What is your ownership structure?

Rainbow is one of only 8 independent and non-profit hospice programs in the state of Wisconsin.  By comparison, 41 are hospital-owned non-profits, 6 are independent for-profits, 4 are nursing home-owned non-profits, 3 are nursing home-owned for-profits and 3 are government-owned non-profits.  It is our firm belief that independent and non-profit hospice programs tend to provide better care and service because they aren't in business to make money and do not own any facilities or employ any physicians that are required to refer to them.  In other words, independent and non-profit programs tend to do business "the old-fashioned way" - they have to earn it.

What is your patient to nurse staffing ratio? 

Rainbow's standard is to maintain a patient to nurse staffing ratio of approximately 5.5 to 1.  It is our belief that smaller case loads allow hospice nurses to see their patients more frequently and spend more time during each visit.  As a consequence, these nurses are better positioned to respond to and anticipate patient needs thereby preventing many crises.

What is your service area?

Rainbow's service area includes Jefferson county and the surrounding counties of Dane, Dodge, Rock, Walworth and Waukesha.  

Does hospice care hasten death?

No.  In fact, a 2007 study published in the Journal of Pain and Symptom Management reported that hospice care may prolong the lives of some terminally ill patients.  Among the patient populations studied, the mean survival was 29 days longer for hospice patients than for non-hospice patients.  In other words, patients who chose hospice care lived an average of one month longer than similar patients who did not choose hospice care.  Researchers selected 4,493 terminally ill patients with either congestive heart failure (CHF) or cancer of the breast, colon, lung, pancreas or prostate.  They then anlayzed the difference in survival periods between those who received hospice care and those who did not.  Longer lengths of survival were found in four of the six disease categories studied.  The largest difference in survival between the hospice and non-hospice cohorts was observed in CHF patients where mean survival period increased 81 days.  The mean survival period also was significantly longer for hospice patients with lung cancer (39 days) and pancreatic cancer (21 days), while marginally significant for colon cancer (33 days).

Does hospice save money?

Yes.  In 2007, findings of a major new study published in Social Science & Medicine demonstrated that hospice services save money for Medicare and bring quality care to patients with life-limiting illness and their families.  6 researchers at Duke University found that hospice reduced Medicare costs by an average of $2,309 per hospice patient.  Additionally, Medicare costs would be reduced for seven out of 10 hospice recipients if hospice had been used for a longer period of time the study found.  For cancer patients, hospice used decreased Medicare costs up until 233 days of care.  For non-cancer patients, there were cost savings seen up until 154 days of care.  While hospice use beyond these periods cost Medicare more than conventional care, the report's authors wrote that "More effort should be put into increasing short stays as opposed to focusing on shortening long ones.".

What's covered by the Medicare Hospice Benefit?

Medicare pays for the following services at 100% when directly related to the palliative care of the terminal illness:

• Services of the hospice patient care team (Medical Director, Nurse, Hospice Aide, PT/OT/ST, Social Worker, Dietary Counseling, Chaplain, Volunteer).
• Medications for symptom control and pain relief.
• Medical equipment (e.g., wheelchairs and walkers).
• Medical supplies (e.g., bandages and catheters).
• Palliative therapies (e.g., chemotherapy, radiation therapy, blood transfusions).
• 13 months of bereavement support.

What isn't covered by the Medicare Hospice Benefit?

• Treatment intended to cure your terminal illness.
• Prescription drugs to cure your illness rather than for symptom control or pain relief.
• Care from any provider that wasn't set up by the hospice medical team.
• Room and board.
• Care in an emergency room, unless it's arranged by your hospice medical team.
• Care in an inpatient facility, unless it's arranged by your hospice medical team.
• Ambulance transportation, unless it's arranged by your hospice medical team. 

What is "Continuous Care"?

Continuous care may be provided when the patient is experiencing a medical crisis and requires predominantly nursing services to achieve palliation and symptom control.  In these situations, the hospice must provide a minimum of 8 hours of care within a 24-hour period (beginning and ending at midnight) until the problem is resolved.  Hospice Aide services may supplement the nursing care during the period of crisis but at least 50% of the care must be provided by an RN or LPN.  This level of care requires a physician order.  Typical triggers include uncontrolled pain, nausea, vomiting, diarrhea, respiratory distress, bleeding and agitation. 

Continuous care is provided exclusively by the hospice team in the patient's home, an assisted living or skilled nursing facility. 

What is the value of hospice in nursing homes? 

