Hospice Care Attorney
in New Jersey

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Has Your Doctor Recommended Hospice Care?

Do You Need to Get Your Final Affairs in Order?

Let us help you. Please contact us to speak to an experienced NJ hospice care attorney toll-free at (855) 376-5291 or you can contact me directly by email fniemann@hnlawfirm.com

If your physician has recommended hospice for you or a family member, you likely have lots of questions. What is hospice? How does one enroll? How much does it cost? And perhaps how it differs from traditional medical care under Medicare or traditional health insurance plans.

For Peace of Mind and Quality of Life
for Loved Ones on or Near Hospice

Dying With Dignity Makes Hospice So Beneficial 

Why Choose Hanlon Niemann

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Hospice Philosophy: Living Well Until We Die

Patients and families who face a terminal illness may at first focus on the impending loss of life. However, hospice programs encourage them to make the most of living and enjoying what may be the patient’s last months. Staying in the home lets patients reunite with friends and family members. It gives everyone a chance to reminisce and laugh together, despite the sadness, anger and pain that often accompany death. Hospice lets patients live until they die — enjoying life to its fullest potential.

What Is Hospice, Anyway?

Rather than a place to receive medical care, hospice is an approach to medical care for patients nearing the end of life. Its goal is to enhance the quality of life for patients with terminal illness. Hospice focuses on pain management and symptom relief, while addressing the patient’s emotional, social and spiritual needs—as well as those of family members. Hospice lets patients and families share the end-of-life experience with dignity and, in most cases, in the comfort of their own homes.

Each person entering a hospice program gets an individualized care plan. This plan is developed by a team of professionals and volunteers working with the patient and family members. Depending on the patient’s needs, the team may consist of the patient’s primary care physician, a hospice physician (or medical director), nurses, home health aides, social workers, clergy, trained volunteers and speech, physical and occupational therapists. NJHospice.org

Why Choose Hospice?

A patient with a life-limiting illness may reach a point where he or she no longer responds to treatments aimed at curing the disease. At that time, the physician may recommend a shift in focus from curing the disease to making the patient as comfortable as possible. This shift toward palliative care is “comfort-oriented” rather than “cure-oriented.” It is medical treatment that seeks to control symptoms and manage pain. When the physician’s estimation of the patient’s life expectancy is six months or less, hospice care often is the best option.

Although some hospice care is administered in assisted living facilities, nursing homes, hospice centers, and inpatient settings, approximately 80 to 90 percent of hospice services occur in the patient’s own home. That’s partly because advances in technology have made it possible to operate much medical equipment in a home setting. It’s also because hospice team members and volunteers are available to provide services, as needed, including:

Pain and symptom management

  • Assistance with the emotional, psychological, social and spiritual needs
  • Drugs, medical supplies and equipment
  • Training for family caregivers
  • Speech, physical and occupational therapy
  • Arrangements for respite care
  • Bereavement counseling for surviving family members and friends
  • Help with day-to-day chores and activities of daily living
  • Experienced counsel for end-of-life decisions
  • 24-hour on-call availability

What Treatment and Medications
Will I Receive?

The purpose of hospice is to provide comfort to the terminally ill patient. This includes relief from pain. To achieve maximum relief from pain, it is usually necessary to administer morphine, which is on the Schedule II list (narcotics).

Narcotic drugs have a proper and constructive role in pain management, and using narcotic drugs for this purpose is endorsed by the federal government. Sometimes, hospice staff can reduce a patient’s pain and increase comfort through “complementary therapies” such as Reiki, aromatherapy and massage. But you can choose not to take narcotic drugs!

Many terminally ill patients receiving narcotics for pain relief gradually build up resistance to these medications and can tolerate much higher levels of medication without fear of addiction. Inasmuch as a hospice patient has a limited life expectancy, it is highly unlikely that addiction will develop.

When hospice is elected, the patient is choosing comfort care over curative treatment. The side effects of chemotherapy (vomiting, nausea, etc.) are rarely seen as comfortable. There are instances, however, when a valid medical decision might include one or more chemotherapy treatments for relief of pain or symptom management. Discuss the situation with the hospice nurse as soon as possible.

“Palliative care” and “comfort care” are terms often used interchangeably to describe an interdisciplinary approach to caregiving that seeks to provide physical, psychosocial and spiritual comfort to a patient. Palliative care can be used in conjunction with curative treatment. In the past few years, some physicians and other caregivers have embraced the concept of palliative care and are using its techniques with their (non-hospice) patients, mainly those in hospitals and nursing homes. Palliative care in those settings can provide a helpful transition to hospice services.

