FAQ’s

Nothing could be further from the truth.  Although your loved one’s condition may have reached a point that a cure is unlikely—or no longer worth the side effects of treatment—that does not mean there is nothing left to do.  In fact, an emphasis on quality of life and easing pain and distress often allows the patient to spend his or her remaining time focusing on things that are ultimately the most important and meaningful.  With the expert guidance of a professional team that includes physicians, nurses/case managers, certified hospice aides, social workers, and chaplains…patients and families find they can focus on their relationships and building wonderful memories together.  Far from giving up, hospice helps families truly live well and support each other by maintaining the highest quality of life possible.

At Bright Horizon, “hospice” is more than a service…it is a philosophy of care.  It treats the person rather than the disease and focuses on quality of life.  It surrounds the patient and family with a team of professionals who not only address physical distress, but emotional and spiritual issues as well. Bright Horizon Hospice care is patient-centered because the needs of the patient and family drive the activities of the hospice care team.

Hospice is not a place – it is a service provided wherever the patient resides.  Hospice brings physical, emotional, and spiritual care support to wherever our patients reside.

While on Palliative Care patients and families may continue to pursue a cure for the illness or diagnosis. Hospice Care treatments focus on palliation of symptoms.  The goal is no longer to cure but to promote comfort.
Palliative Care can be considered at any time during the course of an illness.  Hospice Care, under Medicare guidelines, requires a physician to certify that a patient has a limited life expectancy due to a terminal illness.
Palliative Care services are typically provided through regular physician visits in the office and nursing visits in the home.  Hospice services are more inclusive; Hospice Care includes physician services, nursing services, social worker, spiritual care, bereavement care and volunteers.  In some cases Hospice will incorporate therapeutic services, as well as other counseling services, deemed necessary as part of the Hospice Care Plan to manage terminal symptoms and provide support for the individual and their family.

Comfort vs. Cure: For most home health care providers, the goal is to make the patient well.  With hospice care, the staff and family recognize that the patient may not get well.  They focus on comfort and support rather than cure.  Just the simple act of changing focus often supports the patients to “get well” without trying.

Interdisciplinary Team Approach: In hospice, all members of the care team – physicians, nurses, social workers, chaplains, hospice aides, and volunteers – work together to coordinate care.

Family Focus: Bright Horizon Hospice care focuses on the entire family.  The hospice team teaches the family how to be involved in their loved one’s care.  The team supports both the needs of the patient and their families.

Bright Horizon Hospice is one of the only, family-owned and locally based hospice organizations in the Fresno area.  It is also the first Fresno based hospice organization to be certified by “The Joint Commission;” the same regulatory body that evaluates and dictates healthcare practice in every major hospital across the country.  Our Comprehensive Care philosophy is central to the way we provide hospice care.  Many hospices require patients to have a caregiver at home, or to agree to give up specific “end-of-life” rights.  Bright Horizon Hospice believes there should be no barrier to high quality end-of-life care, admitting any eligible patient who requests hospice care.

Bright Horizon Hospice is committed to the exceptional and compassionate delivery of quality end-of-life care.  Company-wide standards, which exceed industry norms, have been implemented in all Bright Horizon Hospice programs, along with programs of professional development for staff and for education of family caregivers. Bright Horizon Hospice is committed to raising the standards of hospice care throughout Fresno and surrounding counties.

Although there are patients with a diagnosis of cancer being served, Bright Horizon Hospice cares for patients with any life-limiting illness.  Among other illnesses our patients have had are cardiac and respiratory diseases, renal disease, and neurological illness including Alzheimer’s disease, Lou Gehrig’s disease, AIDS, Cirrhosis, and others.

Bright Horizon Hospice services are not specifically for those who are housebound or bedridden; most are living their day-to-day lives.  Care is no matter the activity level or living environment; patients are seen in their home, long-term care facilities, assisted living or retirement communities, nursing homes, and some participating hospitals.

Hospice services can be provided to a terminally ill person wherever they live.  This means a patient living in a nursing facility or long-term care facility can receive specialized visits from Bright Horizon Hospice nurses, home health aides, chaplains, social workers, and volunteers, in addition to other care and services provided by the nursing facility.  Bright Horizon Hospice, and most of the nursing homes in the area, have written agreements in place in order for our hospice  taff to serve residents of each facility.

