FAQ's Top

When is it time to call Hospice of Dubuque?

What is the process for admission into the hospice program?

Does Hospice of Dubuque admit patients who have non-cancer diagnoses?

Who pays for hospice care?

If I have secondary coverage under Medicare or Medicaid, can  I access care from Hospice of
Dubuque even if my primary health insurance does not have a hospice benefit and/or does not recognize Hospice of Dubuque as a participating provider?

Can hospice help with the cost of needed medical supplies?

How is hospice care different from the care provided by a home care agency?

Why would hospice care be needed if the patient resides in a nursing home?

Can I receive hospice services in an assisted living facility?

What is the difference between a living will, durable power of attorney and "DNR" or "Do Not Resuscitate"?

Is it possible to discontinue hospice care if I no longer desire services?

What happens if I decide to leave the Hospice of Dubuque service area?

What happens if my condition improves and I no longer have a limited prognosis?

If aggressive treatment is desired, how would hospice care be affected?

What is the difference between a for-profit hospice and a not-for-profit hospice?

When is it time to call Hospice of Dubuque?
At any time during a life-limiting illness, it is appropriate to discuss all of a patient's care options, including hospice. Hospice of Dubuque encourages patients to be admitted into the program early in the course of their terminal illness. When a patient receives a limited life expectancy from their physician, or when a decision is made by the patient and family to pursue comfort care only, it may be time to ask if hospice care is appropriate. Early admission into the hospice program is beneficial to both the patient and their family. Some health changes that are easily recognized:

• Visible unintentional weight loss
• Eating only a few bites of food at each meal or eating well at breakfast and poorly at dinner and supper
• Short of breath when trying to talk or just sitting still
• Swelling of feet and legs which is not relieved with fluid pills
• Needing a lot of help with daily tasks such as dressing, bathing and eating
• Changing from using a walker to using a wheelchair
• Infections that come back over and over such as infections of the lungs and bladder
• Frequent trips to the hospital
• Calling the doctor’s office often between regularly scheduled visits
• Unable to go without oxygen for more than a few moments
• Pain that is not relieved even when using the pain medication as often as allowed
• Deciding to stop medical treatment for a condition, but wanting to stay comfortable Top

What is the process for admission into the hospice program?
Prior to admission, an informational visit is scheduled with the patient and any interested individuals so they can be well informed about the services provided by Hospice of Dubuque. If the patient and those involved with their care desire time to think about this decision, an admission to the program can be delayed. If an admission is desired, a mutually agreeable time is established for a nurse and social worker to make a joint visit to accomplish the admission.

Hospice of Dubuque Admission Criteria

• The patient is terminally ill as certified by the patient's primary care physician
• The patient and family agree they no longer desire treatment aimed at cure
• The patient and family agree with the hospice approach to care and desire hospice services
• The patient has a primary caregiver, or there is a plan for a primary caregiving system when
  determined to be needed for patient safety
• The patient resides in Hospice of Dubuque's service area, which includes Dubuque County and portions of Jackson, Jones and Delaware Counties in Iowa, portions of Jo Daviess County in Illinois and portions of Grant and Lafayette Counties in Wisconsin Top

Does Hospice of Dubuque admit patients who have non-cancer diagnoses?
Hospice is a care option for individuals with any diagnosis. The individual’s physician will determine if the disease has progressed to its end-stage. The diagnosis may be, but is not limited to, cancer,
end-stage heart, lung, kidney or liver disease, ALS, stroke, Alzheimer’s or Parkinson’s. Hospice care is also available to individuals whose condition is declining due to old age, if it appears there is a limited prognosis. Top

Who pays for hospice care?
The Medicare and Medicaid Hospice Benefit programs pay a fixed dollar amount for each day that a patient is receiving hospice services. Many private insurance plans also cover hospice care. The individual’s insurance policy will dictate benefits and co-payment requirements.