Hospice is a kind of palliative care specifically designed for the terminally ill – that is, when cure is no longer possible or when the side effects of curative treatment have become too burdensome for the patient.

What happens if I suddenly get a lot of pain?

You and your family caregivers should follow the instructions given to you earlier by the hospice nurse. You are encouraged to call the hospice office for instructions and advice.

What is a “pain kit”?

A “pain kit” is a package of medications, prescribed by a pharmacist and secured by the hospice, which is available to treat a hospice patient’s pain. The “pain kit” remains in the patient’s home.

Why won’t hospice pay for all my medications?

Medicare regulations state that the patient will co-pay $5 or 5% of the prescription cost, whichever is less. It is not a decision for hospice to make.

Hospice can only pay for medications related to the terminal illness. If a patient with a chronic heart condition is admitted to hospice for terminal cancer, hospice will be able to pay for the cancer drugs, not for the heart drugs.

Can you help me die – the “little black pill” or something like that?

Hospice provides comfort to the patient, allowing death to occur naturally. Hospice does not hasten or delay death.

They’ll give the patient extra morphine to “push him over the edge” near the end, right?

Hospice seeks to reduce the patient’s physical pain, often through the use of morphine. A patient on morphine often develops a natural tolerance to the morphine over time, requiring the hospice to use larger doses of morphine to keep pain to a tolerable level. Larger doses of morphine may depress respiration (breathing) as a side effect, sometimes to the point where a patient stops breathing. This is called the “double effect,” which is accepted medical practice, widely accepted by religious groups, and in keeping with hospice philosophy, which seeks to ease a patient’s suffering while neither hastening nor delaying death through artificial means.

What’s Permissible?

What if I want to travel to another city or state — to a family event or vacation, to visit someone, or to see someplace that’s important to me?

Hospice patients may travel — unlike some other Medicare benefits, there is no requirement that the patient be home-bound. A hospice agency, however, cannot itself continue providing care if a patient moves out of its service area.

If you plan a short trip, your hospice can contract with another hospice agency to provide care at the site of your visit. This is possible under rules approved by Congress in late 2003. You should begin making these arrangements with your hospice well in advance of your trip.

If you plan an extended stay, or plan to live at the other location, you should let your hospice know beforehand to arrange a transfer. This will allow a hospice agency at your new location to continue your care without interruption.

If I decide I need to go to the hospital, what do I do? What happens if I need to take an ambulance to the hospital?

If you think you need to go to the hospital, you should speak to your hospice caregivers at once.

When you elected hospice care, you authorized the hospice to make some caregiving decisions for you. Hospice care plans are generally designed to maximize the quality of life for patients and families, and allow patients to remain at home. Going to the hospital for anything related to your terminal illness would generally be seen by the hospice as non-compliant with its plan of care. Such action may result in a patient being discharged from hospice care. Also, the hospice will not cover the costs of hospital services or transportation to the hospital if the move was not included in the patient’s hospice plan of care.

If you are now receiving treatment at a hospital (or from a physician) for conditions not related to your terminal illness, you should tell your hospice agency about this at the earliest opportunity, preferably before election of hospice care. This will not necessarily disqualify you from electing hospice care. The hospice will, however, determine whether the treatment for the “other” condition is consistent with the requirement that hospice patients forego curative treatment. It is possible, for example, to be covered under Medicare Part A both for hospice care as well as for certain treatments not related to the terminal illness but which increase patient’s comfort and quality of life.

Can I still see my doctor for my terminal prognosis?

Yes, you may keep your doctor. Hospice will work with your physician regarding your terminal illness. Your doctor is able to bill Medicare for his oversight of your case while you are receiving hospice care.

Sadly, though, some doctors do not wish to continue to follow their patients after they elect hospice care. They may want to focus on patients for whom cure is still an option. They might feel there is “nothing more” he or she can do. They might feel a sense of “failure” if a patient becomes terminal. Many more doctors, however, want to help their patients during this difficult time and understand the extra comfort that patients get from continuing with their own familiar physician despite the change from curative to comfort care.

Can I still see my doctors for my other diseases?

Yes. Let your hospice team know you plan to do so.

What Hospice Services Are Available to Me?

Why can’t I get care ‘round the clock from hospice?

Hospice care is an intermittent care program, meaning that care is provided through visits by hospice team members.

Hospice does not provide ongoing 24-hour care for the patient at home, nor does hospice provide caregivers for the eight to 10 hours a day when a family member is away at work. Hospice care provides support to the family – it does not replace the family. Hospice care is delivered through visits by nurses and counselors, by volunteers (if the family wishes), and by home health aides (if the hospice determines appropriate need).

