Mbese Medicare ikora ku kwita ku murwayi mu rugo amasaha 24?

Igihe imiryango yafata imyanzuro ijyanye n’impera y’ubuzima, imwe mu y’ingenzi cyane ni “Mbese Medicare izishyura amasaha 24 y’ubuvuzi mu rugo mu gihe turi muri iki cyorezo?” Yego, ariko gusa mu gihe cy’ibihe bimwe by’imvune zishingiye ku buvuzi aho urwego rwa hospice rwa Medicare rushobora kwitwa “continuous home care”. Ubwishingizi bwa Medicare bwa hospice bufite ibice bine by’ubuvuzi bigenda byiyongera uko umubare w’umurwayi wiyongera. Ubwoko busanzwe bw’ubuvuzi mu rugo ni routine home care, bwiyongera bugera kuri 99% by’iminsi yose ya hospice mu gihugu hose. Nk’uko byagaragaye, 11% by’abarwayi ba hospice babona continuous home care, ni ukuvuga amasaha 8-24 ku munsi yo kwitabwaho n’abaganga mu gihe gito. Inpatient respite ishobora gutangwa mu kigo igihe cy’iminsi 5 yikurikirana kugira ngo igaburire abagaburira umuryango. Inpatient general care ni urwego rwo hejuru rwo gucunga ibimenyetso byakorewe mu bitaro, iyo ubuvuzi mu rugo budahagije. Centre for Medicare & Medicaid Services (CMS) zashyizeho uburyo bwo kumenya uburenganzira kandi zigakoresha buri rwego.

Ikinyamakuru kiga ku bwoko bine bw’ubuvuzi bwa hospice gutangwa munsi ya Medicare cyangwa mu rugo rw’umuntu, ubwoko bw’amasaha 24 yo kwita ku murwayi mu rugo, amakuru ajyanye n’uburenganzira, n’ibyo imiryango ishobora gutegereza. Amakuru yatanzwe na Medicare.gov, CMS, na The National Hospice and Palliative Care Organization. 

Inzego enye z’ubuvuzi bwa hospice bwa Medicare

Inyungu ya hospice ya Medicare ikorera ku nzego zihamye z’ubuvuzi, abarwayi bakimuka hagati y’inzego uko ibikenewe byabo bihinduka. Kumenya buri rwego bifasha imiryango kumenya ubuvuzi buriho kandi ryari.

Routine home care (RHC) ni serivise ya hospice isanzwe, itangwa aho umurwayi aba. Urugo rw’umurwayi rushobora kuba inzu bwite, ikigo cyo kwiruhukiramo, ikigo cyo kwitabwaho n’abaganga, cyangwa ikigo cy’igihe kirekire cyo kwita ku murwayi. Itsinda ry’abakozi ba hospice (umuganga, abaganga, abakozi b’imibereho, abashumba, abafasha ba hospice, n’abandi) bakora ubugenzuzi busanzwe hashingiwe ku masezerano y’ubuvuzi, ubusanzwe inshuro nyinshi mu cyumweru. Itsinda ryo rishobora guhamagarwa 24/7 mu bihe by’ikinyuranyo, nubwo ritaba ritarimo kwita ku murwayi mu gihe cy’ibisanzwe.

Continuous home care (CHC) ni urwego rutanga amasaha 24 y’ubuvuzi n’abaganga mu rugo. CHC itangwa gusa mu bihe bimwe by’igihe gito by’ikinyuranyo aho ubuvuzi bwigenga n’abaganga bukenerwa kugira ngo umurwayi agume mu rugo kandi akirinde kwirukanwa mu bitaro. Urwego rugomba byibuze amasaha 8 yo kwita ku murwayi mu gihe cy’amasaha 24, aho benshi (birenze 50%) ari ubuvuzi bw’abaganga bwakozwe n’abaganga ba RN, LPN, cyangwa LVN. Abafasha ba hospice n’abagaburira bashobora kongerera ubuvuzi bw’abaganga.