A study conducted by the Department of Health and Human Services entitled "Synthesis and Analysis of Medicare's Hospice Benefit" found that residents in nursing facilities receiving hospice care, as compared to residents in nursing facilities not receiving it:

• received superior pain assessments, and when daily pain was assessed, were far more likely to be treated
• were significantly less likely to be hospitalized
• were less likely to experience a persistent mood disorder
• received far fewer invasive procedures, such as physical restraints, nasogastric or intravenous feedings, and intravenous and intramuscular medications
• experienced less dyspnea or shortness of breath

How long do most patients receive hospice care?

The average length of stay for an American hospice patient is only 67.4 days and the median length of stay 20 days.  Considering that the Medicare Hospice Benefit pays for hospice services at 100% and that coverage remains in effect for as long as the patient continues to meet eligibility criteria (i.e., a prognosis of 6 months or less), a median length of stay of 20 days simply means that most hospice patients are not fully benefiting from the service.  It also means that many clinically trained referral sources (doctors, hospitals, nursing homes) are much better at identifying people who are obviously close to death than identifying patients transitioning from chronic to terminal illness around the six month eligibility window.

Where do most hospice patients receive care?

The majority of hospice care is provided in the place the patient calls "home".  According to the National Hospice & Palliative Care Organization (NHPCO), home means the patient's private residence (42%), a nursing home (22.8%) or an assisted living facility of some kind (5.5%).  By contrast, 19.2% of hospice care nationwide is provided in a hospice inpatient facility while 10.5% is provided in an acute care hospital.

Does hospice deal with any diagnoses other than cancer?

Yes.  When the U.S. hospice community was established in the 1970's, cancer patients made up the largest percentage of hospice admissions.  Today, cancer diagnoses account for less than half of all hospice admissions (41.3%).  In fact, less than 25% of U.S. deaths are now caused by cancer, with the majority of deaths due to eventually terminal chronic diseases.  In 2007, the top 5 chronic illnesses served by hospice included heart disease (11.8% of admissions), debility unspecified (11.2%), dementia (10.1%) and lung disease (7.9%).

Should I wait for our doctor to raise the possibility of hospice or should I raise it first?

The patient and family should feel free to discuss hospice care at any time with their physician, other healthcare professionals, clergy or friends.  While it's true that two doctors (the patient's attending physician and the hospice medical director) must certify the terminal prognosis, anyone can make a referral to hospice.

Aren't all hospice programs the same?

No.  While it's true that all hospices operating in a given community are paid the same by Medicare and Medicaid, the quantity and quality of their services can vary significantly.  To find the best hospice for your needs, ask your doctor, healthcare professionals, clergy, social workers or friends who have received care for a family member.  You may also want to call or meet with the hospice programs and ask questions about their services.

Can a hospice patient who shows signs of recovery be returned to regular medical treatment?

Yes.  If the patient's condition improves and the disease seems to be in remission, he/she can be discharged from hospice and return to aggressive therapy or go on about his/her daily life.  If the discharged patient should later need to return to hospice care, Medicare and most private insurance will allow additional coverage for this purpose.

If the patient isn't covered by Medicare or any other health insurance, will Rainbow still provide care?

Yes.  The first thing Rainbow will do is assist families in finding out whether the patient is eligible for any coverage they may not be aware of.  Barring this, Rainbow will care for anyone who cannot pay using money raised from the community or from memorial or foundation gifts.

Do state and federal reviewers inspect and evaluate hospices?

Yes.  There are state licensure requirements that must be met by hospice programs in order for them to deliver care.  In addition, hospices must comply with federal regulations in order to be approved for reimbursement under Medicare.  Hospices must periodically undergo inspection to ensure they're meeting regulatory standards in order to maintain their licensure to operate and the certification that permits Medicare reimbursement.

How can I be sure that quality hospice care is provided?

Unlike home health care programs (via Home Health Compare at www.medicare.gov/hhcompare/) and skilled nursing facilities (via Nursing Home Compare at www.medicare.gov/nhcompare/), Medicare doesn't currently have a tool that enables end-consumers to objectively compare the quality of care being delivered by hospice organizations.  In 2004, however, the National Hospice & Palliative Care Organization (NHPCO) developed the Family Evaluation of Hospice Care (FEHC) tool, a 61-item post-death survey that asks questions about families' perception of the care provided to the patient, as well as their own hospice experience.  The survey assesses multiple areas of delivery of quality care including: 1) patient comfort and emotional support, 2) coordination of care, 3) shared decision making, 4) provision of information, 5) respect for the patient, and 6) provision of emotional support to the family.  Participating hospices administer the survey once per quarter and then submit their data to the NHPCO where the results are tabulated.  NHPCO member organizations then receive a detailed report that compares their individual program results to state and national outcomes.  The FEHC survey is valuable because it provides useful, meaningful and actionable data, thereby furnishing hospices with a valid means of ensuring quality of care.

Rainbow Hospice Care is an NHPCO member and participates in the above process.  Copies of our survey results are available upon request.