Ka Tautokona e te Medicare te 24-Horo Tiaki Hospice i Roto i te Kāinga?

I te whakatau a ngā whānau i ngā mate whakamutunga, ko tētahi o ngā tino nui rawa atu ko "ka utua e te Medicare te 24 haora o te tiaki i roto i te kāinga i te wā o tēnei pōtiki?" Āe, engari anake i ngā wā tino pōtiki haumanu ka tika ai kia karangatia te taumata hospice a Medicare hei "tiaki kāinga tonu." E whā ngā wāhanga o te tiaki a te hospice a Medicare ka piki ake i te kino o te mate o te manawanui. Ko te momo tiaki kāinga tino noa ko te tiaki kāinga noa, ka piki ki te 99% o ngā rā katoa o te hospice puta noa i te motu. Tata ki te 11% o ngā manawanui hospice ka whiwhi tiaki kāinga tonu, e 8-24 haora ia rā o te tiaki nēhi i roto i te wā poto. Ka taea te whakarite te noho manawa ki roto i tētahi whare mō ngā rā e 5 tōtōtahi hei whakatā mō ngā kaiāwhina whānau. Ko te tiaki manawanui whānui he taumata teitei ake o te whakahaere tohu ka whakawhiwhia ki te hōhipera, ka kore ai te tiaki kāinga e rāwehe. I whakatūria e ngā Pokapū mō te Medicare me ngā Ratonga Medicaid (CMS) ngā paearu mō te tika me ngā whakamahinga mō ia taumata.

Kei roto i tēnei kohinga ngā momo tiaki hospice e whā e whakawhiwhia ana i raro i te Medicare, i te kāinga o tētahi tangata rānei, te wātea o te tiaki kāinga 24-hōra, ngā mōhiohio tika, me ngā mea ka taea e ngā whānau te tatari. Ngā raraunga i tukuna e Medicare.gov, CMS, me Te Rōpū Motu mō te Hospice me te Tiaki Rōwhia. 

Ngā taumata e whā o te tiaki hospice a Medicare

Ka whakahaerehia te painga hospice a Medicare mā ngā taumata tiaki e whā rerekē, ka neke ngā manawanui i waenga i ngā taumata i te wā e huri ana ngā mate. Ko te māramatanga ki ia taumata ka āwhina i ngā whānau ki te mōhio ki ngā tiaki e wātea ana, ā, āhea.

Ko te tiaki kāinga noa (RHC) te ratonga hospice tino noa, ka whakawhiwhia ki te wāhi e noho ana te manawanui. Ka taea te kāinga o te manawanui he kāinga motuhake, he whare noho tautoko, he whare nēhi mātatau, he whare tiaki wā roa rānei. Ka whakahaerehia e te kapa interdisciplinary o te hospice (taote, nēhi, kaimahi pāpori, karekare, kaimahi āwhina hospice, me ētahi atu) ngā toroanga auau i runga i te mahere tiaki, i te nuinga o te wā maha i te wiki. Kei te wātea te kapa i te 24/7 mō ngā mate ohorere, ahakoa kāore rātou e whakarato i te tiaki tūruhi tonu i ngā wā noa.

Ko te tiaki kāinga tonu (CHC) te taumata e whakarato ana i te tiaki nēhi 24-hōra i te kāinga. Ka whakawhiwhia te CHC i roto anake i ngā wā poto o te pōtiki haumanu i te wā e hiahiatia ana te tiaki nēhi kaha ki te pupuri i te manawanui ki te kāinga, me te karo i te hōhipera. Ko te taumata e hiahiatia ana ko te 8 haora te iti rawa o te tiaki tika a te manawanui i roto i te 24 haora, me te nuinga (neke atu i te 50%) he tiaki nēhi mātatau mai i ngā RN, LPN, me LVN. Ka taea e ngā kaimahi āwhina hospice me ngā ratonga kāinga te whakapiki i te tiaki nēhi.