Inpatient respite care igenewe gutanga akaruhuko ku bagaburira umuryango, aho kuba ku gucunga impirimbanyi z’ubuvuzi. Abarwayi babona ubuvuzi mu kigo cyemewe na Medicare (unit ya hospice, ibitaro, cyangwa ikigo cy’abaganga) igihe cy’iminsi 5 yikurikirana. Ubuvuzi bwa respite burimo icumbi n’ibiryo. Abagaburira akenshi bahisemo ubuvuzi bwa respite kugira ngo bagende, bitabire ibikorwa bikomeye, cyangwa bakore ibikenewe ku buzima bwabo.

Inpatient general care (GIP) ikemura ibimenyetso bitashoboye gucungwa mu rugo. Abarwayi babona ubuvuzi mu bitaro, unit ya hospice, cyangwa ikigo cy’abaganga gifite abaganga ba saa 24. GIP ikwiriye kubera ububabare budacungwa, kuruka kwamugaye, guhumeka bigoye, ibikomere bikomeye bisaba ubuvuzi bwigenga, cyangwa ibindi bimenyetso bikomeye bisaba igikorwa kigana cyane.

Kubona uburyo bwagutse bw’ubuvuzi bwa hospice, reba umuyoboro wacu wa hospice Medicare guide.

Igihe continuous home care (amasaha 24) iboneka

Continuous home care ni ubwoko bw’ubuvuzi bwihariye igihe gito cy’igihe cy’imvune zishingiye ku buvuzi. Intego ni ugutanga ubuvuzi bwigenga n’abaganga kugira ngo bashobore gucunga ibimenyetso bikomeye kandi bakwirinde kwirukanwa mu bitaro no gusubiza umurwayi ku buvuzi busanzwe mu rugo igihe ikinyuranyo kirangiye.

Ibindi bintu bifitanye isano n’akenewe kuri continuous home care ni ububabare budacungwa budakemuka n’ibikorwa bya hospice, ingorane zikomeye zo guhumeka (nk’akanyota k’umwuka cyangwa guhumeka bigoye), kuruka gutunguranye cyangwa kwihanganira kudakemuka n’imiti isanzwe, kurwaragurika kwihanganira (kwavuka, cyangwa ibitabashije gucungwa n’imiti isanzwe) na/cyangwa guhindura imiti bisaba kwitonderwa cyane n’abaganga.

Abarwayi n’imiryango bifuza kuguma mu rugo bwakozwe mu bitaro cyangwa mu kigo cy’ubuvuzi bwa hospice. CHC igomba kugira ubuvuzi n’abaganga nk’ubuvuzi bw’ibanze (birenze 50% by’ubuvuzi bwigenga n’abaganga ba RN, LPN cyangwa LVN). Imirimo yo kwita ku murwayi yakozwe n’abafasha ba hospice ntibisaba ubuhanga bw’abaganga nk’umukino, gufasha kurya, nabyo birahari kugira ngo kongere ubuvuzi bw’abaganga.

CHC ntabwo bivuga gucunga abagaburira bafite akazi katari ubuhanga bwo kwita ku murwayi (ibyo ni ubuvuzi bwa respite), cyangwa bigatuma bashyirwa mu kigo, cyangwa ni ubuvuzi bw’igihe kirekire ku murwayi ugenda aceceka nta bikorwa by’impinduka. Igihe ikinyuranyo kirangiye, umurwayi asubira ku buvuzi busanzwe mu rugo.

Urwego rwo hejuru rw’ubuvuzi bwa hospice ni CHC, urwego rw’abagize itsinda rwinshi kandi rw’igiciro. Ibigo byinshi bya hospice bifite abaganga bake bashinze ubuvuzi kandi biragoye kuboneka mu karere no gutegura mu gihe gito cyane kubera ubukenerwa bukabije bw’ubuvuzi mu rugo. Guhuza ibikorwa by’ikinyuranyo (igihe CHC yaba ikenewe) rimwe na rimwe bitangwa binyuze mu masezerano n’ikigo cyo gutanga abakozi.

