How do you get the most out of. Life?

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1 How do you get the most out of Life? Tabitha Hospice

2 Tabitha Hospice services may include: Care directed by your personal physician Skilled nursing visits How do you get the most out of Life? Tabitha Hospice Despite enormous medical advances, too many Americans still die alone or in pain. Too many endure costly and ineffective treatments. And too many come to hospice too late, or not at all. The great majority of Americans surveyed by the National Hospice Foundation say they would prefer to die at home, but only a small percentage do. However, of those with hospice care, 75% die at home. Tabitha Hospice is second to none for quality, compassionate, end-of-life care. A team approach combining expert medical care, pain management and emotional and spiritual support, hospice care allows a person s final months to be lived to the fullest, pain-free and with dignity. What is hospice care? Tabitha Hospice is delivered at home or wherever the patient calls home. Our interdisciplinary teams provide a broad range of services for individuals diagnosed with a condition that limits their life expectancy to six months or less. Social worker support Pastoral care Volunteer visits Counseling services Bereavement services Coordination of pharmacy, durable medical equipment and supplies, and payment for medications and supplies as identified in the care plan Consultation with Tabitha Hospice Medical Director Personal care services Physical, occupational or speech therapy Nutritional counseling Hospice care neither hastens nor postpones death; rather, it affirms life, helping individuals and their families to get the most out of life. Tabitha Hospice supports families by easing the stress of caregiving. We provide a wide range of services, from treatment and advance-directive planning, to emotional and spiritual support, to grief counseling. Tabitha Hospice services are provided to qualified individuals at no cost as a fully-covered Medicare/Medicaid benefit. Tabitha. Your answer for Elder Care photo courtesy Lincoln Journal Star 2 3

3 How will you chart your end-of-life Journey? Without Hospice Care Will I face financial challenges? End-of-life care costs have risen exponentially, especially as our advanced U.S. medical system offers an everexpanding array of interventions, often resulting in repeated hospitalizations and substantial expenses, many of which only nominally impact length or quality of life. With Tabitha Hospice Care Tabitha Hospice reduces financial burdens. Hospice care is a fully covered Medicare/ Medicaid benefit for qualifying individuals. Not only is hospice care paid for, but also covered are the cost of medications for symptom control and pain relief, medical equipment and supplies included in the patient s plan of care, such as beds, walkers, oxygen for home use and dressings. Without Hospice Care How will I spend my final days? 80% of Americans spend the majority of their final days in hospitals even though the vast majority say they would prefer to die at home in the company of family. With Tabitha Hospice Care Enjoy your home and family longer. The majority of Tabitha Hospice patients die at home, not in the hospital. Will my final wishes be fulfilled? When an individual is confined to the hospital or family is overwhelmed by caregiving, it can be difficult to achieve one s final wishes. Make the most of your life. Early engagement with the Tabitha Hospice interdisciplinary team helps individuals enjoy the things they care about most and pursue final wishes and goals. Will I die in pain? Many end-of-life patients experience pain and other distressing symptoms as their illnesses, which cannot be optimally treated by family or are often under-treated in hospitals, progress. Live with dignity as pain-free as possible. Your Tabitha medical director works with your physician to develop a plan for optimum pain relief and symptom management. The medical director will intervene to assure delivery of appropriate treatment to support your care plan, within established hospice guidelines. How can I provide for my family s emotional support? Families can suffer severe emotional stress when dealing with the illness and death of a loved one. Without support, this can have serious negative effects. Tabitha Hospice supports your family. The Tabitha Hospice team will provide the emotional and spiritual support vital to coping with end-of-life situations. Counseling and grief support is available at no cost to families of individuals who have been cared for by Tabitha Hospice. What stress will my family experience? Families shoulder 100% of the stress of organizing and providing caregiving and decision making, taking away valuable time that could be spent enjoying the final months of a loved one s life. Ease the burden on your family. Although not a primary caregiver, your Tabitha Hospice team reduces the stress of caring for a terminally ill loved one by providing nursing, emotional and spiritual support, medical planning and advancedirective help, and many other resources to ease the challenges of caregiving. 4 5