If no one is available around the clock to care for the patient, families can seek ideas from the hospice social worker about how things can be “pieced together” to provide an appropriate level of care and companionship. Families can look at:

  • Splitting the care giving duties so each family member has a “shift.”
  • Having one or more family members take reduced hours at work.
  • Chipping in on payments to one family member who takes a leave of
  • absence from work to stay at home with the patient.
  • Bringing in a relative or friend whose time is more flexible.
  • Hiring a companion for the patient while family members are at work.

Caring for a hospice patient at home is often difficult, sometimes exhausting, and always requires adjustment and extra effort by the family and/or spouse. Nonetheless, families see hospice care at home as the final gift they can offer their loved one, and many family members say they are glad they chose hospice, despite the extra effort.

Can a family get help taking care of the hospice patient?

Hospice is all about helping families care for their loved ones. Hospice staffers provide direct care to the patient and education to family members about providing care.

Hospice, however, does not provide care around the clock, nor does it provide shift care. If the family feels they must hire a companion for the patient for any portion of the day, they are free to do so privately. The hospice’s social worker can help the family identify resources that might help.

What happens if we can’t handle our loved one at home?

Caring for a patient at home can be stressful and tiring, but many families are glad they did so, to be close to their loved one near the end.

There are valid reasons, however, why a family might not be able to handle caregiving at home, and these will be among the first issues to be addressed by the hospice team. Perhaps the only other person living with the patient is a weak or elderly spouse or parent. Perhaps the home or neighborhood is not a safe location for caregiving that involves narcotic pain relief. Perhaps work schedules of adult children cannot be reduced or juggled.

Many families who don’t think they can manage a patient, in fact, can do so with simple and proper training from the hospice team. Your family members will not be expected to become nurses, doctors or counselors. You will, however, need to provide more time and attention to your loved one.

Useful parallels can be drawn between caring for a newborn and caring for a hospice patient. The physical aspects of caregiving are messy and tiring. Also, the entire household tends to focus on the newborn or the hospice patient. There are many changes in your routine, and possibly some emotional stresses will come out. The major difference is between the joy of a newborn and the sadness of losing a loved one. Just provide care to the hospice patient with the same love and patience as you would to a newborn.

Your hospice caregivers are very experienced in these matters. Remember that the patient and family is the unit of hospice care. It is OK to “unload” your concerns on the hospice team and let them know you are tired and stressed out. They will have helpful ideas on how to cope.

Can a nurse come every day?

Frequency of visits is based on the patient’s condition and is determined by the hospice agency hired to care for the person. In cases of severe pain or symptom management issues, daily visits may be necessary, but they are unlikely to be needed for most patients.

How many hours a day can I get from aides? Why did my friend in another state get more hours from the home health aide than I am?

Aides provide support in housekeeping related to the patient’s illness. Aide services are available to hospice families based on need, as determined by the hospice. Every case is considered for aide services, but there is no “requirement” that a hospice agency provide aide services on every case, nor that any particular number of hours be provided.

Why can’t the aide be here when I want her here?

Aides typically see several families each day and may not have much flexibility in their schedules. Also, aides sometimes do not own cars and must travel by public transportation, and therefore must organize their days based on bus schedules. If you have scheduling requests, call the hospice office and speak to the person who organizes the aides’ workloads.

Will somebody hold my hand when I die?

Hospice provides comfort to the dying patient and family. If it is important to you to have someone hold your hand in your final moments of life, or just be by your bedside, you should say that to your family caregivers and to the hospice staff.

Do family members need to be in the house 24/7?

No. It is quite common for hospice staff or trained volunteers to give family members a break of an hour or so if they wish. If your family has been caring for your loved one for weeks, and needs a break of several days, discuss the benefits of respite care with the hospice staff. Respite care will allow the patient to be transported to a health care facility for several days while the family takes a breather.

Do I have to use a hospital bed rather than my own bed?

No. Hospice seeks to improve the patient’s comfort. If you feel more comfortable in your own bed than in a hospital bed, you should say so to your hospice caregivers. If there are reasons why a hospital bed would be helpful in your case, the hospice staff will let you know.

What is continuous care?

Continuous care is one of four levels of hospice care and payment, under the Medicare and Medicaid Hospice Benefits. It designates a short period – usually a day or less – where the continuing presence of hospice staff is required in the home, as determined by the hospice. Usually these are periods when a patient’s pain has suddenly increased or when symptoms need special attention. Most patients do not require any periods of continuous care.

What is respite care?

