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DNRs, Advance Directives, Living Wills
Electing What is Hospice & Revoking Hospice Care
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What Is Hospice?

Hospice is a type of Palliative Care which is specialized for those facing life-limiting illnesses.  Hospice provides supportive services to patients and their loved ones by addressing the patient’s physical, emotional, social, and spiritual needs; as well as assisting loved ones through care challenges. Hospice care takes place in the patient’s home or wherever they call home. Hospice is not a place, but rather a concept and insurance benefit. Hospice care concentrates on promotion of quality of life by managing symptoms so that the patient may live as comfortable as possible and make the most of the time that remains.  A team of hospice experts works to manage symptoms and provide comfort when a cure is no longer possible.

What is Palliative Care?

Palliative care is a healthcare approach that improves the quality of life of patients and their families facing the problem associated with chronic illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

What are the differences between Hospice and Palliative Care?

All hospices provide palliative care, but not all palliative care is hospice care.  Simply put, Hospice care is reserved for those with life-limiting prognosis of less than months (as determined by a patient’s physician and hospice physician). Palliative care can be provided at any stage of chronic illness.

Who pays for Hospice?

Hospice is a covered stand-alone benefit by most private insurance plans, including Medicare Part A and Medicaid, with few out-of-pocket costs to the patient.  The Medicare hospice benefit covers costs related to the patient’s illness, including the services of the hospice team, medication, medical equipment and supplies.

Who pays for palliative care?

Depending on insurance and situation, palliative care may be covered though Medicaid, Medicare, or private insurance plans. There currently is no stand-alone benefit for palliative care which means not all services that fall under palliative care are reimbursed under public and private insurance programs.

What are Advance Directives?

Some of the best tools that ensure you get the care you desired are in the form of documents called “Advance Directives.”  Making choices surrounding healthcare circumstances can be uncomfortable for all those involved. Complicating the difficulty are situations where loved ones are faced with making difficult healthcare decisions without knowing the wishes of those affected.  Fortunately there are ways to communicate your end-of-life wishes to those who are likely to make healthcare decisions for you.  Advance Directives inform your family, loved ones, doctors, hospital, and any other health professional about the types of treatments you desire and those you do not.  Many seek the assistance of an attorney for creating advance directives, however it is not required.

Advance Directives are written statements of your wishes, preferences, goals and values regarding health care decisions and are only used if you are seriously ill and unable to speak for yourself. There are typically two pieces of an Advance Directive:

  • Durable Power of Attorney for Health Care
  • Living will

Durable Power of Attorney for Health Care names the person you want to make treatment decisions on your behalf if you’re unable to make these decisions for yourself. This person is commonly referred to as a “surrogate” or “proxy.”  You can name a family member, close friend, an attorney or anyone who agrees to assist in making health care decisions for you, if you are unable.  Some people name more than one person.  Whomever you choose, you’ll want to know that your surrogate is willing and able to carry out your wishes.

What is a surrogate or health care agent?

A surrogate (or, health care agent or health care proxy) is a person you choose to make healthcare decisions for you, when you are unable to do so yourself.

When choosing a surrogate you should consider someone who:

  • Knows you well
  • Will remain calm in a crisis
  • Is not afraid to ask questions and advocate for you to your medical team
  • Can reassure and communicate with your loved ones
  • Understands how you would make the decisions if you were not able to

Living Will is a separate document that outlines for your surrogate, doctor, hospital, and other healthcare professionals what types of medical treatment you agree to and treatment you wouldn’t want.  In this document, you may be as specific as you like in your instructions.  Your surrogate and doctors will rely on your Living Will for guidance only when you are no longer able to make or communicate healthcare decisions for yourself.  The living will can be tailored to meet your individual wishes. In some states, The “Five Wishes” document is used to communicate your wishes and does not require notarization, but your signature must be accompanied by two witness signatures

When the documentation is complete, what should I do with it?

You must include your signature on all documentation, and your signature must be either notarized or witnessed. You should retain the original version of the completed and signed documentation in a safe, accessible location within your home. Copies should be made for each of your health care decision makers and your health care institution (for their electronic medical record). It is not recommended to keep the only version of the document in a safety deposit box at the bank. This information should be readily available for review when the need arises.

If any of the following situations occur, your document should be updated:

  • When there is a divorce
  • When a family-related death has occurred
  • When chronically ill, or there is a change in your health status
  • During every decade of life

What is a POLST?

A physician order for life-sustaining treatment (POLST) is a medical order that guides the actions of emergency personnel. It is a medical order that gives patients more control in their end-of-life care. A POLST must be signed by a doctor or other medical professional after having a conversation about end-of-life care with the patient.

Videos from Goals of Care on completing the POLST Form.

Tips in preparing an Advance Directive:

  • Talk to your relatives, friends, and healthcare providers and give them copies of your advance directive. 
  • Keep a copy in an easy-to-find place.  Give copies to your doctor, hospital, and family. Some people have cards they place in their wallets that alerts medical professionals that you have advance directives.
  • Review and revise your advance directive as needed.

Having advance care planning discussion is one of the greatest gifts you can share with your loved ones. If you have questions, please contact us at 732-877-1100 or email us at [email protected].

Where do I find information?

New Jersey

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