At Rainbow Hospice Care, our goal is to help make the end-of-life journey a more positive and meaningful experience. To achieve that goal, Rainbow Hospice offers a full spectrum of support services for both patients and their loved ones—all with an emphasis on quality of life. 

Rainbow Hospice Care services are provided through an integrated team approach. Physicians, nurses, and health aides, pharmacists, dietitians and other specialists focus on the patient’s physical and medical needs—managing pain and other difficult symptoms. Others such as social workers, bereavement counselors and chaplains offer emotional and spiritual support to both the patient and his or her loved ones. Trained volunteers provide additional support in a variety of ways. Everyone works together to provide support tailored to each individual’s unique needs and wishes by:

• developing and implementing a plan of care tailored to each individual’s unique needs and wishes
• managing pain and other difficult symptoms that may be present
• arranging for home-care equipment and medications related to the terminal illness
• helping to sort out and communicate the many feelings that arise during this intense human experience
• spending time with a patient, running errands, providing transportation or child care, and doing other tasks that help lessen the burden
• providing respite to caregivers burdened by multiple commitments at home or who simply need some time for themselves
• responding to emergency situations
• offering grief support to help those affected by loss of a loved one

Because most people receiving hospice care prefer to receive care in familiar surroundings, most hospice patients are tended to by family, close friends or other caregivers at home, which may include nursing homes, assisted living facilities or other residential settings. For those who are unable to receive in-home care, other arrangements are made depending on the specific circumstances. Rainbow Hospice works closely with Fort Atkinson Memorial and Watertown Area Health Services, many area nursing homes, and will soon open its own freestanding Rainbow Hospice Care Inpatient Facility in Johnson Creek. 

Who is eligible to receive hospice care services? 

Many physicians find it difficult to accurately predict survival in patients with advanced illness and often overestimate a patient's life expectancy at the time of hospice referral.  As a consequence, many patients are never informed about hospice and others are referred weeks or months after their clinical status makes them eligible.  The solution to this problem is for primary care doctors to view their hospice provider as an "end-of-life specialist" and seek out their advice much like they would consult with the oncologist for cancer diagnosis and treatment.

When it comes to prognosticating about end-of-life, it's better to be wrong than sorry.  In other words, if your intuition tells you that a patient probably won't be alive six months from now and you're seeing evidence of physical (and sometimes also cognitive) decline, then that's the time to write an order to "evaluate for hospice appropriateness".  Acting as your end-of-life specialist, Rainbow Hospice will conduct a medical chart review (and often an in-person assessment) to compare the patient's clinical status against Medicare's hospice eligibility criteria.  This consultation will establish whether or not the patient is terminal, and, if so, what his/her hospice diagnosis should be.

General Eligibility Criteria

The following are the general eligibility criteria for hospice care:

• Patient has six months or less to live if the illness runs its normal course.
• The Attending Physician and Hospice Medical Director must certify the terminal prognosis.
• The patient/family must want palliative care vs. aggressive treatment for the terminal diagnosis. 
• An Attending Physician must be identified to coordinate the care of the patient.
• The patient must reside in the hospice program's licensed service area.

Diagnosis Specific Eligiblity Criteria (Local Coverage Determinations)

Medicare has some very specific eligibility criteria for each of the diagnoses that we deal with in hospice care.  For your viewing and printing convenience, these criteria have been converted to PDF files and are available below:  

General Guidelines for All Diagnoses

Amyotrophic Lateral Sclerosis (ALS)

Debility and Decline

Dementia Due to Alzheimer's Disease and Related Disorders

Heart Disease

HIV Disease

Renal Disease

Liver Disease

Pulmonary Disease

Stroke and Coma

Please note that patients are eligible for hospice if they meet some of the above criteria but also have significant co-morbidities or rapid decline suggesting a six-month or less prognosis.  In addition, patients may still be eligible for hospice even if they do not meet any of the above conditions, provided that life expectancy is six months or less in the judgement of the physician and based on documented data.

Who pays for hospice services?

Financial concerns can be a major burden for many patients and families facing a terminal illness.  The good news is that hospice care is covered under Medicare, Medicaid, and most private insurance plans.  Patients can also receive hospice care regardless of their ability to pay. The Medicare Hospice Benefit, enacted by Congress in 1982, is the dominant source of payment for hospice care. The percentage of hospice patients covered by the Medicare Hospice Benefit vs. other payment sources was 83.6% in 2007.

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, Physical Therapy/Occupational Therapy/Speech Therapy, 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.  If you are enrolled in Medicare prescription drug coverage, however, drugs unrelated to your illness would still be covered.
• 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.

Who qualifies for coverage under the Medicare Hospice Benefit?

You can get Medicare hospice benefits when you meet all of the following conditions:

• You are eligible for Medicare Part A (hospital insurance), and
• Your doctor and the hospice medical director certify that you are terminally ill and have six months or less to live if your illness runs its normal course, and
• You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness,* and
• You get care from a Medicare-approved hospice program.

*Medicare will still pay for covered benefits for any health problems that aren't related to your terminal illness.

For additional information about our services, please feel free to contact us by calling (920) 674-6255 any time.