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What Are the Rules and Regulations for Hospice Care in California?

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California Laws for Receiving and Providing Hospice Care
By AtHome Healthcare Team

As human beings, we all depend on our loved ones to be there for us in times of happiness and pain. Our friends, family, and significant others give us the emotional support we need to live our lives with a positive attitude. Knowing that someone you love is terminally ill can be extremely hard for the patient and you. Often, the emotional distress causes the patient’s life to shorten further.

Terminally ill patients may experience devastating symptoms, physical pain, and depression. However, proper medical care can help manage the pain and symptoms.

Hospice care is a special kind of medical treatment designed to improve the quality of life of a terminally ill patient. The purpose of hospice care is not to treat; rather, it is to maintain the patient’s condition to feel as normal as possible during their last days.

Receiving hospice care allows the patient a chance to cherish the last moments of their life. Moreover, the psychological counseling that comes with the treatment helps the patient and their family mentally prepare for death. As a result, the trauma and distress are reduced, and the patient gets to spend their final moments in peace.

What is the Difference Between Palliative Care and Hospice Care?

The condition of a patient’s disease will determine whether they need to be put in hospice care or palliative care. Both healthcare treatments aim to help the patient live as normally as possible; however, the primary purpose and duration are different. The main differences between palliative care and hospice care include:

  • Hospice care is a special medical treatment aimed to improve or maintain the quality of life of a terminally ill patient. Only a licensed healthcare professional can legally determine and conclude whether a patient is terminally ill or not.

On the other hand, palliative care is a medical treatment aimed at treating a patient suffering from a life-threatening disease.

  • Hospice care is only provided when a terminally ill patient’s life expectancy is six months or lower. Usually, it is challenging to determine this.

On the contrary, you can continue palliative care as long as the treatment is required. The duration for palliative care could be a few months to several years. For palliative care to continue, a doctor needs to prove its progress. If the doctor cannot see any chance of the patient recovering, the patient may be shifted to hospice care.

  • The medication used in hospice care treatment aims to manage the patient’s pain, symptoms, and emotional health.

Whereas palliative care treatment includes medication aimed to manage the patient’s pain, symptoms, and emotional health, along with providing a cure for the disease.

  • Medi-Cal will continue to pay for a patient’s palliative care expenses as long as the doctor can prove that the patient will recover in time. On the other hand, Medi-Cal stops providing financial help if the patient outlives the six months. To continue receiving Medi-Cal, the terminally ill patient needs to be reexamined and reapply for it.
  • Hospice care providers can train the family members of the terminally ill patient to act as caregivers when professional help is unavailable. On the other hand, licensed healthcare professionals can only provide palliative care.
  • Palliative care boosts the patient’s morale and attitude for recovery. In contrast, hospice care helps the patient prepare for their imminent death.

How Does Hospice Care Work in California?

California is ranked to have some of the best healthcare facilities in all over America. According to statistics, California spends 33% of its 200 billion USD budget on improving the quality and accessibility of healthcare facilities.

The USA has almost 5500 hospices; however, only 38% of Americans receive hospice care in America. The low percentage is due to lack of information, inaccessibility, and Medicare regulations.

 California alone has over 1200 hospice providers that have been certified by Medicare after qualifying a specific criterion. These hospice providers must care for a terminally ill patient either at a hospice center, a skilled nursing facility, a nursing home, or at the patient’s residence. However, to request a hospice provider for a home visit, the patient needs to be medically certified for being homebound.

Like everywhere else in the world, a California citizen needs to be attested by a licensed doctor for being terminally ill to receive hospice care. Moreover, the patient’s life expectancy should not be more than six months. If the can doctor finds the patient treatable, they are put in palliative care instead. 

California has its own Medicaid healthcare program called Medi-Cal. Medi-Cal offers financial support to low-income households in California who otherwise would not afford the appropriate healthcare treatment. Regardless of age, gender, race, and disability, a financially unstable California resident can apply for Medi-Cal.

A healthcare professional must be enrolled as a licensed Medi-Cal hospice health provider to provide hospice care. The care period for receiving hospice under Medi-Cal includes two 90-day periods, almost equal to six months. If the patient survives the six months, they can be provided hospice care for an additional 60 days. However, the doctor needs to reanalyze and prove the patient’s terminally ill status again for this two-month extension.

Recent Rules and Regulations

Over the years, California has been actively trying to improve the accessibility and quality of hospice care under Medi-Cal. However, doing so has been an enormous challenge due to the excessive number of hospices being run by for-profit private organizations. The goal of these private establishments is not to maximize the quality and reach of hospice care but rather to generate profits.

Moreover, almost 80% of California’s hospices are not regulated by the state. Instead, private agencies are involved in investigating the quality and procedures. Many poorly operating hospices use less-than-legal methods to qualify the necessary investigations. As a result, hospice care standards are not maintained, and many patients are cheated out of their Medi-Cal compensations.

The recent regulations have been approved to ensure that the state’s funds and efforts to improve hospice care do not get wasted. California Gov. Gavin Newsom has approved two-part legislation to improve the hospice conditions and prevent fraud. 

