I couldn't get a straight (for me) answer from the people in charge of palliative care at my hospital/oncology center.
Basically, hospice is a program open to those with 6 months to live (sometimes more, hard to tell) but definitely nearing EOL. It works in conjunction with Medicare.
The concept, I think, is that if you let Medicare manage your hospice then they won't also let you go to doctor's/hospitals for your condition.
Hospice can be applied at home - often is - but if there's a serious problem they move you to a hospice house if you need round-the-clock care with machines or whatever that isn't feasible at home.
Generally it's held at home. The tradeoff is that you and your doctor agree that you're no longer curative - all the CT scans in the world aren't going to help you get better (they'll just let you know where you are). You're only palliative - they'll make the last few months tolerable at home with all the meds you need in an environment that (hopefully) doesn't stretch you out and makes you feel comfortable. If you accept hospice, then you can NOT got to regular hospitals and doctors RELATED TO YOUR CONDITION because you should be getting covered for all this via Hospice. That said, if you break your back in a car crash, that would still be considered non-hospice and you could still go to your regular doctor or hospital. Likewise you can drop out of hospice at any time (just sign a form) and then you're back on traditional insurance. You can always reapply for hospice.
So, the deal is, Medicare'll send nurses or social workers to your home, give you oxygenators and a hospital bed if you need for your house, but you promise to do everything disease-related through hospice. On the bright side, you can call them 24 hours a day, get as many home visits as you need (ranging just from a nurse asking how you're doing to in-home help taking showers or whatever you need).
They also cover prescriptions, which for me is a good $250+/month savings.
Meds aren't limited - they can pick up your morphine, insulin, etc. The people at hospice (aside from the initial flurry of intake) keep as hands off as you want them, but will be as involved as you need (change bed dressings, move you, get you to the toilet or shower).
Personally, I'm very tired most of the time, but I can drive my car, make phone calls, go to the store, work online, and so forth. Not quite with the energy I used to have, but I'm 99% functional. I suspect that will go down more and I'll more and more rely on hospice services (think visiting nurses association) but I dont have to just yet. That said, we're putting stuff in place, and they're also helping my family, my wife in particular, in understanding the process.
Maybe you don't want to live your last years in your house - either because of tension or maybe because you're alone - and hospital might be more approrpriate if you can afford your doctor visits and scripts. If not, this is a nice alternative. Our objective: learn to accept and put ourselves into the hands of the hospice crew.
As far as medication, Hospice delivered (for me) Morphine, Haldol, and others. We administrated it outselves. But I think they'll come over and administer it if necessary.
Hope this helps. Anything I didn't cover (or didn't cover well?).
- Tab
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