ESSENCE offers four broad types

ESSENCE offers four broad types, or levels, of care as defined by the Medicare hospice benefit:

Routine home care - This is how we provide hospice care most often: in patients’ homes, long-term care facilities and nursing homes.

Respite care - Limited to up to five consecutive days, respite care provides a brief “respite” for the patient’s primary caregiver by admitting the home care patient to an institutional setting without meeting the “inpatient” pain and symptom management criteria.

General Inpatient care - If a patient’s needs cannot be managed at home ESSENCE has special arrangements at other local facilities that provide hospice care around the clock until the patient can return home.

Continuous Care - When medically necessary, acute symptom management is provided at home or in another facility by hospice staff in shifts of up to 24 hours/day so the patient can avoid hospitalization.

Hospice Referral Guide

If you or your patient/family member has experienced some of the following symptoms during the last 6 months, they may qualify for hospice care.

Weight Loss
Decreased/minimal appetite
Significant change in assistance needed with activities of daily living
Increased need for pain medication
Start or increase in oxygen usage
Increased confusion
Increase in treatments or therapies
More restless, withdrawn, isolated
Skin breakdown
Changes in ambulatory ability
Increased hospitalizations

Disease Specific Symptoms

Cardiac Disease (Heart Disease)

Increase assistance with ADL’s
CHF symptoms while on maximum medical treatment
Continued symptomatic CHF while on optimal diuretics and vasodilators
Dyspnea or chest pain at rest
Ejection fraction of 20% or less

Pulmonary Disease (Lung)

Frequent ER visits/hospitalizations
Increased oxygen dependency O2 sat <88% while on O2
Dyspnea at rest/resting tachycardia Hypercapnia (PCO2>50)
10% weight loss over the past 6 months
FEVI <30% after bronchodilator treatment

Cerebrovascular Disease (Stroke/Coma)

Bed or chair bound
Dependent for ADL’s
Poor nutrition, insufficient fluid or caloric intake to sustain life
10% weight loss over the past 6 months

Renal Disease (Kidney)

Anorexia
Abnormal liver enzymes
Ascites/edema
Creatinine clearance <10cc/min (<15cc/min for diabetics)
Elevated prothrombin time
Discontinuing/refusing dialysis

Dementia

Dependent for ADL’s
Refusal to eat, poor nutrition, insufficient
Fluid or caloric intake to sustain life/refuse artificial nutrition
Difficulty swallowing
10% weight loss over the past 6 months
Minimal vocabulary
Incontinence
Bed/chair bound or unable to ambulate without assistance
Co-morbidities (pneumonia, decubitus ulcer)

Cancer

Evidence of metastasis or end stage disease
Curative aggressive treatment has stopped
Anorexia with significant weight loss
Requiring pain/symptom management with frequent interventions

ESSENCE Provides Bereavement Support

Grief is a normal reaction to losing someone you love. Each person grieves differently and there is no timeline for how long it takes before the hurt of loss lessens. Essence Hospice understands this; we know that grieving can begin before the actual death and last longer than a few weeks or months.

ESSENCE offers consistent and continuing grief and bereavement support to families, friends and staff while a patient is under our care and for up to 13 months following a death. Even after that time, we are always available to listen and help you work through your grief.

ESSENCE grief and bereavement services include:

Home visits from bereavement specialists, chaplains and volunteers
Bereavement telephone support
Bereavement support led by ESSENCE Staff
Memorial services
Quarterly bereavement letters of support and educational materials
Community resource referrals to grief therapists, community support groups, etc.

What is Palliative Care?

Palliative care has been a board-certified medical specialty since 2006 in the US, but palliative care has been around for centuries. We’ve all had palliative medicine, also called comfort care. If you break a bone, you seek a cure: the doctor sets it and keeps it immobile in order for it to heal. But he or she prescribes painkillers to make you comfortable. The painkillers are palliative: they improve the quality of your life while you and your physician cope with your broken bone.

Generally when we talk about palliative care, it’s in the context of serious illness: chronic, progressive pulmonary disorders; renal disease; chronic heart failure; HIV/AIDS, progressive neurological conditions, cancer, etc.

