Ngabe i-Medicare Iyayikhokhela i-Hospice Yokunakekelwa Ekhaya Amahora Angu-24?

Ngenkathi imindeni yenza izinqumo zokuphela kokuphila, enye yezinto ezibaluleke kakhulu ithi, “ngabe i-Medicare izokhokhela amahora angu-24 okunakekelwa ekhaya lapho sikhona kule nkinga?” Yebo, kodwa kuphela ngezikhathi ezithile zenkinga yezokwelapha lapho izinga le-hospice le-Medicare lifanele ukubizwa ngokuthi "continuous home care." Inzuzo ye-hospice ye-Medicare inezigaba ezine zokunakekelwa ezinyukayo njengoba isimo saso isiguli siba sibi kakhulu. Uhlobo oluvame kakhulu lokunakekelwa ekhaya luyi-routine home care, oluqhakaza cishe ku-99% wezinsuku zonke ze-hospice kulo lonke izwe. Cishe u-11% weziguli ze-hospice zithola i-continuous home care, okuyihola amahora angu-8-24 ngosuku okunakekelwa odokotela abahlengikazi ngesikhathi esifushane. I-inpatient respite inganikezwa endaweni isikhathi esingafika ezinsukwini ezinhlanu zilandelana ukuze kunikezwe abanakekeli bomndeni isikhathi sokuphumula. I-general inpatient care iyizinga eliphezulu lokuphathwa kwezimpawu olunikezwa esibhedlela, lapho ukunakekelwa ekhaya kunganele. Izikhungo ze-Medicare & Medicaid Services (CMS) zamisa imithetho yokufaneleka kanye nokusetshenziswa kwebanga ngalinye.

Leli pheshana lihlanganisa izinhlobo ezine zokunakekelwa kwe-hospice okunikezwa ngaphansi kwe-Medicare noma ekhaya lomuntu, ukutholakala kokunakekelwa ekhaya amahora angu-24, imininingwane yokufaneleka, nokuthi yini imindeni engayilindela. Idatha ihanjiswe yi-Medicare.gov, CMS, kanye ne-National Hospice and Palliative Care Organization. 

Izinga ezine zokunakekelwa kwe-hospice kwe-Medicare

Inzuzo ye-Medicare hospice isebenza ngezigaba ezine ezihlukene zokunakekelwa, lapho iziguli zihamba phakathi kwezihlobo njengoba izidingo zazo zishintsha. Ukuqonda ibanga ngalinye kusiza imindeni ukuthi yazi ukuthi yikuphi ukunakekelwa okutholakalayo nokuthi nini.

I-Routine home care (RHC) iyisevisi ye-hospice ejwayelekile kakhulu, enikezwa noma ngabe ikuphi lapho kuhlala khona isiguli. Ikhaya lesiguli lingaba yindawo yokuhlala yangasese, indawo yokuhlala enosizo, indawo yokuhlala eneziqu zokwelapha, noma indawo yokunakekelwa isikhathi eside. Ithimba le-hospice elisebenzisana (udokotela, odokotela abahlengikazi, izisebenzi zomphakathi, abapristi, abasizi be-hospice, nabanye) benza ukuvakashela okuvamile ngokusekelwe ohlelweni lokunakekelwa, ngokuvamile izikhathi ezimbalwa ngesonto. Ithimba lisatholakala ngo-24/7 ezimeni eziphuthumayo, yize linganikezi ukunakekelwa okuqhubekayo eceleni kombhede ngezikhathi ezijwayelekile.

I-Continuous home care (CHC) iyizinga elinikeza ukunakekelwa odokotela abahlengikazi amahora angu-24 ekhaya. I-CHC inikezwa kuphela ngezikhathi ezimfushane zenkinga yezokwelapha lapho kudingeka khona ukunakekelwa okukhulu odokotela abahlengikazi ukuze kugcinwe isiguli ekhaya futhi kugwenywe ukulaliswa esibhedlela. Izinga lifuna okungenani amahora angu-8 okunakekelwa ngqo kwesiguli esikhathini samahora angu-24, nenhloko-doloba (ngaphezu kuka-50%) ibe ukunakekelwa okunobuchwepheshe odokotela abahlengikazi abavela ku-RNs, LPNs, noma LVNs. Abasizi be-hospice kanye nezinsizakalo zabakhaya bangagcina ukunakekelwa odokotela abahlengikazi.

