Hospice care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support for patients and their families affected by a life-limiting illness. Hospice care is usually provided in a patient’s home or wherever a patient calls “home” such as a skilled nursing facility or assisted living facility. Care is provided by a team of healthcare professionals all working together with the patient, the patient’s physician, and the patient’s family members. The team makes intermittent visits to a patient’s home, depending on the needs of the patient and family members. And hospice care is very affordable, as it is covered under Medicare, Medi-Cal (Medicaid), most private insurance plans and HMOs. The goal of hospice care is to help the patient live the best quality of life possible, for as long as life lasts – whether that’s weeks, months, or years.

In-home care services in San Diego are available for those in need of assistance with activities of daily living (ADLs), or for family caregivers who may need a break, or additional help, in caring for their loved one. Non-medical home care agencies provide assistance with ADLs, which require no medical intervention. These activities include supervision and assistance with personal care, such as bathing and dressing, feeding, companionship and light household tasks. It’s important to note that non-medical home care (also known as Companion Care) is not covered by Medicare or other commercial insurance policies (i.e. PacifiCare, Secure Horizons, etc). Generally, agencies in the San Diego area can range from $13 to $20 per hour. If your loved one needs assistance 24 hours per day, sometimes known as a “live-in” home care, prices may range from $150 to $250 per 24-hour period. Some services may be covered by long term care insurance, review your policy for details. Medicare, Medi-Cal and private insurance usually cover the cost of visits from a Physician, RN or therapist (if ordered by a Physician). Services must be provided by a Medicare certified Home Health agency.

The main difference is that hospice care team members visit patients on an intermittent basis – they do not “live-in” with the patient or stay with the patient all day (except in cases where the level of care is determined to be continuous care, based on the medical needs of a patient). And services provided by the hospice team are usually covered by insurance. In-home care workers provide non-medical care, can stay as long as needed (depending on the service agreement between the in-home worker and the patient), and services are usually not covered by insurance.

To determine which type of care is best, talk with your doctor or call a San Diego hospice provider for more information.

-by Melissa DelaCalzada

With the recent World Hospice & Palliative Care Day on Saturday, October 8, and the upcoming National Hospice and Palliative Care Month in November, what better time than now to take a moment to reflect on all of the positive things hospice and palliative care has to offer.

In honor of these recognition events, San Diego Hospice and The Institute for Palliative Medicine invites you to join the global hospice and palliative care community to share your supportive stories, thoughts and memories about hospice and palliative care through a global conversation online using the hashtag #WeAreHospice to connect via Twitter.

The goal is to spread positive awareness and encourage a sense of community among peers, patients and caregivers, bringing everyone together to remember what we are ultimately here for in the end.

This is the start to many opportunities down the road to spread the good news about hospice and palliative care. You can find us online @SanDiegoHospice and @PalliativeCare to join the conversation about why #WeAreHospice.

Medi-Cal (known as Medicaid outside of California) is a public health insurance program that is financed by the state and federal government. It provides health care services for low-income individuals including families with children, seniors, persons with disabilities, foster care, and pregnant women. Medi-Cal also provides health care services to low income people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS.

Although Medicaid is a National program, each state sets its own guidelines regarding eligibility and services. The general premise remains the same, but certain state-specified requirements must be met in order to be eligible to receive the Medicaid benefits. In addition, the rules for counting income and resources vary from state to state and from group to group and there are special rules for those who live in nursing homes and for disabled children living at home.

For those living in California, below is the Medi-Cal eligibility criteria.

Medi-Cal Eligibility Criteria:

If you are enrolled in one of the following programs, you can get Medi-Cal:

SSI (Supplemental Security Income)/SSP (State Supplemental Payment)
CalWorks (AFDC)
Refugee Assistance
Foster Care or Adoption Assistance Program
In-Home Supportive Services (IHSS)

You can also get Medi-Cal if you are:

65 or older
Blind
Disabled
Under 21
Pregnant
In a skilled nursing or intermediate care home
On refugee status for a limited time, depending how long you have been in the United States
A parent or caretaker relative or a child under 21 if:
The child’s parent is deceased or doesn’t live with the child, or
The child’s parent is incapacitated, or
The child’s parent is under employed or unemployed
Have been screened for breast and/or cervical cancer (Breast and Cervical Cancer Treatment Program)

One of the caregiver tools we recently wrote about on The Caregiver’s Corner blog, the BenefitsCheckUp website, can help you see if you or someone you are caring for may be eligible for Medi-Cal or a variety of governmental programs.

In general, you should apply for Medicaid if your income is low and you match one of the descriptions of the Eligibility Groups. Even if you are not sure whether you qualify, if you or someone in your family needs health care, it is recommended that you apply for Medicaid and have a qualified caseworker in your state evaluate your situation. For more information, visit California’s Department of Health Care Services website or call your County’s Medi-Cal office. In San Diego County, contact the Dept. of Health and Human Services Agency toll-free at 1-866-262-9881.

It takes all of the siblings working together to help their mother stay at home. But every day, as president of the California Advocates for Nursing Home Reform, McGinnis deals with people who don’t have that choice and must live in nursing homes because they lack the financial resources or social support to remain at home as they age.

Home-based care is increasingly seen as a legitimate and less costly alternative to nursing home care. The Patient Protection and Affordable Care Act, signed into law by President Obama in March 2010, includes provisions to assist people who want to stay in their homes longer.

“I think it’s probably one of the most important reforms to long-term care since Medicare and Medicaid went into effect in 1965,” McGinnis said. “This is imperative, so I am really excited about it.”

About 1.5 million people live in nursing homes in the U.S., according to the Centers for Disease Control and Prevention. And more than 10 million Americans — mostly people 65 or older — need long-term services and support to help them with daily activities, according to the Kaiser Family Foundation.

Elinor Ginzler, senior vice president for livable communities at AARP, said the organization is always fighting for more funding to help people stay in their homes longer.

“Nursing homes are not a first choice,” she said. “People like where they are living. We surveyed the 50-plus population and found that 86% of them want to stay in their homes.”

One of the main reasons is financial.

The cost of staying at a nursing home ranges from about $40,000 to $85,000 a year, according to a recent report by John Hancock Financial Services Inc., an insurance and financial services company. The average cost of a home health aide, on the other hand, is about $37,000 a year.

A long-term care insurance policy McGinnis purchased some time ago pays for most of her mother’s healthcare at home. But not everyone has that kind of insurance. “If you look at the baby boomers coming up, I wonder how we are going to pay for all of this,” she said. “The average retirement savings of people 55 or older is $29,000 a year.”

New provisions of the Affordable Care Act should help. The most ambitious part of the act to do with long-term care is the Community Living Assistance Services and Supports Act, or CLASS — a voluntary, consumer-financed insurance plan to cover long-term care expenses.

“It is a really different and new way of looking at the delivery and financing of long-term care in the U.S.,” said Dee Mahan, deputy director of health policy at FamiliesUSA, a nonprofit healthcare advocacy organization. “I think the program is really, really important.”

The insurance plan is similar to those currently available in the private market, but there are a few major distinctions. First, the program will be administered by the government. Second, any working adult age 18 or older will be able to enroll, regardless of any preexisting medical condition, and benefits will be good for as long as someone needs long-term care.