Ko te tiaki manawa manawa ka hoahoatia hei whakatā mō ngā kaitiaki whānau, ehara mō te whakahaere pōtiki haumanu. Ka whiwhi ngā manawanui i te tiaki i roto i tētahi whare kua whakaaetia e te Medicare (te wāhanga manawa hospice, te hōhipera, me te whare nēhi) mō ngā rā e 5 tōtōtahi i ia wā. Kei roto i te tiaki manawa te noho me te kai. I te nuinga o te wā ka whakarite ngā kaitiaki i te manawa kia haere ai, kia haere ki ngā hui nui, kia whakahaere rānei i ā rātou ake mate.

Ko te tiaki manawanui whānui (GIP) ka whakatika i ngā tohu kaore e taea te whakahaere i te kāinga. Ka whiwhi ngā manawanui i te tiaki i roto i te hōhipera, te wāhanga manawa hospice, me te whare nēhi me te wātea nēhi rēhita 24-hōra. He tika te GIP mō te mamae kaore e taea te whakahaere, te nausea, te ruaki rānei e kore e taea te whakahaere, te raruraru manawa, ngā mate mamae nui e hiahiatia ana te rongoā kaha, me ngā tohu whakapapa rānei e hiahiatia ana te tautoko kaha.

Mō ngā taipitopito tiaki hospice whānui, tirohia ta mātou aratohu Medicare hospice.

A, no te wātea o te tiaki kāinga tonu (24-hōra)

Ko te tiaki kāinga tonu he momo tiaki motuhake mō ngā wā poto o te pōtiki haumanu. Ko te whāinga kia hoatu te tiaki nēhi kaha ki te whakahaere i ngā tohu whakapapa me te karo i te hōhipera, ā, kia hoki mai te manawanui ki te tiaki kāinga noa ka pahure te pōtiki.

Ko ētahi atu mea e pā ana ki te hiahia mō te tiaki kāinga tonu ko te mamae kaore e taea te whakahaere kaore e aro ki ngā tautoko hospice, te uaua nui o te manawa (pēnei i te hiakai hau, te manawa uaua rānei), te nausea, te ruaki rānei kaore e taea te whakahaere me ngā rongoā auau, ngā wahaweka e kore e taea te whakahaere (te timatanga hou, me te hunga kaore e whakahaerea me ngā rongoā auau) me te whakarereke rongoā rānei e hiahiatia ana te tino tirotiro nēhi.

Ko ngā hiahia o te manawanui me te whānau ki te noho ki tō rātou kāinga i te haere ki te hōhipera, ki tētahi whare hospice manawa rānei. Me waiho te tiaki nēhi hei rongoā matua mō te CHC (neke atu i te 50% te tiaki nēhi mātatau mai i te RN, LPN, me LVN). Ka taea hoki ngā mahi tiaki e ngā kaimahi āwhina hospice kaore e hiahiatia he mātātika hauora pēnei i te horoi, te hikoi, me te āwhina kai hei whakapiki i te tiaki nēhi.

Kāore te CHC mō te ngenge o te kaitiaki me ngā mate kore-mātātika (ko te tiaki manawa tena), mō ngā raruraru whare, me te tiaki tonu wā roa mō te manawanui e heke ana kaore he wāhanga pōtiki. Ka hoki mai te manawanui ki te tiaki kāinga noa ka mutu te pōtiki.

Ko te taumata teitei o ngā ratonga hospice ko te CHC, te taumata tino nui te kaimahi me te utu. He tokoiti noa iho ngā umanga hospice he nēhi kua whaimana hospice, ā, he uaua ki te kimi ki te hapori me te whakarite i te wā poto mō te tiaki kaha i te kāinga. I ētahi wā ka whakawhiwhia te tautoko ohorere (ka hiahiatia ana te CHC) mā roto i te kirimana ki tētahi umanga kaimahi.

Tiaki manawa manawa: te whakatā o te kaitiaki

Ka taea e te tiaki manawa manawa te āwhina i te kaitiaki matua i te wā e hiahia ana ia ki te whakatā (ehara i te wā pōtiki te manawanui) ā, ka āwhina i te manawanui mā te 5 rā o te manawa ia urunga ki roto i tētahi whare kua whakaaetia e te Medicare. Ahakoa kaore he rohe motuhake mō ngā urunga manawa ia tau, kei te tirotiro a Medicare mō te whakamahinga tika.