Inpatient respite care: guhumuriza abagaburira

Inpatient respite care ishobora gufasha guhumuriza umugaburira mukuru igihe akeneye akaruhuko (ntaho ari igihe umurwayi ari mu mvune) kandi ikafasha umurwayi igihe cy’iminsi 5 ya respite buri gihe mu kigo cyemewe na Medicare. Nubwo nta ntambara yihariye yo kwakira abasaba ubuvuzi bwa respite ku mwaka, hari ubugenzuzi bwa Medicare kugira ngo bubone ko bukoreshwa neza.

Inpatient hospice care itangwa mu kigo cy’ubuvuzi bwa hospice, ibitaro cyangwa ikigo cy’abaganga gifitanye amasezerano n’ikigo cya hospice. Ikigo gitanga ubugenzuzi n’ubuvuzi buri gihe. Abarwayi ba respite baba mu cyumba gifite icumbi n’ibiryo byishyurwa na Medicare, ibyo ni ikintu gikomeye cyane (akenshi ntibitangwa ku barwayi babona ubuvuzi mu rugo rwabo).

Ubuvuzi bwa respite bufite 5% by’ubwishyu ku munsi w’ubuvuzi, kugeza ku mwaka w’ibitaro byishyurwa ($1,736 muri 2026). Kwishyuza ku muturage ku bintu byinshi bya respite bifata iminsi 5 cyangwa munsi ni ntakare.

Ku murwayi uba mu kigo cy’abaganga, ubuvuzi bwa respite ntibuboneka (kuko umurwayi amaze kubona ubugenzuzi bwa 24h mu kigo cy’abaganga). Respite igenewe gusa umurwayi uba mu rugo kandi ubugenzuzi bwa buri munsi bukorwa n’umugaburira umuryango. 

General inpatient care: igihe urugo rutahagije

General inpatient care (GIP) igenewe abarwayi bafite ibimenyetso bidashobora gucungwa mu rugo nubwo hari ibikorwa bikomeye. GIP itangwa mu bitaro, unit ya hospice, cyangwa ikigo cy’abaganga gifite abaganga ba 24h.

GIP itandukanye na CHC, kuko ikorerwa mu bundi buryo. CHC ikomeza kwita ku murwayi mu rugo hamwe n’insengero nyinshi, GIP yimurira umurwayi mu kigo kugira ngo akore ubugenzuzi bw’ubuvuzi. Ibyo bifatwa hashingiwe ku bimenyetso bikenerwa, impinduka z’umurwayi n’umuryango, n’ibikoresho by’ikigo.

Impamvu za GIP ni ububabare budacungwa bushobora guhindura imiti buri gihe ukoresheje inzira yo mu gifu cyangwa kugabanya inzira yo mu rubwo, n’ingorane zikomeye zo guhumeka bisaba guhindura umwuka cyangwa igikorwa cyihariye, cyangwa kwita ku bikomere bigoye bisaba igikorwa cyinshi buri munsi, cyangwa kuruka kwamugaye bisaba imiti yo mu gifu n’ubugenzuzi buri gihe, no kwirakaza cyane cyangwa umunaniro w’imperuka bisaba kwitonderwa cyane.

Umurwayi ntishyura ubwishyu kuri buri munsi bwa GIP (Medicare yishyura igipimo cyose cya hospice). Igihe ibimenyetso bimaze kuba byoroshye, itsinda rya hospice rishobora kwimurira umurwayi ku buvuzi busanzwe mu rugo cyangwa ahandi hagezweho.

Reba umuyoboro wacu ku buryo igihe kinini Medicare izishyura hospice, reba umuyoboro wacu kuri ubuvuzi bwa hospice.

Ibisabwa ku burenganzira bwa hospice bwa Medicare

Kugira ngo babone urwego rwa hospice rwa Medicare, abarwayi bagomba kuzura ibisabwa. Umuganga uyoboye (iyo hariho) n’umuganga wa hospice bagomba kwemeza ko umurwayi afite indwara y’imperuka n’ubuhanuzi bw’iminsi 6 cyangwa munsi y’iyo indwara yaba ikomeje mu buryo busanzwe. Umurwayi agomba kwandika itangazo ry’ihitamo rikoresha ubuvuzi bwa hospice kandi akemerera kwanga kwakira amafaranga ya Medicare ku buvuzi bw’impamvu y’indwara y’imperuka n’ibindi bifitanye isano nayo.

