Hospice Covers ER, Pain

My grandfather is in hospice.  We were told that we should keep him at home but we could take him to the ER if necessary.  A friend told us that Medicare will not pay if we take him to the hospital; what are we supposed to do if his pain isn’t controlled?

There are really two issues here.

1.  Can you take him to the ER?  One of Medicare’s goals for hospice patients, based on surveys of families/patients preferences, is to help them to remain at home, comfortably, and to die there with dignity.  Therefore, hospice is obligated to do whatever it takes to achieve that, including providing continuous care by an RN if necessary during times of crisis.

However, if the hospice can’t control the symptoms, or some unrelated crisis occurs [such as falling and breaking a hip], patients can be taken to the ER either to be stabilized and return home, or to be admitted.  And these are covered by Medicare (either through the hospice or separately).

2.  How to control his pain?  Your hospice doctor and nurse are responsible for ensuring that a patient’s symptoms are controlled, whether it’s pain, shortness of breath, nausea, or whatever.

For pain, extended-release acetaminophen [Tylenol Arthritis] combined with non-drug options [such as rubbing a mentholated cream, like Bengay or Biofreeze, into the painful area] is adequate for some patients.  But others require stronger drugs such as morphine or methadone.  We avoid hydrocodone if possible because it may cause confusion and doesn’t control the pain as well as other narcotics.  Over half of the patients in our hospice requiring a narcotic are now using methadone with good success.

Remember that just because a drug didn’t help one person, doesn’t mean it won’t work for someone else. By using drugs and other therapies, we can keep over 95% of patients comfortable.

So if he is hurting, call the hospice nurse.  And, ask what to do if a crisis occurs, so you can be better prepared – which should help you and your grandfather be more comfortable.