I-Inpatient respite care ihloselwe ukunikeza abanakekeli bomndeni isikhathi sokuphumula, hhayi ukuphathwa kwezinkinga zezokwelapha. Iziguli zithola ukunakekelwa endaweni egunyazwe yi-Medicare (i-hospice inpatient unit, isibhedlela, noma indawo yokuhlala odokotela abahlengikazi) isikhathi esingafika ezinsukwini ezinhlanu zilandelana ngesikhathi. Ukunakekelwa kwe-Respite kuhlanganisa indawo yokulala kanye nokudla. Abanakekeli bavame ukuhlela i-respite ukuze bahambe, bahambele imicimbi ebalulekile, noma babhekelele izidingo zabo zezempilo.

I-General inpatient care (GIP) ibhekana nezimpawu ezinganakulawulwa ekhaya. Iziguli zithola ukunakekelwa esibhedlela, i-hospice inpatient unit, noma indawo yokuhlala odokotela abahlengikazi enabahlengikazi ababhalisile abatholakala amahora angu-24. I-GIP ifanele ubuhlungu obungalawulwa, isicanucanu noma ukuhlanza okungapheli, ubunzima bokuphefumula, amanxeba abucayi adinga ukwelashwa okubalulekile, noma ezinye izimpawu ezibucayi ezidinga ukungenelela okubalulekile.

Ukuze uthole imininingwane eningiliziwe yokufakwa kwe-hospice, bona isiqondiso sethu se-hospice Medicare.

Nini lapho i-continuous home care (ama-24 awa ngosuku) itholakala khona

I-Continuous home care uhlobo oluthile lokunakekelwa ngezikhathi ezimfushane zenkinga yezokwelapha. Inhloso ukunikeza ukunakekelwa okunamandla odokotela abahlengikazi ukuze kulawulwe izimpawu ezibucayi futhi kugwenywe ukulaliswa esibhedlela nokubuyisa isiguli ekunakekelweni okujwayelekile ekhaya lapho inkinga idlula.

Ezinye izinto ezihambisana nesidingo sokunakekelwa okuqhubekayo ekhaya zihlanganisa ubuhlungu obungalawulwa obungaphenduli ezimweni ze-hospice, ubunzima obukhulu bokuphefumula (njengokuzizwa uphelelwa umoya noma ukuphefumula ngokuzikhandla), isicanucanu esingalindelekile noma esingapheli esingalungiswa nemithi evamile, ukukhathazeka okungapheli (okuqala kabusha, noma okungalawulwa nemithi evamile) kanye/noma ukulungiswa kwemithi okudinga ukuqapha eduze odokotela abahlengikazi.

Isiguli nomndeni bafisa ukuhlala emakhaya abo kunokuba baye esibhedlela noma endaweni ye-hospice. I-CHC kumele ibe nokunakekelwa odokotela abahlengikazi njengokwelashwa okuyinhloko (ngaphezu kuka-50% wokunakekelwa okunobuchwepheshe odokotela abahlengikazi yi-RN, LPN, noma LVN). Imisebenzi yokunakekela eyenziwa abasizi be-hospice engadingi amakhono ezokwelapha njengokugeza, ukuhamba noma ukusiza ngokudla iyatholakala ukuze kugcine ukunakekelwa odokotela abahlengikazi.

I-CHC ayikona ukukhathala komnakekeli ngezidingo zokunakekelwa ezingenawo amakhono (lokho yi-respite care), mayelana nobunzima bokubeka izindawo, noma akuwona ukunakekelwa okuqhubekayo kwesikhathi eside kwesiguli esibuyelayo ngaphandle kwezehlakalo zenkinga. Uma inkinga isidlulile, isiguli sibuyela ekunakekelweni okujwayelekile ekhaya.

Izinga eliphakeme kakhulu lezinsizakalo ze-hospice yi-CHC, izinga elidinga abasebenzi abaningi futhi elibiza kakhulu. Izinhlangano eziningi ze-hospice zinodokotela abahlengikazi abambalwa abaqinisekisiwe be-hospice futhi baye bancipha ukutholwa emphakathini nokuhlelwa ngesikhathi esifushane sokunakekelwa okubalulekile ekhaya. Ukwengeza okuphuthumayo (lapho i-CHC idingeka) kwesinye isikhathi kuhanjiswa ngokusebenzisa inkontileka nenhlangano yabasebenzi.