Umurwayi agomba kuba afite Medicare Part A. Part B ntabwo isabwa kuri hospice, nubwo abenshi bagomba kuba bafite zombi. Abanyamuryango b’ikigega cya Medicare Advantage bashobora guhitamo ubuvuzi bwa hospice munsi ya Original Medicare mu gihe bakomeje kugira ikigega cyabo cya Medicare Advantage ku bindi uretse hospice.

Ubuhanuzi bw’iminsi 6 ni ubupimo bw’ubuvuzi, ntaho ari igihagararo. Abarwayi benshi ba hospice babaho igihe kirekire kuruta uko byari biteganijwe. Ubuvuzi bwa hospice bushobora gukomeza igihe cyose umuganga yemeje ko indwara y’imperuka yongeye kubaho mu bihe bikwiriye (iminsi 90 ku gihembwe cya mbere n’icya kabiri, hanyuma buri minsi 60).

Kubona ibisobanuro byinshi kuri igihe cyo gukora na kwemeza buri gihe, reba umuyoboro wacu w’igihe cya hospice.

Ibibazo bikunze kwibazwa

Mbese Medicare ikora ku kwita ku murwayi mu rugo amasaha 24? 

Yego, ariko gusa mu gihe bimwe by’imvune zishingiye ku buvuzi binyuze mu bwoko bwa “continuous home care,” rumwe mu nzego nini za hospice za Medicare. Continuous home care itanga amasaha 8-24 yo kwita ku murwayi buri munsi igihe abarwayi bafite ibimenyetso bikomeye (ububabare budacungwa, ingorane zikomeye zo guhumeka, kuruka kwamugaye, kwirakaza kwavuka) bisaba kwita ku murwayi bikomeye kugira ngo bashobore gucungwa mu rugo kandi bakirinde kwirukanwa mu bitaro. Ubuvuzi bugomba kuba ari ubuganga bw’abaganga (RN, LPN, cyangwa LVN batangamo hejuru ya 50% by’amasaha). Nk’uko byagaragaye, 11% by’abarwayi ba hospice babona continuous home care mu gihe runaka.

Ni izihe nzego 4 z’ubuvuzi bwa hospice bwa Medicare? 

Inzego nini za hospice za Medicare ni: (1) Routine home care, urwego rwinshi rwihata ubugenzuzi busanzwe bw’itsinda rya hospice aho umurwayi aba; (2) Continuous home care, itanga amasaha 8-24 yo kwita ku murwayi bikomeye mu gihe gito cy’imvune zishingiye ku buvuzi; (3) Inpatient respite care, itanga kugeza ku minsi 5 mu kigo kugira ngo igaburire abagaburira umuryango; na (4) General inpatient care, itanga ubugenzuzi bw’ibimenyetso byo ku rwego rw’ibitaro iyo ubuvuzi mu rugo budahagije.

Umuntu ashobora kwakira continuous home care igihe kingana iki? 

Continuous home care igenewe ibihe bimwe by’igihe gito by’imvune zishingiye ku buvuzi, ntaho kuba ubugenzi bw’igihe kirekire. Abarwayi akenshi bakira CHC igihe cy’amasaha kugeza ku minsi mike mu gihe ibimenyetso bikomeye byashyizwe mu buryo. Igihe ikinyuranyo kirangiye, umurwayi asubira ku buvuzi busanzwe mu rugo. Medicare ntishyizeho igihe gikomeye, ariko ubuganga bw’abaganga bukenerwa na bwo bugomba gukomeza. CHC ntikwiriye ku gikenewe buri gihe amasaha 24 nta bimenyetso bihamagara byihariye.

Ni ikihe gitandukanya hagati ya continuous home care na general inpatient care? 