4 Why is Tabitha is the Answer for hospice care? A pioneer in hospice care. Established in 1979, Tabitha Hospice is the longest-serving hospice program in Nebraska. Tabitha Hospice has gained the trust of families and healthcare providers across the state. Exceptional record of satisfaction. Of families surveyed who had used Tabitha Hospice, 100% said they would choose Tabitha Hospice again and recommend it to their friends. Founded in Christian compassion. Like all Tabitha Elder Care services, Tabitha Hospice is motivated by Christian compassion, not economic gain. We are a not-for-profit hospice care provider. Unlike many of our for-profit competitors, out foremost focus is not generating profits for our owners. Instead, we focus on helping those we serve make the most of their lives. Comprehensive support services. In addition to hospice care, Tabitha offers a broad range of medical and non-medical home care services that can serve needs not covered by hospice care. Admission criteria Tabitha Hospice cares for individuals facing life-ending illnesses. Most people have the mistaken assumption that a hospice patient must be near death, bed bound and unable to continue living life to the fullest. This assumption is simply not true. Tabitha Hospice seeks to help individuals with life-limiting conditions and their families make the most of their remaining time. Many in hospice care continue to enjoy social activities and are encouraged to remain as active and engaged as their physical condition allows. Who is eligible? Tabitha Hospice is available to anyone with a life-limiting illness or condition and a prognosis of less than six months to live. This must be certified, generally by your personal physician and the Tabitha Hospice medical director. You desire palliative hospice care. This means you are choosing symptom and pain management rather than ongoing curative measures. You reside in the Tabitha Hospice service area. You can be cared for safely. Tom was suffering from ALS when he said to his wife, I think it s time we started hospice. She protested, But you re not ready to die. No, he explained, but that s not all hospice is for. We need hospice now so our family can better enjoy the time we have remaining, instead of always worrying about my care. Tom was right, and his Tabitha Hospice team lovingly handled his personal care, helped with light housekeeping and encouraged his family to do special things together, which may not have been possible without the caring, compassionate support of Tabitha Hospice. 6 7

5 Shouldn t your loved one Best Team be supported by the in hospice? When you choose Tabitha Hospice, your family will be supported by an experienced, caring team that is second to none. Our medical director, Dr. Lisa Mansur, is one of the state s foremost experts on hospice and palliative care. She is passionate about helping people make the most of their end-of-life journies. Dr. Mansur and our associate medical directors work with physicians to develop patient care plans and provide ongoing review of Tabitha Hospice care. If necessary, our medical directors can intervene to ensure you receive appropriate treatment that conforms to your care plan and falls within established hospice care guidelines. Your Tabitha Hospice nurse will make scheduled visits according to your needs. Your nurse will work closely with your family and your physician to monitor symptoms and medications, coordinate communications and serve as an educational resource. Nursing staff is on-call 24/7 for consultation and emergency visits. Emotional and spiritual support, and counseling is provided by our mental health counselor, social workers and pastoral team. We can help you access community resources, plan advance directives and make your way through the end-of-life journey. Tabitha is the only hospice program in Nebraska with a licensed mental health counselor available to assist individuals and their families. Home health aides and homemaker services provide assistance with personal care and light housekeeping. Trained, caring volunteers provide assistance through companionship, listening, respite care and helping with everyday tasks such as transportation, child care and bereavement support. Many of our volunteers have become long-term friends of the families they serve. Other team members may include a dietitian or physical, occupational and speech therapists. Tabitha medical and non-medical home care services are available to serve needs not covered by hospice care. Bereavement counseling is provided to loved ones for 18 months following death. Melvin had long been a fan of his hometown high school football team. During Melvin s final year of life, his team made it all the way to the state championship game. Neither Melvin nor his wife ever dreamed he would be able to attend. But because his hospice team had been caring for Melvin for months, and because he was still well enough to travel, something special happened. Melvin s hospice team made arrangements and Melvin, his wife, his Tabitha Hospice nurse and volunteer watched his team win the state championship game from a Memorial Stadium skybox. 8 9

6 What else should you know about Hospice? Tabitha Hospice care is provided at no cost to qualified individuals. Hospice has been included as a Medicare benefit since Tabitha Hospice services are covered 100% under the Medicare hospice benefits. This means there are no out-of-pocket costs for qualified individuals. In addition, Medicare hospice benefits cover the cost of associated medications, durable medical equipment and a variety of nursing and support services. The length of Tabitha Hospice care is not limited. The Medicare hospice benefit is intended for persons facing a life-limiting illness or injury with a prognosis of six months or less. However, coverage is not limited to six months. Some individuals may receive hospice care longer than six months. Some individuals improve and no longer need hospice care. Yet most come to hospice care only in their final days, greatly limiting the benefits they could have accessed. Tabitha Hospice care can begin at any time. Our staff is on call 24 hours a day, seven days a week. Many people think hospice is only for dying. Tabitha Hospice is all about making the most of life. Tabitha Hospice care can be provided for many life-limiting conditions. Hospice care is appropriate for any individual diagnosed with a progressive, life-limiting illness or condition with a prognosis of six months or less. Conditions include, but are not limited to: Acute stroke Coma ALS Cancer Congestive heart failure COPD Dementia/Alzheimer s HIV MS Parkinson s Renal/Liver failure You are not required to sign a do not resuscitate directive to receive Tabitha Hospice. In addition, if you enroll in hospice care, you may still take medications for underlying conditions. Regular medications need not cease; in fact, the cost of many medications will be covered by Medicare/Medicaid. Additionally, Medicare/Medicaid hospice benefits may cover the cost of pain-relief medications, medical equipment and supplies such as hospital beds, walkers, oxygen and dressings all in addition to standard hospice services. You may discontinue hospice care at any time. When you choose hospice care, you are choosing to focus on caring rather than curing. If you decide to return to curative treatments or simply want to discontinue hospice care, you may withdraw from hospice at any time. Should you choose to return to hospice care, there are some restrictions and you will need to be recertified to ensure fulfillment of eligibility requirements. Jean had been diagnosed with cancer. With a poor prognosis, she decided to not undergo chemotherapy or risky surgery. Because of her decision, Jean was able to enjoy the last several months of her life more fully. She spent quality, pain-free time with her family and friends and did more of the things that were important to her during her final days

