Health Care and Hospice

According to the National Institutes of Health (NIH), hospice care is end-of-life care provided by health professionals and volunteers. They give medical, psychological and spiritual support. The goal of the care is to help people who are dying have peace, comfort and dignity. The caregivers try to control pain and other symptoms so a person can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's family.

Today, according to the Hospice Foundation of America, one out of three people in the United States die in the care of hospice. When faced with a life-limiting illness, patients and their families need to understand hospice care and the steps necessary to access this quality end-of-life option. Hospice care can continue longer than six months if needed but requires physician certification.

Usually, a hospice patient is expected to live 6 months or less according to the NIH. And, hospice care can take place:
--At home.
--At a hospice center.
--In a hospital.
--In a skilled nursing facility.

According to HospiceNet.org, the list of frequently asked questions about hospice care can answer many concerns you have:
1. When should a decision about entering a hospice program be made and who should make it?
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. Most hospices accept patients who have a life-expectancy of six months or less and who are referred by their personal physician.

2. Should I wait for our physician to raise the possibility of hospice, or should I raise it first?
The patient and family should feel free to discuss hospice care at any time with their physician, other health care professionals, clergy or friends.

3. Is all hospice care the same?
No. Many communities have more than one hospice. Medicare requires certified hospices provide a basic level of care but the quantity and quality of all services can vary significantly from one hospice to another. To find the best hospice for your needs, ask your doctor, healthcare professionals, clergy, social workers or friends who have received care for a family member. You may want to call or meet with the hospices and ask questions about their services.

4. Can a hospice patient who shows signs of recovery be returned to regular medical treatment?
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 most private insurance will allow additional coverage for this purpose.

5. What does the hospice admission process involve?
One of the first things the hospice program 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. (Most hospices have medical staff available to help patients who have no physician.) The patient will be asked to sign consent and insurance forms. These are similar to the forms patients sign when they enter a hospital. The form Medicare patients sign also tells how electing the Medicare hospice benefit affects other Medicare coverage.

6. Is there any special equipment or changes I have to make in my home before hospice care begins?
Your hospice provider 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, hospice will assist in any way it can to make home care as convenient, clean and safe as possible.

7. How many family members or friends does it take to care for a patient at home?
There’s no set number. One of the first things a hospice team will do is to prepare an individualized care plan that will, among other things, address the amount of caregiving needed by the patient. Hospice staff visit regularly and are always accessible to answer medical questions.

8. Must someone be with the patient at all times?
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, hospice generally recommends someone be there continuously. While family and friends do deliver most of the care, hospices may have volunteers to assist with errands and to provide a break and time away for primary caregivers.

9. What specific assistance does hospice provide home-based patients?
Hospice patients are cared for by a team consisting of a physician, a nurse, social workers, counselors, home health aides, clergy, therapists, and volunteers. Each one provides assistance based on his or her own area of expertise. In addition, hospices provide medications, supplies, equipment, and other services related to the terminal illness.

10. Does hospice do anything to make death come sooner?
Hospice neither hastens nor postpones dying. Just as doctors and midwives lend support and expertise during the time of child birth, hospice provides its presence and specialized knowledge during the dying process.

11. Is caring for the patient at home the only place hospice care can be delivered?
No. Hospice patients receive care in their personal residences, nursing homes, hospital hospice units and inpatient hospice centers.

12. How does hospice “manage pain”?
Hospice believes that emotional and spiritual pain are just as real and in need of attention as physical pain, so it can address each. Hospice nurses and doctors are up to date on the latest medications and devices for pain and symptom relief. In addition, physical and occupational therapists can assist patients to be as mobile and self sufficient as they wish, and they are sometimes joined by specialists schooled in music therapy, art therapy, massage and diet counseling. Finally, various counselors, including clergy, are available to assist family members as well as patients.

13. What is hospice’s success rate in battling pain?
Very high. Using some combination of medications, counseling and therapies, most patients can attain a level of comfort they consider acceptable.

14. Will medications prevent the patient from being able to talk or know what’s happening?
Usually not. It is the goal of hospice to have the patient as pain free and alert as possible. By constantly consulting with the patient, hospices have been very successful in reaching this goal.

15. Is hospice affiliated with any religious organization?
No. While some churches and religious groups have started hospices (sometimes in connection with their hospitals), these hospices serve a broad community and do not require patients to adhere to any particular set of beliefs.

16. Is hospice care covered by insurance?
Hospice coverage is widely available. It is provided by Medicare nationwide, by Medicaid in 47 states, and by most private insurance providers. To be sure of coverage, families should, of course, check with their employer or health insurance provider.

17. If the patient is eligible for Medicare, will there be any additional expense to be paid?
The Medicare Hospice Benefit covers the full scope of medical and support services for a life-limiting illness. Hospice care also supports the family and loved ones of the person through a variety of services. This benefit covers almost all aspects of hospice care with little expense to the patient or family.

18. If the patient is not covered by Medicare or any other health insurance, will hospice still provide care?
The first thing 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, some hospices will provide for anyone who cannot pay using money raised from the community or from memorial or foundation gifts.

19. Does hospice provide any help to the family after the patient dies?
Most hospices provide continuing contact and support for caregivers for at least a year following the death of a loved one. Many hospices also sponsor bereavement groups and support for anyone in the community who has experienced a death of a family member, a friend, or similar losses.

Hospice affirms life and does not hasten or postpone death, according to the American Cancer Society. Hospice care treats the person rather than the disease; it focuses on quality rather than length of life. Hospice care is family-centered care -- it involves the patient and the family in making decisions. Care is provided for the patient and family 24 hours a day, 7 days a week. Hospice care can be given in the patient's home, a hospital, nursing home, or private hospice facility. Most hospice care in the United States is given in the home, with a family member or members serving as the main hands-on caregiver. One of the problems with hospice is that it is often not started soon enough. Sometimes the doctor, patient, or family member will resist hospice because he or she thinks it means you're giving up, or that there's no hope. This is not true. The hope that hospice brings is the hope of a quality life, making the best of each day during the last stages of advanced illness.

When faced with terminal illness, difficult decisions about end of life treatment and care must be made. Often, those family members closest to the patient must make tough choices about how to care for their loved one. If no family is available, close friends may be called into service to help facilitate hospice. Sometimes, hospice is handled by charitable or governmental organizations that step in when no one else is available to help. End of life decisions cause very high stress, so counseling and other types of care are available to help manage grief and other major issues regarding treatment and critical financial issues. Hospice care should be embraced as a way to ease transition from life to death. Although never an easy topic for discussion, hospice provides a vital and dignified way for those who benefit from its service.

Until next time. Let me know what you think.