An example: as you go through chemotherapy, which is prescribed to cure your cancer, your physician also addresses your nausea, depression or anxiety by prescribing a drug, directing you to a talk therapist or arranging for pet visits. If your family is stressed, a social worker or chaplain would provide support. All of these coping mechanisms are considered palliative: they improve the quality of your life while you and your physician cope with your cancer.

Curative care is meant to cure a disease. Palliative care is meant to make the patient more comfortable. To palliate is “to make a disease or its symptoms less severe or unpleasant without removing the cause.”

What is the History of Palliative Care?

Palliative care treatment grew out of the hospice movement. Today 80 percent of hospitals with 300 or more beds offer a palliative specialist or palliative team who work with the patient’s other physicians to address the physical, psychological, social or spiritual distress of serious illness and its treatment.

HOME Medical Equipment

ESSENCE puts the needs of patients and families first. We know you want to return home to the people and things you love, and we have the resources to make that happen.

ESSENCE has everything you need to make your transition from hospital to home as seamless as possible. You’ll have the confidence of knowing your home is ready with the equipment and supplies you need. You can expect equipment that has been carefully inspected, prepped and tested and that adheres to manufacturers’ guidelines.

Medical equipment for your care plan may call for, which may include:

Oxygen and delivery devices
Nebulizer
CPAP and BiPAP
High-flow therapy
Hospital bed
Pressure-relief mattress
Wheelchair and other specialty chairs
Trapeze bar and patient lift
Walker, cane, tub seat and bedside commode
Suction equipment
Feeding pump

How is Hospice covered

Hospice is covered by Medicare, Medicaid/Medi-Cal and most private insurance. Congress established the Medicare hospice benefit in 1982 to provide patients with life-limiting illnesses compassionate, coordinated care to manage the symptoms and consequences of their disease. Medicare's hospice benefit was designed to help terminally ill patients with the often-significant expenses incurred at the end of life, including prescription and over-the-counter drugs, medical equipment and supplies, hospital copayments and grief support for the family.

While the benefit offered a lifeline to terminally ill patients covered by Medicare (later extended to Medicaid/Medi-Cal and to most private insurance plans), it enacted a number of requirements that providers must meet in order to be certified as hospices by Medicare and qualify for payment from Medicare. These include the mandate to provide or manage all services needed to manage the terminal illness.

Other features of the Medicare hospice benefit include a limit on the proportion of days of care a hospice can provide in an inpatient setting rather than the patient’s home; a global cap on total average payment per patient; and a requirement that dedicated and trained volunteers must contribute at least 5 percent of the hospice provider’s services.

Medicare Hospice Criteria

To qualify for Medicare hospice coverage, a patient must:

Be eligible for Medicare Part A

Consent to hospice care and agree that he/she wishes to receive “palliative, not curative care”

Be certified by his/her physician and the hospice medical director as having a “medical prognosis that his/her life expectancy is six months or less if the illness runs its normal course”

Continue to have a six-months-or-less prognosis, although some individual patients may receive hospice services for longer than six months as long as they continue to have a limited life expectancy throughout that time.

How Much Does Hospice Cost?

Hospices are paid a daily per-diem rate for their services in one of four levels of care:

Routine home care
Continuous care
Inpatient care
Respite care

Out of this basic per-diem rate, the hospice is responsible for the following:

All prescription drugs
Over-the-counter medications
Medical equipment and supplies
Labs and other tests related to comfort and management of the terminal illness, as designated by the hospice team.

In addition, patients receive regular visits from nurses, hospice aides, chaplains, social workers, rehabilitation therapists, counselors, volunteers and physician services, as needed. Organized bereavement services are provided to surviving loved ones for at least one year after the patient’s death, again at no cost to the patient's family.

Equal Opportunity Employer

Essence Hospice is an Equal Opportunity Employer and Prohibits Discrimination and Harassment of Any Kind: Essence Hospice is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions at Essence Hospice are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. Essence Hospice will not tolerate discrimination or harassment based on any of these characteristics.” we don’t just accept difference, we celebrate it, we support it, and we thrive on it for the benefit of our employees, our patients, and our community.

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