Respite care is a period of several days for which the hospice patient is moved to a caregiving facility and receives hospice care there. This facility is typically a nursing home or a hospital. Respite care is designed to give a tired or stressed family a break from caregiving. If your family is at such a point, discuss respite care with your hospice staff.

Will the nurse really come in the middle of the night?

Hospice agencies have “on call” nurses for nights and weekends. Much of the work of an on-call nurse is educational in nature and is done by telephone. In cases of extreme pain or symptom issues, however, the nurse can make a house call at any time if, in her or his judgment, it is necessary.

Will you help me with funeral arrangements?

Hospice staff, especially the social worker, will be glad to guide the family in making decisions about the funeral. Families are encouraged to do this well before the patient dies. Let the hospice staff know you’d like to talk about it.

Levels of Care for Hospice in NJ and Medicare Eligibility Requirements

Medicare pays a great deal of the services provided by Hospice throughout the country. In order to be eligible, a patient must be covered under Medicare Part A and must also have certification from a physician that the patient’s life expectancy is six months or less, assuming the illness runs its normal course. There is a great deal of confusion about the six month standard. It does not mean that the patient will lose his or her Hospice benefits after six months. Instead, it simply means that in order to be eligible, there must be a six-month life expectancy. After the initial period of certification, however, the patient can have an unlimited number of additional sixty-day periods. So long as the individual continues to have a life expectancy of six months or less, Hospice can go on indefinitely.

To enroll in Hospice, the patient must sign a statement electing the Hospice benefit. This is perhaps the most difficult step for many families to take, since this election shifts the course of treatment from curative (i.e. intending to help the patient get better) to palliative (i.e. treating the pain, but not trying to cure the illness). Many patients worry that by electing the palliative (pain reducing) course of treatment, they are locking themselves into something that cannot be changed. That is not correct. The election from Hospice to non-Hospice to Hospice care can be made as frequently as the patient desires.

A great benefit of Hospice care is that medication related to the terminal illness is covered with a maximum co-pay of five dollars per prescription. In this day and age of spiraling medication costs, this benefit alone can save families a tremendous amount of money. In addition, the new Medicare law added another valuable Hospice benefit. Under the law, patients can have a one-time educational consultation by a Hospice physician to the terminally ill patient, even when that patient is not yet in Hospice. The consultation could occur in a care facility or at home, and should also include a pain assessment, along with counseling on care options and advance planning.

The question frequently arises… does Hospice pay for nursing home care? If the patient is a nursing home resident, there will be Hospice benefits available, much like if the resident were at home. The Medicare Hospice benefit will not cover the costs of room and board at the nursing facility. It will, however, continue to cover the types of services mentioned earlier.

What if the patient is not eligible for Medicare Part A? Are there other ways to pay?

In addition to Medicare, there are many ways that Hospice care may be paid for. Often, Health Maintenance Organizations (HMOs) and managed care organizations cover the cost of Hospice care. In addition to Medicare, for military patients as well as those covered by CHAMPUS (the health benefits program for retired military personnel and dependents) will frequently cover the cost of Hospice. Additional funding for Hospice also comes from community contributions, memorial donations and foundation gifts. Many Hospice programs also use a sliding-fee scale, based on a patient’s ability to pay for services when insurance and other benefit programs are not available.

TESTIMONIAL

First of all, I just wanted to thank you so much for the time, and most of all, for the knowledge, concern and support you so generously gave me during our meeting on May 26, 2010. I walked out of your office feeling much more confident and very relieved. I’m not sure how you will take this, but you are an extraordinary human being and the antithesis of the stereotypical lawyer. A usually skeptical person, I trusted you from the moment I shook your hand! In addition, every member of your staff with whom I came in contact with was courteous, respectful, and helpful. You and your partner have created a very special environment, and you should be commended.

– Marybeth Kappenberg – Briarwood, NY

TESTIMONIAL

Fred is an amazing and dynamic person. I have attended a few of his work shops and CEU events over the years and his interactive discussions have been both educational and entertaining. He is one of the few lawyers out there that I do trust and does whatever he says he is going to (Accountability) who ever I have referred his way has always thanked me for connecting them and this is why I continue to work w/ Fred. Great person, excellent ethics, and very knowledgeable. I highly recommend him.

– Steve Weiss, Regional Director of Professional Relations, Senior Bridge

TESTIMONIAL

My wife and I wanted to express our gratitude for the guidance and patience from you and your staff along this journey. Life is strange at times and the things that bring us together can be just as strange, if not more.

I not only got to put a few bucks in the bank, but got to reconnect with my cousin Sarah, which was a great surprise for me. That alone was worth the journey for me. Getting to know her and the family has been really nice.