I-Inpatient respite care: ukudluliswa komnakekeli

I-Inpatient respite care ingasiza ukudlulisa umnakekeli oyinhloko lapho edinga isikhathi sokuphumula (hhayi lapho isiguli sikunqenqe) futhi isiza isiguli ngokuhamba kwezinsuku ezifika kwezinhlanu zokuphumula ngomunye umndeni endaweni egunyazwe yi-Medicare. Noma kungabibikho mingcele ethize ekungena komndeni ngonyaka, kukhona ukuvinjelwa yi-Medicare ukuze kusetshenziswe ngendlela efanele.

I-Inpatient hospice care inikezwa endaweni yokunakekelwa kwe-hospice, esibhedlela noma indawo yokuhlala odokotela abahlengikazi enenkontileka nenhlangano ye-hospice. Le ndawo inikeza ukunakekelwa odokotela abahlengikazi okwamasondo kanye nezinsizakalo zokweseka. Iziguli ze-Respite zihlala egumbini lokulala elinenkonzo yokudla ekhokhelwa yi-Medicare, lokhu kuyinzuzo enkulu (ngokuvamile kungasebenzi ezigulini ezithola ukunakekelwa ekhaya emakhaya azo).

I-Respite care inezindleko ezifakwa yi-5% yomuntu ngosuku lokunakekelwa, kufika ku-deductible yonyaka yesibhedlela ($1,736 ngo-2026). Izindleko ezingaphandle kwephakeji eziningi zokuhlala isikhathi esingafika ezinsukwini ezinhlanu azikhulu kakhulu.

Esigulini esihlala endaweni yokuhlala odokotela abahlengikazi, i-respite care ayitholakali (ngoba isiguli sesithola ukunakekelwa amahora angu-24 endaweni yokuhlala odokotela abahlengikazi). I-Respite ihloselwe ngokuqondile isiguli esihlala ekhaya futhi ukunakekelwa kwansuku zonke kunikezwa umnakekeli womndeni. 

I-General inpatient care: lapho ikhaya linganele

I-General inpatient care (GIP) ingeyeziguli ezinzimpawu zazo ezingenakulawulwa ekhaya naphezu kokungenelela okubalulekile. I-GIP inikezwa esibhedlela, i-hospice inpatient unit noma indawo yokuhlala odokotela abahlengikazi enokubuka amahora angu-24 odokotela abahlengikazi ababhalisile.

I-GIP ihlukile ku-CHC, ngokuthi yenzeka endaweni ehlukile. I-CHC iyaqhubeka nokunakekela isiguli ekhaya ngokuwuvakashela njalo, i-GIP idlulisa isiguli siyise endaweni yokunakekelwa okubalulekile kwezokwelapha. Lokhu kunqunywa izimpawu ezidingekayo, ukukhetha kwesiguli nomndeni, nezinsiza zendawo.

Izigaba ze-GIP zihlanganisa ubuhlungu obungalawulwa obudinga ukushintsha njalo kwemithi kusetshenziswa imizila ye-intravenous noma ukuphathwa kwe-epidural, kanye nobunzima obukhulu bokuphefumula obudinga ukushintsha kokwelashwa kwe-oxygen noma ukungenelela okukhethekile, noma ukunakekelwa kwamanxeba ayinkimbinkimbi adinga ukungenelela okuningi ngosuku, noma isicanucanu esingapheli noma ukuhlanza okudinga imithi ye-intravenous kanye nokuhlola njalo, kanye nokukhathazeka okubucayi noma ukungaphumuli kokugcina okudinga ukuqapha eduze.

Isiguli asikhokhi imali eqeqetshiwe yezinsuku ze-GIP (i-Medicare ikhokhela isilinganiso esigcwele se-hospice). Uma izimpawu sezizinzile, ithimba le-hospice lidlulisa isiguli libuyele endaweni yokunakekelwa okujwayelekile ekhaya noma okunye ukunakekelwa okufanelekayo.

Bona isiqondiso sethu sesikhathi sokuthi i-Medicare izokhokhela isikhathi esingakanani i-hospice. 

Izimfuneko zokufaneleka kwe-Medicare hospice

Ukuthola ibanga kunoma yikuphi lokunakekelwa kwe-hospice kwe-Medicare, iziguli kumele zihlangabezane nezimfuneko ezithile zokufaneleka. Udokotela ohambisana naye (uma ekhona) kanye nodokotela we-hospice kumele bobabili baqinisekise ukuthi isiguli sinesifo esibulalayo esilinganiselwa ezinyangeni eziyisithupha noma ngaphansi uma isifo sikhula ngendlela yaso evamile. Isiguli kumele sisayine isitatimende sokukhetha ukunakekelwa kwe-hospice futhi sinqabe izinkokhelo ze-Medicare zokwelapha okubulalayo nezimo ezihambisanayo.

