HOSPICE – is a philosophy of care that focuses on comfort rather than a cure. Hospice care is designed to improve one’s quality of life and to help the individual make the most of whatever time they have left.
WHO qualifies for hospice services?
Anyone with a terminal illness. A physician must certify that, in their best guess, if the patient were to continue in their current condition, that the patient has SIX months or less to live. Of course, no one is able to tell for certain how long a patient is going to live.
How long can a patient stay on hospice? Do you kick them off after six months?
In hospice, patients often come to our care very late in the disease process, and die within days. Other hospice patients live for months or even years. Studies show that hospice patients sometimes live much longer than expected because they have a nurse visiting regularly, managing their symptoms, and often preventing the medical crises that land patients in the hospital in critical conditions. If a patient lives longer than six months, they can continue on hospice services as long as they meet hospice criteria and we can document an overall decline. Some patients, especially those with chronic illnesses such as congestive heart failure or COPD, may show a significant improvement in their condition, often related to having a nurse visiting weekly, monitoring their symptoms, and managing their medications. Sometimes patients improve so much that they no longer meet hospice criteria and they get to ‘graduate’ from hospice services. (I personally had not just one, but two 101 year old women who ‘graduated’ from hospice because they were doing so well!)
Where does hospice care take place? Do I have to leave my home?
Hospice is not a place – although many people picture hospice as a ‘hospice house’, most hospice patients are cared for wherever they live – in a private home, adult foster/family home, assisted living, or nursing home. A small number of patients may be cared for at an inpatient hospice house, where specially trained staff provide 24 hour nursing care. Home patients sometimes stay at a hospice house for short stay (usually less than a week) to manage symptoms that are out of control, or to provide a respite for caregivers, and then they return home.
What kind of care does hospice provide?
Hospice provides holistic care, striving to meet the patients emotional and spiritual needs, as well as physical needs. Hospice also provides family-centered care – we not only care for the patient, but the family as well. Hospice care is provided by a care team that works together with the patient, their family and caregivers, and their primary care physician.
The hospice team consists of a nurse who will visit weekly and as needed. I usually tell people it’s like a doctor’s office visit in the home, and visits can last from 30 minutes to over an hour, as needed. The nurse will usually take the patient’s vital signs and assess their heart, lungs,skin, and manage any distressing symptoms. They will discuss medications and how they are working, and will contact the doctor if changes are needed. Nurses will also educate the family and caregivers on how to care for the patient, how to administer medications, and what to expect as the patient’s condition changes. A hospice aide will assist with bathing and hygiene needs. A medical social worker will provide emotional support and will also help with things like funeral arrangements, state aid applications, and finding community resources for caregiving and other needs. Spiritual care is available to discuss the unique spiritual issues that arise at end of life. Bereavement services are available for at least one year after the loved one’s death. Volunteers are available for things like companionship, housekeeping, running errands, and other needs. Many hospices also offer complimentary and alternative therapies such as massage, music therapy, art therapy, acupuncture, pet therapy, and therapeutic touch.
Who pays for hospice care?
Hospice care at home is paid for by most insurances and Medicare.The Medicare hospice benefit includes all equipment and medications related to the patient’s terminal diagnosis and comfort. Hospice does not pay for aggressive or life-prolonging treatment. The philosophy of hospice is to allow natural death to occur and to keep the patient as comfortable as possible, focusing on the patient’s dignity and quality of life. Important to note: hospice does NOT provide around-the-clock custodial care.
Medicare does not cover room and board at an inpatient facility or if you are receiving home hospice services. Medicaid (state aid for low income patients) will sometimes cover all or part of room and board costs, or in-home caregivers.
If you have any questions that are not answered here, please post them in the comments.
For additional information, here are some helpful resources:
- The National Hospice and Palliative Care Organization (NHPCO) has posted a series of short videos on the Basics of Hospice
- Medicare Hospice Benefits booklet (PDF)
- Hospice information from Caring Connections (includes Hospice Checklist – what to look for)
One goal of this site is to help patients, family members, and caregivers as well as healthcare professionals, so I wanted to include some basic information about hospice for those of you who are just learning. This is basically the information that I give to patient’s and their families when I meet with them in the hospital for a hospice consult.