Bright Horizon Hospice works with local, inpatient residential centers to care for patients who cannot stay where they usually live.  Some patients may require a different place to live during this phase of their life when they need extra care.

Hospice is for people who have a limited life expectancy.  Generally speaking, hospice is for patients whose condition is such that a doctor would estimate a life expectancy of six months or less.  This doesn’t mean the patient is going to die in the next six months – it simply means that he or she has a condition that suggests their passing is a realistic possibility.

Bright Horizon Hospice does not automatically end patient care after six months.  Medicare, and most other insurers, will continue to pay for hospice care as long as a physician certifies that the patient continues to have a limited life expectancy.  Statistically, the quality of care provided by hospice leads to improved health and the life expectancy does often exceed six months.

A person may sign out of the hospice program for a variety of reasons, such as resuming aggressive curative treatment or pursuing experimental measures.  Additionally, if a patient shows signs of recovery, he or she can be discharged from hospice care and return to the program when the illness has progressed at a later time.

Certainly.  If the patient’s condition improves and the disease seems to be in remission, patients can be discharged from hospice and return to aggressive therapy or go on about their daily life.  If the discharged patient should later need to return to hospice care, Medicare and many private insurance will allow coverage for this purpose.  There is no penalty for getting better!

At any time during a life-limiting illness, it’s appropriate to discuss all of a patient’s care options, including hospice.  By law the decision belongs to the patient or patient’s designee when they are no longer able to make decisions.  There is no better time than right now to ask questions about what to expect from hospice services.  Research has proven that patients live longer the earlier they are started on hospice.  Although end-of-life care may be difficult to discuss, it is best for family members to share their wishes long before it becomes a concern.  This can greatly reduce stress when the time for hospice is needed.  By having these discussions in advance, patients are not forced into uncomfortable situations.  Instead, patients can make an educated decision that includes the advice and input of family members and loved ones.

You can, but more frequently, doctors often wait for families to bring it up.  This is part of the reason that people often receive hospice care so late in the process.  If you think your loved one and family might benefit from the support of weekly home visits from staff who specialize in pain control and the easing of distress, ask your doctor if hospice might be something to consider now, or in the near future.  If, when you are truly honest with yourself, you realize that you would not be surprised if your loved one were to pass in the next six to twelve months, ask the doctor if he or she would be surprised. If the physician confirms that it would not come as a surprise then it is a good time to begin a discussion about hospice.  We will be happy to talk with you or to arrange  for an informational visit.  If you would like more information, please feel free to call our office at (559) 443-0303. 

Most patients and families who receive hospice care say they wish they had known about it earlier, that they needed the help much sooner than they received it.  Research has shown that hospice can increase both the quality of life and how long a patient lives.  Families who receive hospice care near the very end–just a few days to a week–have been shown to have a harder time adjusting during the bereavement period than those whose loved one has received hospice care for weeks and months before passing on.  Experts agree that at least two to three months of care is optimal. It is better to ask sooner rather than later so you do not regret having missed the support that hospice has to offer.

Hospice patients are those with very serious medical conditions.  Usually they have diseases that are life threatening and make day-to-day living very uncomfortable—physically, emotionally, or spiritually.  Some are in pain.  Others experience difficult symptoms such as nausea, extreme fatigue, and shortness of breath.  These symptoms may be caused by the disease, or they may have been caused by treatments intended to cure the disease.  Often patients turn to hospice because they are anxious or depressed, or they are feeling spiritually distressed because of their medical condition. Hospice specializes in easing pain, discomfort, and distress on all levels.  The care provided by hospice is often helpful for conditions such as cancer, heart disease, COPD (emphysema), advanced dementia, or a general weakness and “failure to thrive.”  Seriously ill patients who have decided that their priority is to have the best quality of life possible are the people who are best suited for hospice.

When patients have a legitimate need for pain medication, they do not become addicted to it.  Bright Horizon Hospice has the expertise to manage pain so that patients are comfortable, yet as alert as possible, and are able to enjoy each day to the fullest extent given their medical condition.