I know it was a long day for all of us in mediation, but I really am blessed to have gotten to know you and talk with you. I admire your skills, work ethic and attitude regarding time and Patience. When the opposing attorney was running her big mouth and doing her thing, you never lost your composure, nor your position. I’m hoping it’s one of the nuggets I’m able to take and implement in my personal/professional life.

The short version of this story is that you have a lot to offer people, you’re a true, trusted advisor. Your words and actions seem to align with your values, which is like common sense, very hard to come by now a days. Your staff does a great job as well. Please let them know that as often as you can.

Keep up the good work Fred and thanks again.

– Mike Price – Plainfield, IN

Recent Speaking Events by Fredrick P. Niemann, Esq.
You Can View Fred’s Current Schedule by Clicking Here

Fredrick P. Niemann Esq.

Fredrick P. Niemann Esq.

Do you have questions about hospice not addressed here? If so, contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com to schedule a consultation about your particular needs. He welcomes your calls and inquiries and you’ll find him very approachable and easy to talk to.

Fredrick P. Niemann, Esq. was recently asked to speak at the NJ State Bar Association Institute of Continuing Legal Education in New Brunswick, NJ on the essentials of estate planning.

Mr. Niemann addressed attorneys from throughout the state of NJ interested in learning key concepts and principals of NJ estate planning, including such topics as wills, trusts, estate taxations, asset protection, powers of attorney, health care directives, special needs and supplemental needs trusts for disabled and incapacitated individuals, avoiding probate through creative use of beneficiary planning, inheritance taxes, gifting and changes coming to federal estate taxation.

Fredrick P. Niemann, Esq. attended the 46th annual Heckerling Institute on Estate Planning Conference from January 9th to January 13th at the Orlando World Center sponsored by the Community of Miami School of Law. This week long session assembled the nation’s leading authorities to lecture and discuss the latest in estate planning techniques and strategies. Topics analyzed and discussed included 1) elder law; 2) asset protection; 3) statutory case law developments; 4) planning with financial assets including annuities, Roth IRA’s, and life insurance policies; 5) litigation and tax controversies; 6) networking and practice development.

Please see our other related websites:

LOOK WHERE FRED HAS BEEN

OFFICE OF CONTINUING EDUCATION WORKSHOPS

Rutgers State University is pleased to invite Mr. Fred Niemann of Hanlon Niemann to be the guest speaker at their workshops for the Office of Continuing Education.

Mr. Niemann will offer continuing Education courses on “Elder Abuse and Financial Exploitation”, “Hidden Secrets of Veterans Benefits”, “Veterans Aid and Attendance Benefits 2013”, “Medicaid Changes: The Approaching Storm”, and the “New NJ Comprehensive Waiver Demonstration”.

Click here to check our website for current dates for these events.

Fredrick P. Niemann, Esq. was recently asked to speak at the NJ State Bar Association Institute of Continuing Legal Education in New Brunswick, NJ on the essentials of estate planning.

Mr. Niemann addressed attorneys from throughout the state of NJ interested in learning key concepts and principals of NJ estate planning, including such topics as wills, trusts, estate taxations, asset protection, powers of attorney, health care directives, special needs and supplemental needs trusts for disabled and incapacitated individuals, avoiding probate through creative use of beneficiary planning, inheritance taxes, gifting and changes coming to federal estate taxation.

Fredrick P. Niemann, Esq. attended the 46th annual Heckerling Institute on Estate Planning Conference from January 9th to January 13th at the Orlando World Center sponsored by the Community of Miami School of Law. This week long session assembled the nation’s leading authorities to lecture and discuss the latest in estate planning techniques and strategies. Topics analyzed and discussed included 1) elder law; 2) asset protection; 3) statutory case law developments; 4) planning with financial assets including annuities, Roth IRA’s, and life insurance policies; 5) litigation and tax controversies; 6) networking and practice development.

Mercer County Chapter of the New Jersey Society of CPAs

Fredrick P. Niemann spoke before the State Society of CPAs Mercer County Chapter on the subject of Estate Planning and Asset Protection Planning for individuals and families.  Topics addressed during the 4 hour seminar included hospice planning and asset protection, Veterans Aid & Attendance, planning through the use of a Power of Attorney, Living Will and Healthcare Directive.  Attendees at the seminar were eligible to receive 4 hours of professional CEU credits from the State Society.

Hospice Care attorney serving these New Jersey Counties:
Monmouth County, Ocean County, Mercer County, Middlesex County, Bergen County, Burlington County, Union County, Passaic County, Somerset County, Morris County, Hudson County