A guide for every step of hospice care.

We work together to provide the necessary medical services as well as additional comfort measures, creating a more meaningful experience for patients and the people who love them.

Pharmacy

All drugs related to the patient's certifying terminal diagnosis are covered by the Medicare hospice benefit and delivered to the patient's home. Pharmacists may substitute a generically equivalent drug unless a written request for a brand name is made. The hospice provides medication that pertains to the terminal illness; the patient is responsible for medications unrelated to the terminal diagnosis.

Medical Equipment

The hospice provides standard medical equipment needed for comfort, such as an electric hospital bed, wheelchair, walker, and commode. Equipment is supplied through contracted vendors, and caregivers are responsible for its proper care and use.

24/7 On-Call Service

Our services are available 24 hours a day, 7 days a week. Patients and families are encouraged to contact us to report any change in the patient's condition. The on-call nurse will advise on how to manage the change and will make a home visit if necessary. Understanding why certain symptoms occur makes it easier to provide comfort and relief.

Hospital Emergency Rooms

Please contact the hospice first whenever you feel the patient needs emergency assistance. Many situations can be resolved at home with our guidance. If further medical assistance is needed, the hospice will arrange admission to a contracted inpatient unit for short-term acute pain and symptom management, with the goal of returning the patient home as soon as symptoms stabilize.

Aggressive Treatment

Aggressive treatment is any care, such as chemotherapy or surgery, intended to cure the disease. A patient who chooses to resume curative treatment may revoke the hospice benefit, and can reapply for admission later if they discontinue or complete that treatment.

Medicare Benefit Periods

• First benefit period: 90 days
• Second benefit period: 90 days
• Unlimited 60-day benefit periods thereafter

At the end of each benefit period, the patient must be medically recertified as appropriate for hospice. A patient may transfer to another hospice once during each benefit period.

Volunteers are an important part of the hospice team. They provide companionship and support, friendly visits, help with errands, reading, letter writing, games, or simply a caring presence. Your hospice nurse can arrange volunteer services whenever you would like them.

As a hospice patient, you have the right to receive safe, professional care appropriate to your needs without discrimination; to have access to necessary professional services 24 hours a day, 7 days a week; to have your pain recognized and addressed; to be involved in your plan of care; to be treated with consideration, respect, and dignity; to have your privacy and property respected; to be informed of the financial aspects of your care; to formulate advance directives; and to voice complaints without fear of reprisal.

As a patient, you also share in responsibilities: providing complete and accurate health information, participating in and following your plan of care, treating staff with respect, providing a safe environment for care, and informing the team of any concerns or changes.

Notice of Patient Financial Responsibility

You have the right to know, before care begins, exactly what you will and will not be asked to pay. This notice states your out-of-pocket responsibility for every hospice service we provide. Please keep it with your admission papers.

Your Cost for Hospice Services at a Glance

If you are a Medicare or Medi-Cal beneficiary, your cost for the hospice services below is:

In plain terms: your out-of-pocket cost for the hospice services in your plan of care is zero dollars ($0).

Costs That Are Not Part of the Hospice Benefit

• Room and board: If you live in a nursing home, assisted living, or board-and-care facility, your hospice benefit does not pay your rent or facility fees. You (or Medi-Cal, if you qualify) remain responsible for room and board.
• Unrelated conditions: Care for conditions our medical director determines are unrelated to your terminal illness is not covered by hospice, but it remains covered by your regular Medicare, Medi-Cal, or other insurance, subject to that coverage's usual deductibles and copayments.
• Services we did not pre-approve: Emergency room visits, hospital admissions, chemotherapy or radiation, outpatient services, and physician services from doctors other than your attending physician or our Medical Director must be pre-approved by us. If you obtain these without our pre-approval and they relate to your terminal illness, you may be responsible for the provider's charges. Call us first, any time, day or night: (805) 496-0044.
• Curative treatment: If you choose treatment intended to cure your terminal illness, it is not covered while you are on hospice. You may revoke hospice at any time to return to your regular Medicare coverage.