Many patients may have pain and other serious symptoms as their illness progresses.  Bright Horizon Hospice staff receives special training to care for all types of physical and emotional symptoms that cause pain, discomfort and distress.  Because keeping the patient comfortable and pain free is an important part of hospice care, Bright Horizon Hospice frequently measures how comfortable the patient is during the course of their stay in hospice and adjusts the plan of care accordingly.  Hospice staff works with the patient’s physician to make sure that medication, therapies, and procedures are designed to achieve the goals outlined in the patient’s care plan.  The care plan is reviewed frequently by the interdisciplinary group to make sure any changes and new goals are in the plan.

Bright Horizon Hospice believes that emotional and spiritual pain are just as real, and in need of attention, as physical pain so we address each area.  Our nurses and doctors are up to date on the latest medications and devices for pain and symptom relief.  In addition, our team can assist patients to be as mobile and self sufficient as they wish, and they are sometimes included in music therapy, art therapy, and diet counseling.  Finally, various counselors, including clergy, are available to assist family members as well as patients.

Bright Horizon Hospice has a high success with pain management. Using an agreed upon combination of medications, counseling, and therapies most hospice patients can attain a level of comfort they consider acceptable.

If the patient has Medicare and meets hospice eligibility requirements, then the government will pay as much as 100% of the cost.  In such a case, there is no deductible and no co-payment.  Not only are the services of the hospice staff entirely covered, but medical supplies and prescriptions (only those relating to pain and comfort management) are also covered.  Medicaid will also provide coverage.

Medicare and Hospice

100% Coverage if These Four Requirements Are Met:

• The patient is eligible for Medicare Part A (Hospital Insurance)
• The patient’s doctor and a hospice medical director certify that the patient is terminally ill and has an estimated 6 months or less to live if the illness runs its normal course
• The patient signs a statement choosing hospice care instead of continued curative treatment of the terminal illness
• The patient receives care from a Medicare-approved hospice program like Bright Horizon Hospice

Services

Hospice Provides Under the Hospice Medicare Benefit:

• Doctor services
• Nursing care
• Medical equipment
• Medical supplies
• Social worker services
• Spiritual care
• Dietary counseling
• Volunteers
• Grief counseling for patient and family
• Medications for symptom control or pain relief
• Medical supplies and equipment related to the terminal diagnosis
• Hospice aide and homemaker services
• Physical and occupational therapy, as appropriate for the plan of care
• Music, pet, and/or massage therapy as appropriate for the plan of care.  Call to see if available in your area
• Speech-language pathology services, as appropriate for the plan of care
• Short-term inpatient and respite care
• Any other Medicare-covered services needed to manage pain and other symptoms, as recommended by the hospice team

Services Medicare Does Not Cover While Under Hospice Care:

• Treatment intended to cure the terminal illness
• Prescription drugs to cure the illness rather than for symptom control or pain relief
• Room and board.  However, room and board is covered for Respite and General Inpatient (GIP) level of care
• Care in an emergency room, inpatient facility care, or ambulance transportation, unless it’s either arranged by the hospice medical team or is unrelated to the terminal illness

The Medicare Hospice Benefit covers the full scope of medical and support services for a life-limiting illness. This benefit covers almost all aspects of hospice care with little expense to the patient or family.

Hospice coverage is widely available.  In addition to Medicare and Medicaid most private insurance providers provide a hospice benefit.  To be sure of coverage, families should, of course, check with their employer or health insurance provider.  In some cases, co-pays and deductibles may apply.

The first thing Bright Horizon Hospice will do is assist families in finding out whether the patient is eligible for any coverage they may not be aware of.  Barring this, if board approved, the Bright Horizon Hospice Foundation ( a non-profit 501c(3) can provide for patients who cannot pay using funds raised from the community or through memorial gifts.