The first part of the legislation puts a moratorium on new hospice provider licenses being issued. This means that a stricter criterion will be set to qualify for the hospice provider license. Moreover, according to this law, new hospice-providing licenses will only be issued in areas where an increased need for hospice care can be proven.

The second part of the legislation limits the authority and control of private auditing agencies to involve state regulations. As a result, hospices will have to maintain the state’s standards to continue operations.

Which Criteria Must Be Met for a Patient to be Eligible for Hospice Care?

Hospice care is designed to manage the pain and symptoms of the patient. Moreover, it also includes counseling and psychological therapy for the patient and their loved ones to reduce emotional distress and depression.

Medicare and Medi-Cal provide financial assistance to financially weak patients requiring hospice care. The patient could be of any age, race, occupation, or gender to receive the medical air for hospice care treatment. However, to ensure that the authorities are not deceived and that the state’s money is used for the right reasons, a patient must prove their need for hospice care.

To receive hospice care, the patient has to:

  • Be suffering from the final stage, a life-limiting disease. For instance, if an individual has blood cancer stage 3, they would not qualify for hospice care and instead, be put into palliative care. Similarly, a patient suffering from renal failure will not be provided hospice care if there is a chance of finding a kidney donor in time.
  • The patient’s life expectancy should be six months or fewer. To be categorized as terminally ill with less than six months to live, a licensed healthcare provider or a member of the hospice interdisciplinary team must submit the required evidence. They will have to certify the patient’s fatal condition in writing.

All documents of evidence and certifications have to be submitted to the state authorities to apply for Medi-Cal.

Moreover, if patients outlive their six-month hospice care period, their Medi-Cal assistance will be discontinued. A hospice physician will be required to reexamine and recertify the patient’s terminally ill condition. Once the Medi-Cal services are recontinued, the state will require the hospice physician to perform examinations every 60 days.

What Are the Four Levels of Hospice Care?

Fighting a life-limiting disease in its final stage takes up every last bit of the patient’s energy. The body starts accepting defeat and slowly begins to give up. Mobility is significantly affected, and the person’s mental health keeps deteriorating.

Watching a loved one go through this is equally as painful. However, receiving hospice care can ensure that the person’s final days are not spent writhing in pain. Instead, it allows the patient and their family to accept reality and mentally prepare for their final goodbyes.

Medi-Cal helps shoulder the financial burden on the patient and their family and manages 100% of the expenses for six months. To maximize comfort and rest, Medi-Cal examines the patient’s condition, household, and preference to select the appropriate level of hospice care. Hospice care has four different levels, and a patient can switch to another level when necessary.

Hospice Care at Home

Living at home with familiar faces and surroundings can help lower anxiety, depression, and mental distress. Patients living in the monotonous settings tend to become extremely lonely and depressed. Nothing could be better than at-home hospice care for a patient who has a few months to live.

It allows them a chance to experience love, affection, and familial support, something that a hospital setting could not offer. However, Medi-Cal will only approve of providing hospice care at a patient’s home when a licensed hospice physician can attest to the patient’s homebound condition. For instance, if the patient is bedridden and lives from a hospice center, Medi-Cal approved them for at-home hospice care. 

One has the option to request a hospice provider to make daily visits at a time that suits both the patient and the provider. However, in emergencies, the hospice provider must reschedule other responsibilities and make the patient’s visit their priority.

Moreover, the hospice care providers could help the patient take their pain and depression medication and maintain a necessary diet. They are also required to assist with tasks like walking, going to the bathroom, bathing, etc. 

Continuous Hospice Care

At times, the severity of a patient’s terminal disease requires more intensive care and around-the-clock management. Without intensive efforts, the risk of a patient collapsing or dying earlier increases.

Medi-Cal puts the patient in continuous hospice in such situations, also referred to as crisis care. The hospice providers are not allowed to leave the patient’s side and monitor the patient’s vitals. Continuous hospice care plays a huge role for patients who do not have family available all the time. Moreover, it also helps shoulder some of the family’s responsibility. It allows them the freedom to focus on their everyday occupations.

Inpatient Hospice Care

A patient is admitted to a hospital, a skilled nursing facility, a healthcare home, or a private hospice center when they do not have a home or sufficient family to care for them. This also happens when providing hospice at their home is more inconvenient and costly.

Respite Hospice Care

The ideal place for patients to spend their final days is their home. However, sometimes, family members struggle with being available due to their occupational responsibilities. In such circumstances, a patient could opt for respite hospice care allows the inpatient hospice centers to accept the patients for a temporary stay.

What Are the Limitations of Hospice Care?

  • It cannot be continued beyond a standard period of six months. If a patient outlives this period, they have to reapply to continue receiving Med-Cal.
  • When a patient is put in hospice care, treatment medication to cure the patient is discontinued. As a result, any chance of hope or recovery is eliminated.

Final Thoughts

Just like a newborn infant, a dying person needs extra attention, love, and care. Facing death is never easy for a patient or their family; however, the process could be made less painful with the help of hospice care.

Hospice care helps manage the patient’s pain and symptoms, so they feel as normal as possible. Moreover, psychological counseling helps the family and the patient accept reality and mentally prepare for their final goodbyes.


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