Our Contracted Providers: No Cost to You

We contract with the following providers for covered items. When we arrange your medications and equipment through them, you pay nothing:

• American Care Pharmacy: (747) 788-7887
• Select Pharmacy: (310) 341-3455
• Montgomery DME: (562) 777-7088

If you obtain items from a pharmacy or supplier that is not contracted with us and not arranged by us, you may be responsible for those charges.

Your Right to a Written, Personalized List

At any time, you may request in writing the "Patient Notification of Hospice Non-Covered Items, Services, and Drugs," a personalized list of anything we have determined is unrelated to your terminal illness and not covered by us, with a plain-language explanation. If you request it at the start of care, we will provide it within 5 days; if you request it during care, within 72 hours.

If You Have Private Insurance

Private plans vary. Before admission, we will verify your benefits and give you a written statement of any deductible, copayment, or coinsurance your plan requires. If your plan requires no cost-sharing, your statement will say $0. You will never be denied hospice care based on ability to pay.

Questions About Coverage or a Bill

If you receive any bill you did not expect, from us or anyone else, call us before paying it: (805) 496-0044, available 24/7.

• BFCC-QIO Immediate Advocacy (Medicare), Livanta: 1-877-588-1123 / TTY 1-855-887-6668
• DHCS Managed Care Ombudsman (Medi-Cal): 1-888-452-8609 / MMCDOmbudsman@dhcs.ca.gov
• California Department of Public Health 24-hour hotline: 1-800-228-1019
• The Joint Commission: 1-800-994-6610 / complaint@jointcommission.org

You have the right to request restrictions on how your information is used, to receive confidential communications, to inspect and copy your health information, to request amendments, and to receive an accounting of disclosures. Our Privacy Official can be reached through our main office. A complete Notice of Privacy Practices is provided at admission.

For each medication, know the reason for it, the correct times and frequency, common side effects, and how to administer and store it safely. Your nurse will review your medications at every visit.

Controlled Substances

Controlled substances are dispensed directly to the patient or representative, and the team monitors the amount issued and the time between renewals. When a controlled medication is no longer needed, your case manager will instruct you on proper disposal. Hospice personnel do not dispose of patient medications.

Disposal of Unused Medicines

• Use a community medicine take-back program when available.
• If none is available, mix medicines (do not crush) with an unpalatable substance such as used coffee grounds or kitty litter, seal in a bag, and place in household trash.
• A small number of medicines (for example certain opioids) should be flushed if no take-back option exists; follow the specific disposal instructions provided with the prescription.

General Safety

• Stay in touch with others; if you live alone, arrange a daily check-in.
• Rise slowly from a chair or bed to avoid dizziness, and never hurry.
• Lift with your legs, keep walkways clear, and use a stable step stool rather than a chair.
• Set hot water to 100 degrees F or lower to prevent burns.

Walkways & Stairs

• Remove or secure rugs, repair torn carpet, and wipe up spills immediately.
• Ensure handrails are secure and add non-slip treads to stairs.
• Keep walkways well lit with accessible light switches.

Bathroom & Kitchen

• Use a non-slip mat, grab bars, a bath seat, and an elevated toilet seat as needed.
• Do not lock bathroom doors if you may need assistance.
• Use front or back burners safely, turn pot handles inward, and keep a fire extinguisher accessible.

Electrical Safety

• Keep appliances away from water and inspect cords for damage.
• Use grounded outlets for medical equipment and keep cords out of walkways.
• Avoid overloading outlets.

Fire Prevention

• Install smoke detectors in bedrooms, hallways, and the kitchen, and keep an ABC fire extinguisher accessible.
• Never smoke in bed, and keep a hospital bed near an exit with an evacuation plan ready.
• Notify the fire department if the patient uses oxygen, in case of a power outage.

Home Oxygen Safety

• Oxygen is not flammable but causes other materials to ignite rapidly. No smoking is allowed near oxygen.
• Keep cylinders upright, well ventilated, and at least 8 feet from heaters and electrical appliances; keep portable tanks at least 5 feet from open flames.
• Do not use petroleum-based lotions, flammable liquids, or synthetic fabrics near oxygen.