Isiguli kumele sibe ne-Medicare Part A. I-Part B ayidingeki ku-hospice, yize abaningi abazuzayo benazo zombili. Amalungu ohlelo lwe-Medicare Advantage angakhetha ukunakekelwa kwe-hospice ngaphansi kwe-Original Medicare ngenkathi egcina uhlelo lwabo lwe-Medicare Advantage lokunakekelwa okungeyona i-hospice.

Isilinganiso sezinyanga eziyisithupha siyisilinganiso sezokwelapha, hhayi umkhawulo oqinile. Iziguli eziningi ze-hospice ziphila isikhathi eside kunalokho obekulindelekile ekuqaleni. Ukunakekelwa kwe-Hospice kungaqhubeka noma ngabe udokotela uqinisile isifo esibulalayo ngezikhathi ezidingekayo (izinsuku ezingu-90 ezikhathini ezimbili zokuqala zezinzuzo, bese njalo ngezinsuku ezingu-60).

Ukuze uthole okuningi mayelana nokuhlala kwe-hospice nokuqinisekiswa kabusha, bona isiqondiso sethu sokuhlala kwe-hospice.

Imibuzo Evame Ukubuzwa

Ngabe i-Medicare iyayikhokhela i-hospice yokunakekelwa ekhaya amahora angama-24? 

Yebo, kodwa kuphela ngezikhathi ezithile zenkinga yezokwelapha nge-"continuous home care," enye yezinye iziinzi ezine ze-Medicare hospice levels. I-Continuous home care ihlinzeka ngamahora angu-8-24 okunakekelwa odokotela abahlengikazi nsuku zonke lapho iziguli zinezimpawu ezibucayi (ubuhlungu obungalawulwa, ubunzima obukhulu bokuphefumula, isicanucanu esingapheli, ukukhathazeka okusha) ezidinga ukunakekelwa okubalulekile odokotela abahlengikazi ukuze kulawulwe ekhaya futhi kugwenywe ukulaliswa esibhedlela. Ukunakekelwa kumele kube ukunakekelwa okunobuchwepheshe odokotela abahlengikazi (RN, LPN, noma LVN enikeza ngaphezu kuka-50% wamahora). Cishe u-11% weziguli ze-hospice zithola i-continuous home care ngesikhathi esithile.

Yiziphi izinga ezine zokunakekelwa kwe-hospice kwe-Medicare? 

Izinga ezine ze-Medicare hospice yilezi: (1) I-Routine home care, izinga elivame kakhulu elinikeza ukuvakashelwa njalo kwe-hospice team lapho kuhlala khona isiguli; (2) I-Continuous home care, enikeza amahora angu-8-24 okunakekelwa okubalulekile odokotela abahlengikazi ngezikhathi ezimfushane zenkinga yezokwelapha; (3) I-Inpatient respite care, enikeza izinsuku ezifika kwezinhlanu endaweni ukuze kunikezwe abanakekeli bomndeni isikhathi sokuphumula; kanye (4) I-General inpatient care, enikeza ukuphathwa kwezimpawu ezingeni lesibhedlela lapho ukunakekelwa ekhaya kunganele.

Umuntu angathola i-continuous home care isikhathi esingakanani? 

I-Continuous home care ihloselwe izikhathi ezimfushane zenkinga yezokwelapha, hhayi ukunakekelwa okwandisiwe. Iziguli ngokuvamile zithola i-CHC amahora noma ezinsuku ezimbalwa ngenkathi izimpawu ezibucayi zizolile. Uma inkinga isidlulile, isiguli sibuyela ekunakekelweni okujwayelekile ekhaya. I-Medicare ayibeki umkhawulo othile wesikhathi, kodwa ukubaluleka kwezokwelapha kokunakekelwa okuqhubekayo odokotela abahlengikazi kumele kuqhubeke. I-CHC ayifaneleki ezidingweni zokunakekelwa zama-24 awa ngosuku ngaphandle kwezimpawu zenkinga ezithile.

Yini umehluko phakathi kwe-continuous home care kanye ne-general inpatient care? 

