When someone is put on home hospice care or enters a hospice facility, it’s a common assumption they must only have days or weeks to live. But that is not actually the correct definition of the term.
Hospice is actually a type of medical care. The goal of hospice is to maintain or improve quality of life for someone with an incurable illness, disease, or condition. As a result, some people could live for years while receiving hospice care.
While hospice addresses all symptoms of a disease, it puts a special focus on providing comfort. That often includes the management of pain, as well as a dedicated hospice team to oversee maintenance care. The one thing hospice does not do, however, is try to cure a condition.
When a doctor assigns a patient to hospice, this means that patient may not live beyond six months. But it doesn’t mean they won’t live. It simply means their condition carries with it an increase in mortality risk and a need for special caretaking. As a result, however, this designation may contribute to the accumulation of high medical care costs. And this leads some people to wonder if they can qualify for disability to defray expenses.
To that effect, we recently had a reader write in asking: “I’m on home hospice care with congestive heart failure. Can I get disability if I haven’t worked in six years?” The answer in this case is “no” but not because of the CHF condition. Read on for specifics.
Can I Get Disability for Home Hospice Care?
An individual may need home hospice care when there’s no hope of their illness going away. Remember, this classification isn’t a death sentence. But it does mean this care is necessary for preserving quality of life in the face of an incurable condition.
In general, people on hospice may in fact qualify for Social Security Disability Insurance (SSDI). But, an individual must satisfy the Social Security Administration’s (SSA) Blue Book definition for their disability.
In the case of our reader, CHF is a difficult disability to prove, but it is possible. However, if home hospice care is necessary then their condition is likely debilitating enough to warrant benefits. Remember, disability requires that an individual be unable to work for 12 months. Or they must demonstrate an ailment that’s expected to result in death. For someone to be on hospice care for CHF, then their condition likely falls in the latter category (Class IV).
The problem with our reader’s claim, however, lies in the work requirement. Before even looking at an applicant’s illness or condition, the SSA will review their work record. To qualify for SSDI an individual must show that they have enough work credits to be eligible. But they must also demonstrate employment for five out of the last 10 years.
Since our reader states being out of the workforce for six years, that will render this particular claim ineligible. This is because they fail the “recent work test.”
What Other Disability Assistance Is Available for Someone Needing Hospice?
Without knowing the specifics of our reader, it’s difficult to understand their corresponding financial situation. However, since they don’t have a qualifying work record, they might be eligible for Supplemental Security Income (SSI). Especially if they’ve been unable to work much in the last 10 years.
SSI is another type of disability payment that does not require an employment history. The determination is made by assessing financial need, but it’s only available to those individuals who are very low income. Applicants for SSI in 2023 cannot have a household income above $1470 per month.
What About Medicare for Home Hospice Care?
Additional hospice assistance may also come in the form of Medicare. Again, we don’t know much about our reader’s situation. But if someone is on Medicare — or qualifies for it — they can get home hospice care coverage through that program.
To qualify for Medicare, usually an individual must be age 65 or over. But if someone receives Social Security disability, they’ll also become eligible for Medicare after 24 months of benefit payments. There are medical cases where the SSA waives that 24-month waiting period — like for ALS — predicated on severity.
Hospice via Medicare requires an applicant is eligible for Medicare Part A, has a terminal illness, and selects hospice benefits. The program necessitates that an individual must show:
- Certification from their hospice/regular doctors of terminal illness (with a life expectancy of six months or less).
- Acceptance of palliative (comfort) care instead of treatment to cure the illness.
- Signed statements choosing hospice care instead of other Medicare-covered treatments for the terminal illness and related conditions.
If the hospice recipient satisfies the above criteria, they will be eligible for hospice care on an ongoing basis. However, they will have to routinely requalify. That’s because Medicare provides hospice benefits in “periods of care.” That consists of two 90-day initial periods followed by an unlimited number of subsequent 60-day periods.
No later than two calendar days after the beginning of each care period, the hospice must receive a doctor’s statement. This recertification is meant to show the continued necessity of hospice care for the patient.
How Fast Can I Get Coverage?
The need for home hospice care is not a death sentence and doesn’t hasten a person’s passing. Nonetheless, there is a timely element to it since the patient must demonstrate an incurable condition that limits life expectancy.
As a result, as long as qualifying criteria are met, disabled hospice patients will likely be eligible for some assistance. This may come as SSDI, SSI, Medicare, or other social programs, but there is help out there.
A typical disability claim may take months for the SSA to process. However, in particularly serious cases the SSA may expedite claims through the TERI (terminal illness) system. Some TERI cases may even see benefits within weeks.
The best bet if you find yourself in a hospice situation with a life-shortening ailment, however, is to seek legal counsel. A skilled disability attorney will help you through the process and will know which channels to push your claim through.
Because even in legal matters, when hospice is the designation, time is of the essence and comfort is the goal.
Kimberly Dawn Neumann
Kimberly Dawn Neumann is a multi-published NYC-based magazine and book writer whose work has appeared in a wide variety of publications ranging from Forbes to Cosmopolitan. She graduated summa cum laude from the University of Maryland, College of Journalism. For more, visit: www.KDNeumann.com, Instagram @dancerscribe, and Twitter @KimberlyNeumann