End of Life

End-of-Life Hospice Care Basics

An Overview of Hospice

While advances in modern medical treatments and life-prolonging technologies have made impressive strides, situations still arise in which patients either cannot or will not pursue efforts to cure a life-limiting illness, disease, or condition. In these cases, many individuals instead seek comfort and care to maintain their quality of life during their remaining time. So it is important to know what exactly hospice care is, the services it generally provides to patients and families, and how to determine if seeking it is appropriate for you or a loved one.

What Is Hospice Care?

Hospice is a specialized form of medical care that seeks to provide comfort and maintain a patient's quality of life (to the greatest extent possible) for those facing a life-limiting illness, disease, or terminal condition. After entering hospice, a patient receives individualized care that generally focuses on their overall or holistic well-being by addressing not only his or her physical condition but also any emotional, social, and even spiritual/religious needs as death approaches.

In addition, the patient's team of hospice professionals continually evaluates his or her condition and updates the care plan as needed.

Hospice care also provides practical support, resources, and information to a patient's family and loved ones during this difficult time—particularly to any family member(s) providing caregiving to the patient—as well as assistance planning a funeral, memorial service, or interment and grief support for survivors after a hospice patient's death occurs.

Hospice care is typically provided wherever the patient calls "home." This setting might comprise his or her house or that of a family member, a nursing home or assisted-living center, a hospice inpatient facility, or even a hospital.

Regardless of the location, the patient receives care from family members and trained hospice volunteers as well as an interdisciplinary team of hospice professionals, such as physicians, nurses, social workers, aides, and others.

Typical Services

Most hospices provide the following services, as defined by the Medicare Hospice Benefit which was passed in the United States in 1982:

  • Counseling services: When necessary and/or appropriate, hospice patients and/or their loved ones may receive dietary services, pastoral or spiritual support, and bereavement counseling for family and caregivers for a minimum of one year after the patient's death.
  • Home health aide: A hospice home health aide can help both patients with their personal care, such as bathing or dressing, or home caregivers with their responsibilities and typically visit two to three times per week, depending upon need.
  • Laboratory tests and other necessary diagnostic studies
  • Medical equipment: Hospice provides the equipment necessary for a safe, comfortable, and caring environment in a patient's home. These supplies might include a hospital bed, a wheelchair, adult diapers, bandages, and/or disposable latex gloves.
  • Medication: Hospice typically covers all medications related to the hospice diagnosis and those intended to control or alleviate pain and other symptoms.
  • Nursing services: A hospice patient is assigned a case-manager nurse who typically visits one to three days a week, depending upon need. An on-call nurse is also available to hospice patients and their caregivers 24 hours per day.
  • Physician participation: The patient's regular physician often provides his or her care in cooperation with the hospice medical director.
  • Respite care: This form of temporary, short-term assistance can help a family caregiver alleviate or avoid caregiver stress and burnout.
  • Social services: Hospice patients are assigned a certified medical social worker to assist them and their families with their emotional and/or social needs.
  • Therapists: If appropriate, hospice may provide a physical, occupational, and/or speech-language therapist to help the patient.
  • Additional assistance: Some individual hospice agencies also provide additional services through trained hospice volunteers and/or charity programs.

    In addition, Medicare defines four distinct levels of hospice care—the hospice facility and the patient's hospice physician will determine the appropriate level of care during admission. As part of the patient's individualized and updated care, this level can be adjusted as needed.

    Covering Expenses

    According to the National Hospice and Palliative Care Organization (NHPCO), Medicare paid for the care received by 85.5 percent of hospice patients in 2014. To qualify for the Medicare Hospice Benefit, however, an individual must qualify for Part A of Medicare and be physician-certified as terminally ill with a prognosis of six or fewer months—if the disease runs its usual course, among other things. (A physician may recertify the patient if his or her condition continues to decline but lives longer than six months.)

    In addition, many private or commercial health-insurance plans offer hospice benefits as do most state Medicaid programs.  If an individual lacks the necessary insurance coverage or other financial resources, many hospices will still accept a patient and cover the costs using financial donations or money received during community fundraising events and other charitable sources.

    There are several important factors to consider when choosing a hospice provider, and , obviously, your personal medical insurance and financial situation will factor into your decision. Do not hesitate to ask your physician and a potential hospice agency questions regardless of your circumstances—few hospices will turn someone away who can benefit from their services.

    Common Misconceptions

    Because there are various myths about hospice, many people think this form of specialized medical care is only for those dealing with cancer. According to the NHPCO, however, the majority of patients (63.4 percent) were admitted to hospice in 2014 with non-cancer primary diagnoses, such as dementia, heart disease, lung disease, stroke, or coma. The fact is that hospice professionals can provide care and comfort for those facing a wide variety of life-limiting conditions beyond cancer.

    Another widely held misconception is that those entering a hospice program have given up hope or want to die. It's important to understand that while hospice care does not seek to cure a patient's life-limiting illness, disease, or condition, hospice also does not hasten death or "help someone die." The overall mission of hospice care often affirms life because it views death as part of a natural process and helps patients spend the remainder of their lives as fully and comfortably as possible.

    Is Palliative Care Similar?

    The terms palliative care and hospice care are often used interchangeably, but they are actually not the same thing. While both of these forms of specialized medical care focus on relieving a patient's symptoms and improving his or her quality of live, palliative care can be administered at any time and for as long as deemed necessary to someone dealing with a chronic or life-threatening condition. ​

    For example, while not limited to this disease, someone diagnosed with cancer might start receiving palliative care to treat both the symptoms and the side effects of his or her treatment while still undergoing cancer treatment itself, such as chemotherapy or radiation.

    Hospice is a form of palliative care for those approaching the end of life, but palliative care can be administered at any time regardless of whether the patient's disease or condition can be cured.

    Is Hospice Right for Me or a Loved One?

    There are pros and cons to entering a hospice program and anyone facing a life-limiting illness, disease, or terminal condition should discuss all of their options, including hospice, with their physician, caregiver(s), and family. A patient is generally ready for hospice, however, when he or she decides to pursue treatments meant only to promote/provide comfort rather than seek a cure for his or her illness, disease, or condition.

    Such medical care might include medications to alleviate pain, nausea, shortness of breath (dyspnea), appetite loss, muscle cramps, itching, or other symptoms and conditions. While under hospice care, a patient may receive more-aggressive treatments, such as blood transfusions, chemotherapy, or radiation, when the goal is to alleviate his or her pain and discomfort but not to cure the disease.

    While hospice care is generally appropriate for a patient with a life expectancy of six or fewer months, such diagnoses are merely estimates (some patients die sooner and some live much longer). The earlier a patient can access hospice services, however, the greater the benefit he or she—and his or her family members and loved ones—will receive from this specialized form of medical care.

    Sources:

    "Hospice eligibility requirements." National Hospice and Palliative Care Organization. Retrieved August 14, 2016. http://www.nhpco.org/hospice-eligibility-requirements

    "NHPCO Facts and Figures: Hospice Care in America," September 2015. National Hospice and Palliative Care Organization. Retrieved August 16, 2016. http://www.nhpco.org/sites/default/files/public/Statistics_Research/2015_Facts_Figures.pdf

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