7 Will Medicare cover Hospice Care? Benefits Since 1983, Medicare Part A has covered hospice care for qualifying individuals. Hospice care is focused on support and pain/symptom relief rather than curative treatment and recovery. If you choose to use the hospice benefit, you waive the right to standard Medicare Part A benefits for services related to end-of-life illness. Medications. The Medicare hospice benefit includes arrangement and payment for medications for sympton management and pain relief related to a life-limiting illness. The patient is not required to discontinue regular medications (such as blood pressure medication)s although the cost may not be covered. Durable medical equipment. The Medicare hospice benefit provides and pays for durable medical equipment that the patient s physician and hospice team determine are necessary. This may include a walker, hospital bed, oxygen and commode. Tabitha Hospice will arrange for delivery of equipment. Benefit periods. The Medicare hospice benefit begins with two 90-day periods, followed by an unlimited number of 60-day periods. Health status must be recertified at the end of each period and after each 60-day period requires a face-to-face physician/medical director consultation. Hospice care is delivered continuously unless you choose to revoke the benefit or your condition is no longer considered life-limiting. Revocation of the hospice benefit. You make revoke (end) hospice care at any time by completing a signed statement. This may be necessary if you decide to pursue further curative treatments or simply decide you do not want to be in a hospice program. Any remaining days in the benefit period are forfeited as of the revocation date. Levels of Care Routine home care includes all hospice services provided in your home or where you are living or being cared for. Tabitha staff schedule visits depending on your needs, as outlined in your care plan. Tabitha Hospice does not serve as a primary caregiver but in a role that supports you and your family. Inpatient care may be necessary if acute or chronic pain and symptoms cannot be managed at your home. This can be done at any number of hospital or nursing facilities. Additional information can be provided upon request. Inpatient respite care may be planned to provide temporary rest and relief for family caregivers. Continuous home care may be provided during periods of crisis, for a specific time period when the patient requires a nurse or other support to achieve management of acute medical symptoms. The goal of continuous care is to provide support at home and to avoid a move to a nursing facility or hospital. Medicaid hospice benefits are available if you have an income below a certain level. Some seniors are on both Medicaid and Medicare, while Medicaid-only patients do not qualify for Medicare, generally because they are younger. PAYMENT INFORMATION Generally speaking, Medicare, Medicaid or your insurance will cover the costs associated with hospice care. As a licensed and certified hospice care provider, Tabitha can bill Medicare, Medicaid, V.A. and insurance carriers for hospice services. If you are using other Tabitha services outside of hospice care, you may pay privately. Additional insurance information specific to your situation is available upon request. When you sign the Tabitha Hospice election/assignment of benefits form, you authorize Tabitha to bill the appropriate agency and obtain medical and billing records concerning your condition. This form also allows us to release information to or from other care providers or third-party reimbursement sources

8 Where is Tabitha Hospice available? Tabitha Hospice can care for you where you are: in a private residence, assisted living facility or skilled nursing home. We serve 28 counties in southeast Nebraska and work with nearly all senior care facilities. Journey House Tabitha understands that life s story never ends. We are here to help families, friends and loved ones celebrate the journey of life. That s why we opened Journey House on our Lincoln campus. This one-of-a-kind environment provides end-of-life care in a comfortable, home-like setting. Many families say they wish they had Don enrolled in hospice earlier. t wait! 14

9 LOCATIONS AND PHONE NUMBERS Main Campus Randolph Street, Lincoln, NE West Region Grant Avenue, York, NE East Region Central Avenue, Nebraska City, NE TTY from Nebraska Relay Service: TT TTV www. TabithaHOSPICE.org 11_0431_HSP_P 2011