Ka tukuna te tiaki hospice manawa ki tētahi whare tiaki hospice manawa, hōhipera, me te whare nēhi kua whai kirimana ki te umanga hospice. Ka whakawhiwhia e te whare te tiaki nēhi me te tautoko huri noa i te karaka. Ka noho ngā manawanui manawa ki roto i tētahi rūma me te kai, te noho ka utua e te Medicare, he painga nui tēnei (kāore e whakawhiwhia ki ngā manawanui e whiwhi tiaki ana i te kāinga ki tō rātou ake kāinga).

He 5% te moni tōtō o te tiaki manawa mō ia rā o te tiaki, tae noa ki te tauākī nama mō te hōhipera (A$1,736 i te tau 2026). Kāore te utu mai i te pukoro mō te nuinga o ngā noho manawa 5 rā, iti iho rānei, he nui.

Mō te manawanui e noho ana ki tētahi whare nēhi, kāore e wātea te tiaki manawa (nō te mea kua whiwhi kē te manawanui i te tiaki 24-hōra ki roto i te whare nēhi). Ko te manawa he motuhake mō te manawanui e noho ana ki te kāinga ā, ko te tiaki ia rā ka whakawhiwhia e te kaitiaki whānau. 

Tiaki manawanui whānui: kaore te kāinga e rāwehe

Ko te tiaki manawanui whānui (GIP) mō ngā manawanui kaore e taea te whakahaere i ō rātou tohu ki te kāinga ahakoa ngā tautoko kaha. Ka tukuna te GIP ki te hōhipera, te wāhanga manawa hospice, me te whare nēhi rānei e whai kapi nēhi RN 24-hōra.

He rerekē te GIP i te CHC, i te mea ka puta ki tētahi wāhi rerekē. Ka haere tonu te CHC ki te tiaki i te manawanui ki te kāinga me ngā toroanga auau, ka whakawhiti te GIP i te manawanui ki tētahi whare mō te whakahaere hauora kaha. Ka whakatauhia tēnei e ngā tohu e hiahiatia ana, ngā hiahia o te manawanui me te whānau, me ngā rauemi whare.

Ko ngā wāhanga GIP ko te mamae kaore e taea te whakahaere e hiahiatia ana te whakawhiti rongoā auau mā te uruuru toto, te whakahaere epidural rānei, me te uaua nui o te manawa e hiahiatia ana te whakarereke rongoā hāora, te tautoko motuhake rānei, te tiaki mate nui rānei e hiahiatia ana ngā tautoko maha ia rā, te nausea rānei, te ruaki rānei e hiahiatia ana te rongoā uruuru toto me te arotake auau, me te riri nui, te ohorere whakamutunga rānei e hiahiatia ana te tirotiro tata.

Kāore te manawanui e utu moni tōtō mō ngā rā GIP (ka utua e te Medicare te reiti hospice katoa). Ka puta mai ngā tohu ki tētahi āhua pumau, ka neke te kapa hospice i te manawanui ki tētahi wāhi tiaki kāinga noa, me ētahi atu tiaki tika rānei.

Tirohia ta mātou aratohu wā mō te roa e utua ana e te Medicare mō te hospice. 

Ngā whakaritenga mō te Medicare hospice

Hei whiwhi i tētahi taumata o te tiaki hospice a Medicare, me tutuki ngā manawanui ki ngā whakaritenga tika. Me whakapuaki te taote tiaki (ki te mea kei reira) me te taote hospice e rāua ko te manawanui he mate whakamutunga me te matapae hauora 6 marama, iti iho rānei mena ka pērā te mate i tōna tikanga noa. Me hainatia e te manawanui tētahi korero whiriwhiri e kōwhiri ana i te tiaki hospice me te whakakore i ngā utu Medicare mō te rongoā o te mate whakamutunga me ngā mate e pā ana.

