Advanced illnesses create new needs for patients and place new demands on families. People with advanced illnesses may have special skilled nursing or skilled therapy needs, or may need help to manage uncomfortable symptoms. They may prefer to receive care at home, and families may need assistance with care giving and counseling responsibilities to help them cope with advanced illnesses .

Medicare offers two benefit options that can help cover these needs. The Medicare Home Health Benefit can be combined with other Medicare hospital and medical benefits to meet the needs of any advanced illness. The Medicare Hospice Benefit will organize a team to help people who are terminally ill live as comfortably and as well as possible for the duration of their lives. Patients can get these benefits whether they are in traditional Medicare or a Medicare HMO.

Home Health Care 

Home health care is care provided at home for homebound patients who need skilled nursing or skilled therapy. Whether the illness is acute, chronic or advanced, a home health agency can:

·	Deliver skilled nursing, skilled therapy, and home health aide services in the patient's home and supplement the care giving of the family.
·	Provide practical guidance on planning for the illness, and counseling to the patient and family
·	Provide rehabilitative, maintenance or palliative care in the home.

Home health care provides the services necessary to care for patients with many different kinds of illnesses.

Hospice 

Hospice (pronounced HOS-pis) is a unique kind of service provided to people with advanced illness and limited life expectancies. When the treatment goals have changed from cure to care, a hospice can:

·	Manage the patient's pain and other symptoms so that the patient and family can make the most of the time that remains.
·	Deliver palliative care in the patient's home, or in a homelike setting, and supplement the care giving of the family.
·	Provide practical, emotional and spiritual support to both the patient and the family.

Hospice neither shortens nor prolongs life. Instead, it concentrates on improving the quality of life as much as possible.

Eligibility  

Home Health Care

Under Medicare, home health patients must:

	Have Medicare Part A or B.
	Be homebound. Leaving home must require a considerable and taxing effort.
	Require skilled nursing or skilled therapy services on an intermittent or part-time basis. Home health aide services will not be covered without an accompanying skilled need.

You need not have been hospitalized to qualify. You can be eligible whether your condition is acute, chronic or terminal.

Hospice

Under Medicare, hospice patients must:

	Have Medicare Part A.
	Be certified by an attending physician and the hospice medical director to have an advanced illness with a life expectancy of six months or less.
	Consent in writing to choose palliative rather than curative care. You need not be in a severely deteriorated physical condition or in a medical crisis to qualify.

Home Health Coverage

If you qualify, you may receive up to a total of 35 hours per week of skilled nursing and home health aide services. You may receive additional hours of skilled therapy and medical social services. The amount of care allowed in the plan of care depends upon your health status. Go to above section to read full details.

Hospice Coverage 

The hospice benefit provides four levels of care: I) routine home care; 2) continuous home nursing care; 3) respite care; and 4) general inpatient care. Covered services include: (go to link)

To Obtain Home Care 

·	You must be certified by your doctor to meet the requirements for eligibility. Your doctor should specify the skilled services, frequency and duration of care needed.
·	Your doctor's referral or letter of certification must be sent to a Medicare-Certified Home Health Agency (CHHA). The CHHA will send a nurse to evaluate you for a plan of care.

WHAT CAN YOU DO IF YOU ARE DISATISFIED OR DENIED CARE?
The procedures for grievances and appeals in home health agencies and hospice agencies are included in the papers given to patients by agency nurses during the initial evaluation.
1.	You should discuss complaints and requests for further services with the nurse administering the care plan.
2.	You should complain to the program administrator (or, in hospice, the supervising physician) of the agency. Also, your doctor may be able to help you work with the CHHA to obtain care. Ask your doctor to communicate with the CHHA about necessary changes to your plan of care.
3.	You may contact the State Department of Health, or the federal government at 1800-HHS-TIPS, with complaints. You may also try changing agencies until you find one that delivers satisfactory care. You may change CHHAs at any time, and hospices once every benefit period.

To Elect Hospice 

Medicare HMOs
Managing Pain 

Costs of Care 

Resources for Caregivers