Hospice is a system of care for patients with a terminal illness who have a life expectancy of six months or less and who choose not to seek (or to discontinue) treatment to cure the illness. The goal of hospice care is to make the patient as comfortable as possible — and to support the patient and family, emotionally and spiritually, — during the final months of life. This care is often provided in the patient’s private residence, but may also be provided in a hospital, assisted living facility, nursing home or specialized inpatient hospice facility.
Hospice care does not provide curative treatment for the terminal condition, but offers palliative care, which gives relief from pain and other symptoms.
People whose illnesses are not curable and who have a limited life expectancy. They may no longer want or are unable to receive curative treatment. Hospice is available to people with cancer, heart disease, lung disease, or any other life limiting condition. Patients must live in the service area and have approval of a doctor who will manage their medical care. It is also necessary to have a primary caregiver (family member or friend) who is willing to manage and provide the care along with the help of the hospice team.
Hospice care is a family-centered approach that includes, at a minimum, a collaborative team of doctors, nurses, social workers, chaplains, bereavement counselors and trained volunteers. Care and services are provided based on assessed physical, psychological and spiritual needs as well as patient and family choices. Hospice team members will visit the patient on a pre-arranged schedule in addition to visits requested by the patient or family as circumstances change.
Below is a list of services available to Medicare hospice recipients:
- Physician oversight for the medical direction of the patient’s care and home visits as needed
- Specialized palliative care as needed to control pain and symptoms, i.e., physical therapy, palliative radiation treatment, etc.
- Dietary counseling
- Regular home visits by registered nurses and licensed practical nurses
- Hospice aides for hands-on personal care and hygiene services such as dressing and bathing
- Social work and counseling
- Chaplains for spiritual support
- Assistance with planning and accessing community resources
- Volunteer support to assist patients and loved ones
- Bereavement counseling and support for families
- All medications for symptom control and pain relief
- Medical supplies such as bandages and catheters
- Medical equipment such as hospital beds and oxygen
Medicare Part A provides a hospice benefit that pays for 100 percent of all the services, medications and equipment hospice provides. There is no out-of-pocket cost to patients for hospice. Medicaid and most private insurance plans also include benefits for hospice care.
Based on the physician order, 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 Medicare hospice election form says that the patient understands that the care is palliative (that is, aimed at pain relief and symptom control) rather than curative.
In the early weeks of care, it is usually not necessary for someone to be with the patient all the time. Later, however, as the patient’s needs change and to ensure the patient’s comfort and safety, hospice works with the patient and family to see that the patient is not left alone.
Hospice does nothing either to hasten or to postpone the dying process. Hospice rejects the practice of assisted suicide or euthanasia in the care of the terminally ill. Just as doctors and advanced practitioners lend support and expertise during the time of childbirth, so hospice provides its presence and specialized knowledge during the dying process.
The choice to receive hospice care does not replace your relationship with your doctor. Hospice works directly with the patient’s primary physician and encourages patients to continue to see their doctor as they wish. Under Medicare patients receive all treatment for the illness for which they were admitted to hospice from their doctor and the hospice team. Patients are free to continue treatments for other medical conditions, and still use their Medicare benefits.
It is the goal of hospice to allow the patient to be pain-free but alert. This can be a delicate balance depending on the condition of the patient. But, by continually consulting with the patient, the family and the physicians, hospices have been very successful in reaching this goal.
One of the basic goals of hospice is that patients will be comfortable, with well-controlled pain or discomfort. Hospice nurses are experts in pain and symptom management. They work closely with the patient, family and doctor to assure optimal comfort by using medications, counseling and therapies.
Hospice has hospice team members available 24/7/365 to meet our patient’s needs. Patients and families need only to call us and our on-call staff will answer to address any problem or concern.
No. Hospice patients are certified by the doctor for periods of care. Once a period of care ends, the doctor can recertify the individual for further hospice care if they are still eligible. For example, under Medicare, a patient can be certified for two 90-day periods, followed by an unlimited number of 60-day periods. As long as the doctor certifies that the person needs hospice care, he or she will continue to receive it.
Hospice patients do improve! A patient can sign out of hospice any time their condition improves or they decide to pursue aggressive, curative treatment. The hospice may discharge a patient if the condition improves such that the physicians do not feel the condition is likely to be terminal.
For patients living at home, respite allows family caregivers to take a break from their care-giving responsibilities. The care is usually provided in a nursing home or inpatient hospice facility. Generally the family may receive up to five consecutive days for respite care.
The hospice team will come when the patient dies and will handle the notification of family members, the patient’s physician, the funeral home and any local authorities that must be contacted. There is no need to contact emergency medical services, the police or any other service. We will be there to take care of these things as needed.
No. Bereavement care provides continuing contact and support for survivors and caregivers for 13 months following the death of a loved one. 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.
You may talk to the patient’s doctor and ask if a hospice referral can be made, or you can call and make the referral yourself. The hospice intake staff will contact the physician to verify appropriateness. Most appropriate patients are enrolled in the hospice program within 24 hours of the first call. Hospice is open 8 am–5 pm Monday–Friday and our staff is on-call 24/7/365.