How to Know When It’s Time for Hospice Care

When you hear the word “hospice,” what is your first thought? Is it “an improved life” or “pain relief” or “free care”? As evidenced by the number of people who access hospice care far too late in their journey or not at all, those phrases are typically not at the top of the list.

When to Consider Hospice Care

People are eligible for hospice care when a physician determines that life expectancy is six months or less, provided a terminal illness runs its normal course. Recertification can take place if a hospice patient continues to live six months after participation. Following the physician’s determination, family members or friends can also refer the person to hospice care, or the person can choose to enter hospice on his or her own.

The decision to enter hospice care is based on many factors, including:

• Frequent trips to the ER or hospital for disease complications
• Frequent calls to physician’s office
• Increased pain
• Issues with ineffective pain medications
• Shortness of breath, even at rest
• Significant, unintentional weight loss
• Increased confusion
• Withdrawal
• Most of time spent in a chair or in bed
• Skin tears, infections, and other signs of deteriorating health
• Assistance needed with most activities of daily living
• Frequent falls

At its most basic, hospice care should be considered when an illness has progressed to the point that there is no cure. Pain management and comfort become the primary focus for patients rather than treatment.

What Can Hospice Do?

The hospice team will work with the patient and their family to determine the goals about the kind of care that will be provided. The patient does not lose control of his or her choices when it comes to the care he or she will receive.

Hospice can provide care in a hospital setting, a senior community or the patient’s home. Depending upon the hospice program, care is provided by a team of professionals. For example, the team could include:

• Nurses/case managers
• Hospice aides
• Social workers
• Hospice Medical Director
• Therapists
• Pharmacists
• Chaplains
• Volunteers
• Bereavement counselors

Nurses/case managers will visit and provide care. They will also coordinate the hospice team’s care.

Hospice aides are on hand to help the patient with daily activities like dressing, bathing and eating.

Social workers offer counseling services and can provide referrals to other support systems.

The hospice medical director oversees care, along with a primary physician chosen by the patient.

Therapists, such as those specializing in speech, physical, or occupational therapy, can help patients better manage the physical aspects of their daily lives.

Pharmacists provide medication oversight and recommendations of medications for symptom relief.

Chaplains or other spiritual counselors offer spiritual care and guidance for the family if requested.

Volunteers are trained to offer a variety of services, including providing company, giving family members time to rest, helping with transportation needs or other practical needs.

Bereavement counselors provide support and guidance to family members after the death of the loved one.

In addition, all medical equipment and supplies related to the diagnosis are provided.

Hospice care is covered by Medicare, Medicaid, and most private insurance companies (check with your insurer), meaning the team care and extra support provided is generally provided at no cost to the patient or their family.

Veterans Benefits are also available for hospice care.

Hospice decreases the burden on family members who may have been providing care. This also enables them to spend more relaxed, quality time with their senior loved one.

Hospice staff will make regular visits to where the patient resides, and staff is on call 24/7.

Timing is Important

The full benefits of hospice cannot be realized in the last few days of a terminal illness. If you qualify for hospice or your loved one qualifies, there is no reason to hesitate accessing the care it provides. Should the patient recover from the illness or wish to resume curative treatment, he or she are free to leave the program.

Unfortunately, statistics show that 43 percent of people who qualify for hospice do not enter a program until the final weeks of life.

Entering hospice is not a sign of defeat or resignation. In fact, it has been shown that hospice patients live longer than people with a terminal illness who choose not to enter hospice.

But it’s not just the length of life that can be increased, it is also the improvement in the quality of life that hospice provides its patients, and the support family members receive from it.

For more tips on Hospice, visit Bethesda’s Hospice Care blog.