Me whai Medicare Wāhanga A te manawanui. Kāore te Wāhanga B e hiahiatia mō te hospice, ahakoa te nuinga o ngā painga ka whiwhi i ngā mea e rua. Ka taea e ngā mema o te mahere Medicare Advantage te kōwhiri i te tiaki hospice i raro i te Medicare Taketake i te wā e pupuri ana i ā rātou mahere Medicare Advantage mō te tiaki kore-hospice.

Ko te matapae 6 marama he aromatawai haumanu, ehara i te rohe pakeke. He maha ngā manawanui hospice ka ora roa ake i te mea i tatarihia. Ka taea te haere tonu te tiaki hospice i te wā e whakapuaki ana te taote i te mate whakamutunga i ngā wā e hiahiatia ana (90 rā mō ngā wāhanga painga tuatahi e rua, katahi ka ia 60 rā).

Mō ētehi atu mō te roa o te hospice me te whakapuaki anō, tirohia ta mātou aratohu roa hospice.

Nga patai auau

Ka utua e te Medicare te tiaki hospice 24-hōra i te kāinga? 

Āe, engari anake i ngā wā pōtiki haumanu motuhake mā te "tiaki kāinga tonu," tētahi o ngā taumata hospice Medicare e whā. Ka whakarato te tiaki kāinga tonu i te 8-24 haora o te tiaki nēhi ia rā i te wā he tohu whakapapa te manawanui (te mamae kaore e taea te whakahaere, te uaua nui o te manawa, te nausea kaore e taea te whakahaere, ngā wahaweka hou) e hiahiatia ana te tiaki nēhi kaha ki te whakahaere i te kāinga me te karo i te hōhipera. Me waiho te tiaki hei tiaki nēhi mātatau (RN, LPN, me LVN e whakarato ana neke atu i te 50% o ngā haora). Tata ki te 11% o ngā manawanui hospice ka whiwhi tiaki kāinga tonu i tētahi wā.

He aha ngā taumata 4 o te tiaki hospice a Medicare? 

Ko ngā taumata hospice Medicare e whā ko: (1) Tiaki kāinga noa, te taumata tino noa e whakarato ana i ngā toroanga kapa hospice auau ki te wāhi e noho ana te manawanui; (2) Tiaki kāinga tonu, whakarato 8-24 haora o te tiaki nēhi kaha i ngā wā poto o te pōtiki haumanu; (3) Tiaki manawa manawa, whakarato tae noa ki te 5 rā i roto i tētahi whare hei whakatā mō ngā kaitiaki whānau; ā, ko (4) Tiaki manawanui whānui, whakarato tiaki taumata hōhipera mō te whakahaere tohu kaore i te rāwehe te tiaki kāinga.

Kia hia te roa ka taea e tētahi te whiwhi tiaki kāinga tonu? 

Ko te tiaki kāinga tonu ka hoahoatia mō ngā wā poto o te pōtiki haumanu, ehara mō te tiaki roa. I te nuinga o te wā ka whiwhi te manawanui i te CHC mō ngā haora ki te rua rā i te wā e whakatauhia ana ngā tohu whakapapa. Ka hoki te manawanui ki te tiaki kāinga noa ka mutu te pōtiki. Kāore te Medicare e whakatakoto i tētahi roa wā motuhake, engari me haere tonu te tika hauora mō te tiaki nēhi tonu. Kāore te CHC e tika mō ngā mate tiaki 24-hōra tonu kaore he wāhanga pōtiki motuhake.

He aha te rerekētanga i waenga i te tiaki kāinga tonu me te tiaki manawanui whānui? 

Ko ngā taumata e rua ka whakatika i ngā āhuatanga kaore i te rāwehe te tiaki hospice noa. Ka pupuri te tiaki kāinga tonu i te manawanui ki te kāinga me te 8-24 haora o ngā toroanga nēhi kaha. Ka neke te tiaki manawanui whānui i te manawanui ki tētahi hōhipera, wāhanga hospice manawa, me te whare nēhi rānei mō te whakahaere tohu kaha. He tika te CHC i te wā ka taea te whakahaere ngā tohu ki te kāinga me te tautoko nēhi kaha; ko te GIP mō ngā āhuatanga e hiahiatia ana ngā tautoko hauora kaha ake pēnei i ngā rongoā IV me te tirotiro tonu.

