It can be expensive…
A significant portion of the population turns to hospice care in the United States. Over half seek care at a specialized hospice care facility, but almost 20% undergo hospice care at home. Debt.org reports:
Nearly 42 percent of terminally ill Americans receive some sort of hospice care; 83 percent of them are older than 65, and more than one-third are older than 85.
In 2016, approximately 1.43 million patients received hospice care in 4,382 Medicare-certified hospice agencies: 58% were freestanding or independent facilities; 21.3% were part of a hospital system; 19.2% were home health care-based; and about 1.5% were skilled nursing facility-based. In addition, there are a few hundred agencies that are not certified by Medicare.
When people enter hospice at home, then most likely a family member is going to be their caregiver. If the hospice care extends for a while, the family member is going to need breaks. Being a caregiver for a loved one who is near death is an emotionally and physically demanding job. Deacons should enlist members of the church to plan a respite day or weekend if possible.
Debt.org reports how expensive hospice care can cost in the final two months of a person’s life:
Hospital inpatient charges exceed $6,200 per day, and costs to maintain someone in an ICU can reach up to $10,000 per day. Skilled nursing facilities were reimbursed at a rate of approximately $622 per day.
U.S. News explains that, even when covered by insurance or Medicare, custodial care is extra:
Remember, custodial care is not covered. While hospice benefits are comprehensive, they will not cover room and board or ongoing custodial care. Terminally ill patients can receive hospice care in an assisted living facility or nursing home, but they’ll have to pay for their stay out-of-pocket.
The cost for this can be $5,000 a month.
AN ESTIMATE OF EXPENSES
Most people who use hospice care do not pay the expense out of pocket because it is covered by insurance, Medicare, or Medicaid. But these do not cover all the expenses.
An analysis published by the National Bureau of Economic Research (NBER) examined a large dataset and identified a range of out-of-pocket expenses that are not covered by insurance, Medicare, or Medicaid:
The authors find that out-of-pocket expenditures toward the end of life are large – the average amount is $11,618 in the last year of life. There is also considerable variation in end-of-life expenditures, with ten per-cent of respondents spending more than $29,000 per year and the top one percent of respondents spending more than $94,000 per year. These values are large relative to the non-housing wealth of a typical older household, which is about $25,000.
The authors find that the largest single category of spending is nursing home and hospital expenditures, which average $4,731 in the last year of life; roughly two-thirds of that amount is for nursing home care. Here too the distribution is skewed, with the top one percent spending more than $75,000 per year in this category. Other big expenditure categories include insurance ($1,746 on average), prescription drugs ($1,496), home health care and helpers ($1,966) and spending to make houses accessible ($721).
They also discovered that wealthier people pay more than poor people:
The authors also explore whether out-of-pocket health care expenditures vary with the respondent’s income or wealth. They find that they do, particularly with respect to wealth – the richest 20 percent of households spend an average of $18,232, versus $7,173 for the poorest 20 percent of households. These differences ap-pear to be driven mostly by greater spending for nursing homes, home health care, and items related to making houses accessible.
Medicare pays for most of the hospice care in the United States. Medicare’s daily payment rates for 2020 were:
- Routine Home Care (Days 1–60): $194.50
- Routine Home Care (Days 61+): $153.72
- Continuous Home Care: $1,395.63
- Inpatient Respite Care: $450.10
- General Inpatient Care: $1,021.25
If patients and their families had to pay these costs themselves, then business for the hospice care industry would fall significantly.
An older study reported that the average hospice stay was about 3 weeks.
Even when covered by insurance, Medicare, or Medicaid, families can expect to pay about $12,000 in out-of-pocket expenses in their final year of life.
This is at least $24,000 for both spouses, assuming all the other costs are covered by someone else.