All hospices offer similar services…this does not mean they are all the same.  Consider any other “service” you might find on the internet – lawn care, taxes, painters, car repair, plumbers…the list goes on.  The service they offer is supposed to be the same – but, there is always a difference.  Although the services hospice companies offer may be similar, the reputation, compassion, staff, and consideration of each family member’s needs may vary greatly between each organization.  Bright Horizon Hospice takes pride in our mission to provide loving, compassionate care to our patients and their families with every encounter.  Medicare requires that certified hospices provide a basic level of care.  The quantity and quality of all services, however, can vary significantly from one hospice to another.

One of the first things Bright Horizon Hospice will do is contact the patient’s physician to make sure he or she agrees that hospice care is appropriate for this patient at this time (our hospice program has medical staff available to help patients who have no physician).  A nurse will evaluate the patient at either the referring facility or in their residence – home or other facility.  The patient will be asked to sign consent and insurance forms.  These are similar to the forms patients sign when they enter a hospital.  Arrangements will then be made for follow up visits and initiation of care.

Typically, hospice care starts as soon as a formal request, or a “referral,” is made by the patient’s doctor.  Often a Bright Horizon representative will make an effort to visit the patient within 2-hours of that referral, providing the visit meets the needs and schedule of the patient and family/primary caregiver.  Usually, hospice care is ready to begin within the same day of the referral.

The Bright Horizon Hospice case manager will assess your needs, recommend any equipment, and help make arrangements to obtain any necessary equipment.  Often the need for equipment is minimal at first and increases as the disease progresses.  In general, Bright Horizon Hospice staff will assist in any way we can to make home care as convenient, clean, and safe as possible.

There is no set number.  At Bright Horizon, although we encourage as much family support as possible, we do not require a set number of caregivers be available.  One of the first things our team will do is to prepare an individualized care plan that will, among other things, address the amount of care-giving needed by the patient.  Hospice staff will visit regularly and are always accessible to answer medical questions.

In the early weeks of care, it’s usually not necessary for someone to be with the patient all the time. Later, however, since one of the most common fears of patients is the fear of dying alone, Bright Horizon Hospice generally recommends someone be there as often as they can be available.  While family and friends are crucial to the support group, Bright Horizon hospice can also offer volunteers to assist with errands and to provide a break and time away for primary caregivers.

Hospice is designed to provide intermittent visits by the hospice team members unless the patient has significant symptoms that need constant monitoring.

A team consisting of a physician, a nurse, social workers, counselors, home health aides, clergy, therapists, and volunteers cares for Bright Horizon Hospice patients.  Each one provides assistance based on his or her own area of expertise.  In addition, our services provide medications, supplies, equipment, and other services related to the terminal illness.

Bright Horizon Hospice includes the services of an interdisciplinary team of healthcare professionals:

Physicians (the patient’s own physician and the hospice physicians, who are specialist in controlling pain and other symptoms of serious illness) prescribe medications and other methods of pain and symptom control.

Nurses are experts at maintaining patient comfort.  They assess the patient frequently and help family members provide the necessary support.

Hospice aides provide personal care and help the patient and family with activities of daily living. They are available to provide light housework and even some light cooking duties.  Bright Horizon Hospice aides also provide companionship and valuable emotional support.

Social workers coordinate community resources and help the patient and family with non-medical concerns.  They can help family members mend damaged relationships, plan for the future and ease other emotional difficulties.  The social workers also support bereavement by helping patients and families deal with grief.  Grief support services continue for at least one year after the death of a hospice patient.

Chaplains and spiritual counselors help patients and families cope with spiritual questions and concerns at the end of life, either directly or by coordinating services with the patient’s and family’s spiritual advisors.

Volunteers provide companionship and emotional support and offer help in myriad ways.

Bright Horizon Hospice also provides medications, medical equipment, and supplies necessary to promote comfort at home or in other hospice care settings.

At Bright Horizon Hospice there is always a nurse available during the regular work day or by phone exchange during off hours.

Most hospice patients live at home or in a nursing home.  Routine home hospice care covers the services, of the interdisciplinary hospice team, medications and equipment.  Other categories of care are available when needed:

Routine:   Basic level of hospice care as needed.

Continuous Care:  May be provided for a short term when you require more assistance then Routine Care.  Usually, when the patient has unrelieved pain or significant medical symptoms that require more extensive interventions.

