between what the staff at the facility can provide and what hospice can provide. Since a nursing facility is staffed 24/7, there is no need in this setting for private duty help, unless the patient or family desire one-on-one assistance.
Hospice is covered by Medicare and many other insurers. The one exception under Medicare is that if the patient is in a skilled nursing facility and Medicare is paying for the nursing facility, Medicare will not pay for hospice in the nursing facility until it stops paying for the nursing facility.
Because calls to 911 initiate the “prolong life by any means available” system, hospice agencies ask patients and their caregivers to call the hospice agency with any questions about care. Hospice agencies have nurses who are on-call after hours and on weekends to help insure that the patient’s comfort and his or her quality of life needs are maintained. Hospice agencies recognize that a family’s needs do not stop after the death of their loved one. These agencies provide bereavement care to the family following the patient’s death. In our society many people find it difficult to talk with grieving family members about the death of their loved one; this can leave the family feeling isolated in their grief. With bereavement follow up, the family has support during the grieving process, and they have help learning to live with the loss of their loved one.
The focus of palliative care is to assist patients and their families manage the care of serious illnesses. The goal is to improve the quality of life for people with serious illnesses by helping with pain and symptom management, improving communication between the patient, family, and medical team, and making sure the care is coordinated. Palliative care is a relatively new area of medical practice. Many hospitals offer palliative care consultations, but it is more difficult to find in the community. If the individual’s primary difficulty is pain control, he or she may find assistance in the community at a pain management center. Some hospice care agencies have palliative care programs for people who feel they are benefiting from life-prolonging treatment and who do not want treatment stopped in order to receive hospice care. The hospice agency will then transition these individuals to hospice care if and when it is appropriate.
Power of Attorney
A Power of Attorney can be used to give another person the right to sell a car, home, or other property in the place of the maker of the Power of Attorney. A Power of Attorney might be used to allow another person to sign a contract for the maker of the Power of Attorney (the person who makes a power of attorney is called the “principal”). It can be used to give another person the authority to make health care decisions, do financial transactions, or sign legal documents that the principal cannot do for one reason or another. With few exceptions, Powers of Attorney can give others the right to do any legal acts that the makers of the Powers of Attorney could do them themselves. A General Power of Attorney gives the “power of attorney Agent” or simply “Agent” (the legal name of the person who is authorized to act for the principal) very broad powers to do almost every legal act that the principal can do. When Elder Law Attorneys draft general Powers of Attorney, they still list the types of things the Agent can do but these powers are very broad. People often do general Powers of Attorney to plan ahead for the day when they may not be able to take care of things themselves. By doing the General Power of Attorney, they designate someone who can do these things for them.
Normal Powers of Attorney terminate if and when the principal becomes incompetent. Yet many people do Powers of Attorney for the sole purpose of designating someone else to act for them if they cannot act for themselves. It is precisely when persons can no longer do for themselves that a Power of Attorney is most valuable. To remedy this inconsistency, the law created a Durable Power of Attorney that remains effective even if a person becomes incompetent. The only thing that distinguishes a Durable Power of Attorney from a regular Power of Attorney is special wording that states that the power survives the principal’s incapacity. Even a Durable Power of Attorney, however, may be terminated under certain circumstances if court proceedings are filed. Most Powers of Attorney done today are durable.
Yes. At the time the Power of Attorney is signed, the principal must be capable of understanding the document. Although a Power of Attorney is still valid if and when a person becomes incompetent, the principal must understand what he or she is signing at the moment of execution. That means a person can be suffering from dementia or Alzheimer’s Disease or be otherwise incompetent sometimes but as long as they have a lucid moment and are competent at the moment they sign the Power of Attorney, it is valid even if they do not remember signing it at a later date. At the time it is signed, the principal must know what the Power of Attorney does, whom they are giving the Power of Attorney to, and what property may be affected by the Power of Attorney.
Any competent person eighteen years of age and older can serve as an agent. Certain financial institutions can also serve. There is no course of education that agent must complete or any test that Agent must pass. Because a Power of Attorney is such a potentially powerful document, agents should be chosen for reliability and trustworthiness. In the wrong hands, a Power of Attorney can be a license to steal. It can be a big responsibility to serve as an agent.
Medicare is health insurance and covers medical services such as physician appointments, therapy, blood tests, x rays, medical procedures and hospitalization. Medicare will sometime pay for rehabilitation in a long-term care facility for a period of 20 to 100 days, but not longer. In long-term care, Medicaid covers the cost of ongoing support services for daily functioning, such as room and board in a nursing home.
Medicaid is a federal program that is overseen by the Center for Medicare and Medicaid Services (CMS). In Pennsylvania, Medicaid is called Medical Assistance and is administered by the Department of Human Services (DHS).
In Pennsylvania, Medicaid funds are not available to pay for assisted living or personal care.
For Medicaid to pay for care in a nursing home, an individual recipient must be determined to need a nursing home level of care by a physician and the local Office of Aging. An individual whose income is not greater than three times the poverty level may keep up to $8,000 of total resources, but may otherwise keep only $2,400. The cash value of life insurance counts as a resource, but one car and a residential home does not count as a resource.
Empowering Clients with Holistic Planning at
Keystone Elder Law
At Keystone Elder Law, we believe that the physical, social, legal, and financial considerations of our clients all intertwine. We utilize an interdisciplinary approach to evaluate each area, which allows for the creation of a plan that addresses the concerns of the individual as a whole as well as the family. To this end, our model of practice includes a Care Coordinator (usually a nurse or social worker), whose expertise complements our team of attorneys.
When the road of life is smooth, decisions about legal and financial matters are easy to push aside for “a rainy day.” Planning ahead, however, will allow for more options as you view the map of where you’ve been and where you want to go. Don’t let a crisis limit your choices or derail your plans.(717) 697-3223