Ka utua e te Medicare te tiaki manawa hospice? 

Āe. Ka whakarato te tiaki manawa manawa i te 5 rā tōtōtahi i roto i tētahi whare kua whakaaetia e te Medicare (wāhanga hospice manawa, hōhipera, me te whare nēhi) hei whakatā mō te kaitiaki whānau. Kāore he rohe mō te maha o ngā urunga manawa ia tau. Ko te utu mō te manawanui he 5% moni tōtō ia rā. Ka utua e te Medicare te noho me te kai i te wā manawa, rerekē ana ki te tiaki kāinga noa i ngā kāinga motuhake. Kāore te manawa e wātea mena ka noho te manawanui ki tētahi whare nēhi (nō te mea kua whakawhiwhia kē te tiaki 24-hōra ki reira).

Ko wai e whakarato ana i te tiaki hospice 24-hōra i te kāinga? 

Ko te tiaki kāinga tonu ka whakawhiwhia e te kapa umanga hospice o te manawanui, ko te nuinga he nēhi kua whaimana (RN, LPN, me LVN) me ngā kaimahi āwhina hospice e tautoko ana i te tiaki kore-mātātika. Ka whakahaere te umanga hospice i ngā kaimahi, i ētahi wā ka mahi kirimana ki ngā umanga kaimahi mō te tautoko ohorere i te wā kaore ā rātou ake kaimahi e rāwehe ana. Kāore ngā umanga hospice katoa e whai kaha CHC kaha ana i te mea kua kore nēhi, nā reira ka hiahia pea ngā whānau ki te pātai motuhake mō te wātea o te CHC i te wā e kōwhiri ana i tētahi kaiwhakarato hospice.

Te putanga

Ka utua e te Medicare te tiaki hospice 24-hōra i te kāinga i raro i te "tiaki kāinga tonu," tētahi o ngā taumata tiaki hospice e whā kua hoahoatia mō ngā wā "pōtiki" haumanu poto. Ko ngā taumata tiaki e whā ko te tiaki kāinga noa (te nuinga, ~99% o ngā rā hospice), te tiaki kāinga tonu (8-24 haora o te tiaki nēhi i ngā pōtiki tere, poto, ~11% o ngā manawanui), te tiaki manawa manawa (tae noa ki te 5 rā hei whakatā mō te kaitiaki), me te tiaki manawanui whānui (te whakahaere tohu taumata hōhipera). Ko te tohu whakapapa e hiahiatia ana te tiaki nēhi kaha mai i te kāinga me te hiahia o te whānau ki te noho ki te kāinga ka whakawhiwhia ai te tiaki tonu i te kāinga. Ka neke te kapa hospice i te manawanui i tētahi taumata tiaki ki tētahi atu i te wā e huri ana āna mate. Hei whiwhi i ngā taipitopito katoa mō te tiaki hospice, tirohia ta mātou aratohu mō ka utua e te Medicare te hospice me te roa e utua ana e te Medicare mō te hospice. Ki te rapu koe mō te tiaki Medicare whānui, tirohia ta mātou arararararararara me ngā arararararararararararara.

Ahakoa te ngāwari o tēnei, me te mea ko tētahi o ngā wheako tino uaua e pa ana ki ngā whānau, ka mōhio mātou he kaupapa uaua tēnei. Ka taea e koe te hiahia tautoko atu, ā, me whakapā atu koe ki tētahi kaimahi pāpori hospice, ki te kapa rongoā rongoā o tō hōhipera, me te kaiāwhina pouri rānei. Ka taea e ngā whānau te kimi rauemi i Te Rōpū Motu mō te Hospice me te Tiaki Rōwhia, nhpco.org/">nhpco.org.