Inpatient Care:  May be provided when pain or symptoms cannot be controlled at home, and the patient is taken to an inpatient care center.  When the symptoms are under control, the patient returns home.

Respite Care:   When caregivers need a rest from their caregiving responsibilities, patients can stay in a nursing home or hospice residential care center for up to five days.  Medicare covers the cost of room and board.

Bright Horizon Hospice staff is on call for emergencies 24 hours a day.  Hospice care, however, does not include a nurse in the home 24/7.  If the patient should require more care than can be provided in the home, our Social Worker will collaborate with inpatient residential centers for care options.

Hospice neither hastens nor postpones dying.  Just as doctors, midwives, and nurses lend support and expertise during the time of childbirth, hospice provides its presence and specialized knowledge during the end-of-life process.

While some churches and religious groups are associated with specific hospices (sometimes in connection with their affiliated hospitals), Bright Horizon Hospice serves a broad community and does not require patients to adhere to any particular set of beliefs.  Our Spiritual Care program serves all religious denominations.

Bright Horizon Hospice provides continued support for caregivers for at least a year following the death of a loved one.  Our hospice also sponsors bereavement groups and support for anyone in the community who has experienced a death of a family member, a friend, or similar losses.

Typically, one full-time registered nurse provides care to several different families.  Social workers usually work with about twice the number of patients/families as nurses.  If needed, home health aides, who provide personal care to the patient, will visit more frequently.

All visits, however, are based on the patient and family needs as described in the care plan and the condition of the patient during the course of illness.  The frequency of volunteers and spiritual care is often dependent upon the family request and the availability of these services.

Hospice care is available ‘on-call,’ through our phone exchange after the administrative office has closed, seven days a week and 24 hours a day.  Bright Horizon Hospice have nurses available to rapidly respond to any call for help, or for new referrals/admissions, if necessary.

Bright Horizon Hospice volunteers are generally available to provide different types of support to patients and their loved ones including running errands, preparing light meals, performing light housework, staying with a patient to give family members a break, lending emotional and/or spiritual support, and companionship for patients and family members.  They have all been screened and trained to assure that each person is right for this type of volunteer work.

Our company was created shortly after its founder lost a dear member of his family.  As he pondered the future, and strategized possibilities to provide support to those he cared for in his home community, he gazed out at the ocean horizon.  While the sun slowly rose his calling became clear.  It was then he decided to devote his efforts in creating the hospice organization known as, “Bright Horizon Hospice.”

Yes.  There are state licensure requirements that must be met by hospice programs in order for them to deliver care.  In addition, hospices must comply with federal regulations in order to be approved for reimbursement under Medicare.  Hospices must periodically undergo inspection to be sure they are meeting regulatory standards in order to maintain their license to operate and the certification that permits Medicare reimbursement.

Many hospices use tools to let them see how well they are doing in relation to quality hospice standards. To help hospice programs in making sure they give quality care and service, the National Hospice and Palliative Care Organization (NHPCO) has developed recommended standards entitled ‘Standards of Practice for Hospice Programs’ as one way of ensuring quality.  NHPCO also offers hospices a tool to do a self-evaluation of their program compared to the NHPCO Standards. When evaluating a hospice, ask the agency when they last completed a self-assessment using the NHPCO Standards.  Bright Horizon Hospice completes this self-assessment every quarter and reviews the outcomes with the Board of Directors.

There are also voluntary accreditation organizations that evaluate hospice programs to protect consumers.  Because they are voluntary, hospices are not required to use them.  These organizations survey hospices to see whether they are providing care that meets defined quality standards.  These reviews consider the customary practices of the hospice, such as policies and procedures, medical records, personal records, evaluation studies, and in many cases also include visits to patients and families currently under care of that hospice program.  Bright Horizon Hospice not only chose a regulatory agency to review our practices, we chose the same one that evaluates and dictates practice in every major hospital across the country.

Bright Horizon Hospices uses Fazzi Hospice CAHPS Survey Service, a national patient satisfaction service company approved by the Centers for Medicare and Medicaid Services (CMS)  satisfaction surveys to get feedback on our services and make improvements. Our customer satisfaction scores remain greater than benchmarked expectations.