Because Hospice of Dubuque believes that hospice care should be available to all terminally ill persons, services are provided to any eligible person. If there is no insurance coverage, cost will be determined by a sliding fee schedule that complies with the Medicare requirement. Proceeds from ongoing fundraising efforts, memorials and donations make it possible to extend hospice care to all individuals. These funds are also used for the care of patients whose hospice expenses are greater than the reimbursement received and for bereavement services that are entirely funded by community support. Top

If I have secondary coverage under Medicare or Medicaid, can  I access care from Hospice of Dubuque even if my primary health insurance does not have a hospice benefit and/or does not recognize Hospice of Dubuque as a participating provider?
Yes. Primary insurance through a private health plan does not affect your entitlement to the Medicare or Medicaid Hospice Benefit. The primary insurance plan does not need to have a contract with Hospice of Dubuque, nor provide a hospice benefit as part of your plan. When Medicare or Medicaid are secondary insurers, the hospice benefit may be accessed when receiving care from Hospice of Dubuque. Top

Can hospice help with the cost of needed medical supplies?
Over-the-counter items such as incontinence pads, dressings, laxatives and nutritional supplements are generally supplied by the family. Donations of some items are made to Hospice of Dubuque and are then provided to families as available. Top

How is hospice care different from the care provided by a home care agency?
Hospice care is specialized care, provided by a staff with extensive experience in managing end-of-life issues and end-stage disease symptoms. The hospice interdisciplinary team provides expertise tailored to meet the needs of the patient and family experiencing a terminal illness. Top

Why would hospice care be needed if the patient resides in a nursing home?
Hospice care is available to residents of nursing homes. Hospice considers the nursing facility to be the patient’s home. The hospice staff provides additional expertise to the nursing home staff in the areas of symptom management and end-of-life care. Both organizations work collaboratively for the benefit of the patient and family. Nursing home nurses excel in the areas of rehabilitation and health maintenance. Hospice nurses understand the physical changes and comfort measures for the symptoms experienced at the end-of-life. However, hospice care is more than nursing care, in addition to symptom management, hospice care also provides emotional and spiritual support to both the patient and family while they deal with end-of-life challenges. Volunteers are also available to help provide respite, companionship and help to patients and their caregivers. Top

Can I receive hospice services in an assisted living facility?
Yes. Hospice of Dubuque works with all area assisted living facilities to provide residents with access to hospice care. The patient, their family, assisted living staff and hospice determine if supplemental care- giving support is needed. Top 

What is the difference between a living will, durable power of attorney and "DNR" or "Do Not Resuscitate"?
A living will is a document directing a physician to withhold or withdraw certain life-sustaining procedures if a patient is in a terminal or irreversible condition. It directs a physician to continue all care necessary for comfort. The durable power of attorney for health care is a document that allows a patient to name another person as an “agent” or “attorney-in-fact” to make health care decisions when a patient is physically or mentally unable to make these decisions. DNR means that the patient does not want chest compression, mouth to mouth resuscitation, or an ambulance called at the time of death. Death will be allowed to occur peacefully and comfortably. All efforts will focus on managing symptoms through the time of death, and not on prolonging the dying process. A living will, durable power of attorney or DNR are not necessary to receive services from Hospice of Dubuque, however the hospice social worker can make these forms available to you at no cost and assist with the completion of these documents if desired. Top

Is it possible to discontinue hospice care if I no longer desire services?
Services can be discontinued at any time by simply signing discharge forms. The hospice staff will provide these upon request. Under Medicare and Medicaid, there is no penalty for revoking the Hospice Benefit and this benefit remains available for the future. Likewise, private insurance policies also allow for discharge. Top

What happens if I decide to leave the Hospice of Dubuque service area?
If a decision is made to move to a location outside of the service area, Hospice of Dubuque will assist in the transfer of hospice care to a hospice in the new community. If travel plans outside of the service area will be short-term, temporary discharge forms will be necessary prior to departure for Medicare or Medicaid recipients.  Top

What happens if my condition improves and I no longer have a limited prognosis?
While hospice care is in place, the hospice staff will consult with the primary physician on a regular basis to ensure that continued hospice care is appropriate. If the patient’s medical condition improves and the physician, along with the hospice interdisciplinary team, believes hospice care is no longer appropriate, discharge from the program will occur.  Top

If aggressive treatment is desired, how would hospice care be affected?
Because the focus of hospice care is on comfort, not cure, hospice services would be discontinued if more aggressive treatment for disease-altering care is pursued. Top

What is the difference between a for-profit hospice and a not-for-profit hospice?
For-profit hospices exist to make a profit for the owner(s) or dividends for stockholders. Thus, decisions regarding the delivery of services are based upon goals for achieving market penetration and maximizing profitability. As a not-for-profit organization, Hospice of Dubuque exists solely to fulfill its mission of providing compassionate care for the terminally ill and their loved ones. At Hospice of Dubuque, all patient care decisions are guided by our mission. Top