Izinhlobo zombili zibhekana nezimo lapho ukunakekelwa okujwayelekile kwe-hospice kunganele. I-Continuous home care igcina isiguli sikhaya ngokuvakashela odokotela abahlengikazi ababalulekile amahora angu-8-24. I-General inpatient care idlulisa isiguli siyise esibhedlela, i-hospice inpatient unit, noma indawo yokuhlala odokotela abahlengikazi ukuze kulawulwe izimpawu ezibalulekile. I-CHC ifanele lapho izimpawu zingalawulwa ekhaya ngokwesekwa okubalulekile odokotela abahlengikazi; i-GIP ingeyezimo ezidinga ukungenelela okubalulekile kwezokwelapha njengemithi ye-IV noma ukuqapha okuqhubekayo.

Ngabe i-Medicare iyayikhokhela i-hospice respite care? 

Yebo. I-Inpatient respite care inikeza izinsuku ezifika kwezinhlanu zilandelana endaweni egunyazwe yi-Medicare (i-hospice inpatient unit, isibhedlela, noma indawo yokuhlala odokotela abahlengikazi) ukuze inikezwe umnakekeli womndeni isikhathi sokuphumula. Akukho mingcele ekungeni komndeni ngonyaka. Izindleko zesiguli zingama-5% wemali enyanga nsuku zonke. I-Medicare ikhokhela indawo yokulala nokudla ngesikhathi se-respite, ngokungafani nokunakekelwa okujwayelekile ekhaya ezindaweni zokuhlala.

Ubani ohlinzeka i-hospice yokunakekelwa ekhaya amahora angama-24? 

I-Continuous home care inikezwa yithimba le-hospice agency lesiguli, ikakhulukazi odokotela abahlengikazi abanamalayisense (RNs, LPNs, LVNs) nabasizi be-hospice abasekela ukunakekelwa okungeyona okunobuchwepheshe. I-hospice agency ihlela abasebenzi, ngezinye izikhathi isebenzisana nezinhlangano zabasebenzi ukuze kutholwe imvume yokuphuthuma lapho abasebenzi bayo bangeneleli. Akuzona zonke izinhlangano ze-hospice ezinekhono elanele le-CHC ngenxa yokushoda kodokotela abahlengikazi, ngakho-ke imindeni ingafisa ukubuza ikakhulukazi mayelana nokutholakala kwe-CHC lapho ikhetha umhlinzeki we-hospice.

Isiphetho

I-Medicare izokhokhela i-hospice yokunakekelwa ekhaya amahora angu-24 ngaphansi kwe-"continuous home care," enye yezinzi ezine zezinga lokunakekelwa kwe-hospice ezihloselwe izimo ezimfushane zenkinga. Izinga ezine zokunakekelwa yilezi: i-routine home care (ejwayelekile kakhulu, cishe i-99% yezinsuku ze-hospice), i-continuous home care (amahora angu-8-24 okunakekelwa odokotela abahlengikazi ngezikhathi ezimfushane, ezingalindelekile zenkinga, cishe i-11% yeziguli), i-inpatient respite care (izinsuku ezifika kwezinhlanu ukuze kukhululeke umnakekeli) kanye ne-general inpatient care (ukuphathwa kwezimpawu ezingeni lesibhedlela). Izimpawu ezibucayi zidinga ukunakekelwa okubalulekile odokotela abahlengikazi ekhaya nomndeni ofisa ukuhlala ekhaya kwakha ukunakekelwa okuqhubekayo ekhaya. Ithimba le-hospice lidlulisela isiguli esinyathelweni esisodwa sokunakekelwa kwenye njengoba izidingo zaso ziguquguquka. Ukuze uthole imininingwane egcwele mayelana nokunakekelwa kwe-hospice, bona isiqondiso sethu mayelana nokuthi ngabe i-Medicare iyayikhokhela yini i-hospice nokuthi i-Medicare ikhokhela isikhathi esingakanani i-hospice. Uma ufuna ukufakwa kwe-Medicare okubanzi, hlola iziqondiso zethu ze-Medicare kanye nezingxenye ze-Medicare ezichaziwe.

Noma ngabe lokhu kuthinta kanjani, futhi kungenye yezinto ezinzima kakhulu imindeni ezobhekana nazo, siyazi ukuthi lesi sihloko sinzima. Ungase udinge usizo olwengeziwe futhi kufanele uxhumane nesisebenzi somphakathi se-hospice, ithimba le-palliative care esibhedlela sakho, noma umeluleki wokudabuka. Imindeni ingathola izinsiza kwi-National Hospice and Palliative Care Organization, nhpco.org/">nhpco.org.