Earthquake Preparedness

• Keep a 1 to 2 week supply of non-perishable food and medication, a flashlight, and a portable radio.
• Know what to do if electric-powered medical equipment loses power, and anchor tall furniture.
• After a quake, check for injuries, shut off gas if a leak is suspected, and tune to local emergency broadcasts.

• Call for assistance before getting up if you feel unsteady, and sit at the edge of the bed before standing.
• Take your time and use your walker or cane as recommended.
• Keep frequently used items within arm's reach and remove clutter, cords, and loose rugs.
• Ensure good lighting and a clear, wide base of support when standing.

When using a walker, lift rather than slide it, set it about one foot ahead, and step with the weaker leg first. The handgrips should reach the level of your wrist when your arms hang at your sides.

There are over-the-counter medicines for mild pain (such as ibuprofen and acetaminophen) and prescription medicines for more severe pain, available as pills, liquids, suppositories, and injections. The doctor decides the type and amount after talking with the patient and nurse, and you may be asked to keep a written pain record between visits.

• The best pain control usually comes from taking medicines on a regular schedule rather than waiting until pain becomes severe.
• If underlying pain increases, the dose or frequency may need to increase. This is normal.
• Fear of addiction should not prevent appropriate relief; hospice patients take these medicines for genuine pain, under medical supervision.
• Non-drug measures such as repositioning, massage, relaxation, and heat or cold can complement medication.

• Reduced appetite and thirst. Natural dehydration at the end of life is generally not painful and can ease symptoms. Moisten the mouth and lips for comfort rather than forcing food or fluids.
• Cool, sometimes bluish skin in the arms and legs. Use warm blankets, not electric blankets.
• Slower, sometimes noisy breathing. Elevate the head of the bed and use prescribed medications and a cool-mist humidifier.
• Decreased hearing and vision. Always assume the patient can hear you, keep the room lit, and speak gently.
• Restlessness or visions from reduced circulation. Stay calm, speak slowly and reassuringly, and offer gentle reminders of time, place, and person.

These changes can come and go. Holding the patient's hand, speaking softly, and simply being present are deeply comforting. Your hospice team will increase visits and support during this time.

• Serve meals in a relaxed, pleasant setting and provide mouth care beforehand to stimulate taste.
• Appetite is often best earlier in the day, so make the most of breakfast.
• Offer small, frequent meals and high-protein snacks, and keep the head of the bed elevated after eating.
• Give pain or nausea medication before meals when needed, and provide soft foods if dentures are no longer worn.
• Liquids can be offered in other forms such as gelatin, pudding, and ice cream.

What to Do

• Call Generation Care, not 911. A staff member will come to your home to pronounce the death, provide comfort, and help make calls. If you prefer time alone with your loved one first, your wishes will be honored.
• Generation Care will notify the mortuary of your choice. The body does not need to be moved until you are ready, and family may help prepare the body if they wish.
• The police do not need to be called; the hospice nurse will notify the physician.
• Take the time your family needs to gather, share memories, and say goodbye.

There are two common forms of service: a funeral service, held with the body present, and a memorial service, held without the body and generally less expensive. Funeral and memorial societies are non-profit organizations that promote dignity, simplicity, and economy through pre-planning.

Financial Resources

• County assistance may be available for individuals determined to be indigent, but must be applied for before arrangements are made.
• Social Security may provide a lump-sum death benefit to eligible survivors.
• Payment plans and savings arrangements can help manage costs.

• Free burial in a VA national cemetery, including the gravesite, opening and closing of the grave, and perpetual care.
• A headstone or grave marker and a United States flag.
• Possible reimbursement of burial expenses for veterans receiving or entitled to VA compensation or pension, or whose death occurred in a VA facility.

Complete information is available from the VA at 1-800-827-1000 or through Veterans Service Organizations. Other benefits may be provided by trade unions, fraternal organizations, life insurance, and credit unions.