Caring for a loved one with late-stage kidney disease can be heartbreaking. When kidneys begin to fail, the patient may experience extreme fatigue, unbearable bone and joint pain, nausea and drastic weight loss. As a caregiver seeing your loved one experience these symptoms of late-stage kidney disease, you may feel at a loss and like there’s nothing you can do to help. However, it’s important not to despair. Know your options when kidney disease advances into its end stages.

Hospice for kidney failure provides compassionate care to help ease suffering from the as the end of your loved one’s life draws near. Knowing when the right time is for kidney disease hospice can be a difficult decision for a family to make. However, understanding hospice eligibility criteria for kidney disease is quite simple. Accessing hospice care for your loved one as soon as they’re eligible can help improve their quality of life.

Read on to learn more about who qualifies for kidney disease hospice, how this specialized form of care can benefit your loved one and your family and how insurance coverage works for hospice care. 

Kidney Disease Hospice Eligibility

With kidney disease, a person is eligible for hospice care when their doctor confirms that in their best estimate, their patient has six months or left to live should the disease take its natural course. This is a universal Medicare guideline that applies to all areas throughout the U.S.

Additionally, many hospice organizations have their own hospice criteria specific to certain diseases. For late-stage renal disease specifically, a patient may be eligible for hospice care if they meet the following criteria:

• A serum creatinine level of 8.0 mg/dl or higher in people without diabetes or 6.0 mg/dl or higher for those who have diabetes
• Uremia, a condition in which there’s an elevated level of waste in the blood
• Hyperkalemia, or higher than normal potassium levels in the blood
• Extremely low urine output

There should also be a plan in place for the discontinuation of dialysis. Your loved one’s doctor and hospice care team will work together to ensure your loved one is treated with compassion, respect and dignity during this transition.

What Is Late-Stage Kidney Disease?

Late-stage kidney disease is the final stage of kidney disease in which the kidneys are no longer able to support the body’s needs. Also known as end-stage kidney disease, or ESKD, it’s an irreversible condition. With ESKD, either a kidney transplant or dialysis are needed to keep the patient alive.

What Is Kidney Disease Hospice?

Kidney disease hospice is specialized healthcare focused on maximizing comfort and improving quality of life during the final stages of disease at the end of life. Hospice care aims to relieve pain and other symptoms, as well as provide holistic care for physical, emotional and spiritual health.

Benefits of Kidney Disease Hospice

Accepting that a loved one is dying from a chronic illness like kidney disease can be one of the toughest, most emotionally challenging things a family can face. It may be tempting to put off deciding on hospice care for as long as possible, but that denial can end up doing more harm than good for your loved one.

Enrolling in kidney disease hospice as soon as your loved one is eligible can lead to improved quality of life. They’ll have access to the many services and resources hospice care offers, including:

• Compassionate Care. Early hospice admission maximizes comfort and improves quality of life, focusing on symptom management rather than prolonging painful or invasive curative treatments that are no longer working.
• Pain Relief. Kidney disease hospice provides comprehensive pain and symptom control for a more dignified end-of-life experience.
• Holistic, Patient-Centered Approach. Your loved one’s hospice care team includes counselors, social workers and faith leaders who offer both emotional and spiritual support to patients and families.
• Respite for Caregivers. Hospice care helps alleviate the burden on the caregiver with services like caregiving assistance, counseling and respite care. These give you time and support, helping you take much-needed breaks to focus on your own health and wellbeing.
• Flexible Care Options. Starting hospice care sooner instead of later enables your family to make informed decisions about end-of-life care, including the option to receive hospice care at home. This results in a more personalized approach and a less acute care setting compared to late-stage admission to hospice care at hospitals.

Kidney Disease Hospice Coverage

Navigating end-of-life care for a loved one with late-stage kidney disease can be extremely overwhelming. One of the most pressing questions around kidney disease hospice is how families will pay for it. The good news is that many hospice patients are eligible for hospice care under government-run insurance programs Medicare and Medicaid. Private insurance companies may also cover some hospice costs.

Medicare and Medicaid

Hospice care costs are covered by Medicare under the Medicare Hospice Benefit at no cost to the patient. In the U.S., people 65 and older are eligible for Medicare. According to Medicare.gov, those who are younger than 65 and have end-stage renal disease are also eligible for Medicare if they meet the following criteria:

• Your kidneys no longer work
• You need regular dialysis or you’ve had a kidney transplant
• One of these applies to you:
  • You’ve worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee.
  • You’re already getting or are eligible for Social Security or Railroad Retirement benefits.
  • You’re the spouse or dependent child of a person who meets either of the requirements listed above.

You can contact Social Security of the RRB to get more information on the amount of time required to be eligible for Medicare for kidney disease hospice.

Medicaid, or free or low-cost healthcare for low-income individuals and families, also covers hospice services in many states. Check with your state Medicaid agency for more information.

Private Insurance

If you’re not eligible for Medicare or Medicaid, some private health insurers will cover hospice costs. Hospice coverage varies by provider and by plan. Every private insurer has their own guidelines for what, how, and when they reimburse for hospice costs. Check your explanation of benefits or contact your insurer for more information on kidney disease hospice coverage.

CIGNA Hospice Coverage

According to CIGNA’s 2023 Medical Coverage Policy, coverage for hospice care is subject to the terms, conditions, and limitations of each benefit plan. When the benefit coverage for hospice care is applicable, hospice care is considered medically necessary when all the criteria below are met:

• The individual is terminally ill and expected to live twelve months or less.
• Potentially curative treatment for the terminal illness may be part of the prescribed plan of care.
• The individual or appointed designee has formally consented to hospice care (i.e., care which is directed mostly toward palliative care and symptom management).
• The hospice services are provided by a certified/accredited hospice agency with care available 24 hours per day, seven days per week.

The list below includes some of the other top health insurance providers in the United States and the information they provide on hospice coverage.

• United Healthcare
• Aetna
• Humana
• Anthem
• Molina Healthcare
• Centene (PDF)
• HealthPartners
• Bright Health
• CareFirst

Late-Stage Kidney Disease Hospice: Three Oaks Hospice Can Help

Late-stage kidney disease is a devastating diagnosis, and it’s normal to feel overwhelmed when navigating end-of-life care for a loved one. In these trying times, Three Oaks Hospice is here to make your loved one’s final days, weeks, and months as comfortable and peaceful as possible. 

If you have any questions on kidney disease hospice eligibility, please reach out to our team. While it may seem daunting at first, remember that earlier admission to hospice care leads to improved health and quality of life as your loved one prepares for their final transition. Our compassionate and experienced staff are here for your family every step of the way. Find a Three Oaks Hospice location near you or contact us online at any time. 

References

• Hospice Care Medicare.gov
• Kidney Failure (ESRD) – Symptoms, Causes and Treatment Options American Kidney Fund
• End-Stage Renal Disease (ESRD) Medicare.gov
• Hospice Benefits Medicaid.gov
• CIGNA’s 2023 Medical Coverage Policy Cigna
• End-Stage Renal Disease (ESRD) Johns Hopkins Medicine
• End-Stage Renal Disease Mayo Clinic