Inzego zombi zikemura ibintu aho ubuvuzi busanzwe bwa hospice budahagije. Continuous home care iguma umurwayi mu rugo hamwe n’insengero 8-24 z’abaganga bikomeye. General inpatient care yimurira umurwayi mu bitaro, unit ya hospice, cyangwa ikigo cy’abaganga kugira ngo akore ubugenzuzi bw’ibimenyetso bikomeye. CHC ikwiriye igihe ibimenyetso bishobora gucungwa mu rugo hamwe n’ubufasha bukomeye bw’abaganga; GIP igenewe ibintu bisaba ibikorwa byinshi by’ubuvuzi nk’imiti ya IV cyangwa kwitonderwa buri gihe.

Mbese Medicare ikora ku buvuzi bwa hospice respite care? 

Yego. Inpatient respite care itanga kugeza ku minsi 5 yikurikirana mu kigo cyemewe na Medicare (unit ya hospice, ibitaro, cyangwa ikigo cy’abaganga) kugira ngo igaburire umugaburira umuryango. Ntaho ari ntambara y’ibikorwa byinshi byo kwakira abasaba ubuvuzi bwa respite ku mwaka. Kwishyura ku murwayi ni 5% by’ubwishyu ku munsi. Medicare yishyura icumbi n’ibiryo mu gihe cyo guhumurizwa, bitandukanye n’ubuvuzi busanzwe mu rugo mu ngo bwite. Respite ntiboneka niba umurwayi aba mu kigo cy’abaganga (kuko ubugenzuzi bwa 24h buriho).

Ni nde utanga ubugenzi bwa hospice bw’amasaha 24 mu rugo? 

Continuous home care itangwa n’itsinda ry’ikigo cya hospice cy’umurwayi, cyane cyane abaganga bashoboye (RNs, LPNs, LVNs) hamwe n’abafasha ba hospice bashyigikira ubugenzi butari ubwihindurire. Ikigo cya hospice gishyira mu murongo abakozi, rimwe na rimwe gikora amasezerano n’ibigo byo gutanga abakozi kugira ngo biyongere mu gihe abakozi babo batari bahagije. Ntabwo ibigo byose bya hospice bifite ubushobozi buhagije bwa CHC kubera kubura kw’abaganga, ku buryo imiryango ishobora kwibaza ku bwoko bw’ubuvuzi bwa CHC igihe bahisemo uwitanga ku buvuzi bwa hospice.

Ibisobanuro

Medicare izishyura ubugenzi bwa hospice bw’amasaha 24 mu rugo munsi y’ubwoko bwa “continuous home care”, rumwe mu nzego nini z’ubuvuzi bwa hospice zigenewe ibihe bimwe by’igihe gito “by’ikinyuranyo”. Inzego enye z’ubuvuzi ni routine home care (inshi cyane, ~99% by’iminsi ya hospice), continuous home care (amasaha 8-24 yo kwita ku murwayi mu gihe gikomeye cyane, ~11% by’abarwayi), inpatient respite care (kugeza ku minsi 5 kugira ngo abagaburira bagaburire) na general inpatient care (ubugenzuzi bw’ibimenyetso byo ku rwego rw’ibitaro). Ikimenyetso gikomeye gisaba ubugenzi bukomeye n’abaganga mu rugo hamwe n’umuryango wishimira kuguma mu rugo bigize ubugenzi bwa continuous mu rugo. Itsinda rya hospice ryimurira umurwayi ku rwego rwa ubugenzi uko ibikenewe bye bihinduka. Kugira ngo ubone ibisobanuro byinshi ku buvuzi bwa hospice, reba umuyoboro wacu ku cyo Medicare ikora ku buvuzi bwa hospice no ku gihe Medicare ishobora kwishyura hospice. Niba ushaka kwumva uburyo bwinshi bwa Medicare, reba imiyoboro yacu kuri Medicare na Medicare parts explained.

Nubwo iki kintu gishobora kuba kitoroshye, kandi nubwo ari kimwe mu bibazo bikomeye imiryango ihura nabyo, turabizi ko iki ari ikibazo gikomeye. Ushobora kuba ukeneye ubufasha bwinshi kandi ugomba kwegera umukozi w’imibereho wa hospice, itsinda ry’ubuvuzi bwo mu bitaro, cyangwa umujyanama w’umubabaro. Imiryango ishobora kubona ibikoresho kuri National Hospice and Palliative Care Organization, nhpco.org/">nhpco.org.