At the end of life, hospice is intended to provide compassionate care that assists the dying to live as fully and comfortably as possible. Hospice services are provided at home, in hospitals, in assisted living and nursing facilities and in stand-alone hospice facilities.
Hospice reflects a philosophy of care. It emphasizes immediate quality of life rather than a possible cure or recovery. In this, hospice workers are a breed apart. Most medical personnel regard death as the ultimate enemy, to be fought as long as anything can be done. In contrast, hospice workers accept dying as the final stage of life and focus on alleviating discomfort and furthering peace of mind. This is often called “palliative care.”
For hospice workers, death is neither to be hastened nor postponed. The goal is to manage symptoms so that a person’s last days may be spent in comfort and with dignity.
Here is a brief history of the hospice movement. In recent years, for-profit corporations have entered the “hospice market” with predictably awful results. For more information: Differences in Care at For-Profit Hospices, Hospice Firms Draining Billions from Medicare.
Qualifying for hospice care
Hospice care is for those who have a short time to live. A doctor must certify that the patient has a terminal illness and will probably not live longer than six months. (Terminal illnesses include cancer, heart disease, dementia, chronic obstructive pulmonary disease (COPD), and others.) Hospice is available to everyone in that situation, regardless of age, culture or financial status.
In general, hospice costs are covered by Medicare after a patient signs a statement choosing hospice care instead of medical treatment. (Medicare continues to cover treatment for health problems not related to the terminal illness.) However, Medicare has some pilot programs where patients may opt for palliative care while continuing aggressive treatment.
Patients may go in and out of hospice as their medical condition fluctuates. A cancer patient may leave hospice if the cancer goes into remission and re-enter it if symptoms recur. A patient may leave hospice to try a new or experimental medical treatment.
Medicare generally covers a total of 210 days of hospice care. This is broken into two 90-day periods followed by a 30-day period. These periods may be extended if a doctor re-certifies that the patient’s condition remains terminal.
Most people don’t opt for hospice until their final days, when all hope is lost. But if you know you don’t want further aggressive medical interventions, it’s best to start hospice as early as possible. It will bring you into contact with people whose focus is alleviating your symptoms and keeping you comfortable.
The hospice team
An interdisciplinary health care team manages each individual’s hospice care. The team can include doctors, nurses, social workers, counselors, home health aides, clergy, therapists and trained volunteers. For seniors without family, the hospice team often becomes a surrogate family whose express goal is to keep their best interests in mind.
Hospice care is often based in the patient’s home but can be given in a hospital, nursing home, or private hospice facility. It includes medical equipment such as wheelchairs, walkers, hospital beds, oxygen equipment, bedside commodes, and medical supplies such as bandages and catheters as well as laboratory and other diagnostic studies related to the terminal illness.
Home Hospice
If hospice is to be provided at home, a hospice team member will first visit the senior’s home to learn about their situation and assess their needs. Future visits will be set up so for regular re-evaluations. An on-call nurse will make home visits as well as answering phone calls 24/7. There may also be visits for check-ups or special services like administering injections. If a visit is needed between the regularly scheduled ones, the nurse will contact an appropriate team member. Hospice teams also provide help with insurance and financial paperwork as well as bereavement care for survivors. In addition, home health aides help with everyday needs such as bathing, cooking, and cleaning.
For home hospice, someone needs to be in attendance at all times. If you don’t have enough friends or family to support you through home hospice, it will be more difficult to stay in your home. Trained hospice volunteers may be able to spell friends acting as caretakers, but the home hospice team probably can’t replace family and friends altogether. Hospice team members teach friends and families the necessary skills for providing care.
Hospice Care Outside the Home
In some hospitals and facilities, hospice care is provided in a special hospice unit while in other facilities, a hospice team will visit patients in any nursing unit. In some hospitals, the staff on the patient’s unit will act as the hospice team.
Many nursing homes have small hospice units or specially trained nursing staff to care for hospice patients. If not, they will often make arrangements with home health agencies or independent community-based hospices to provide services.
Many communities also have independently owned hospices that offer both inpatient and home care hospice services.
Costs
The majority of hospice care is paid by Medicare. Costs may vary since some Medicare policies include copays and co-insurance. Many hospice programs will work with patients unable to cover their own costs.
Evaluating hospice programs
Here are some of the questions for evaluating hospice programs:
- How will the patient’s pain and symptoms be managed?
- What other services are offered?
- Which services are available 24/7? How are they provided?
- How involved are the primary care doctor and hospice care doctor?
- What professions are represented in the hospice care team, and how are they trained and screened?
- Is the hospice program reviewed and certified or licensed by the state?
- If home hospice proves inadequate and a move to a facility becomes necessary, does the hospice program have contracts with local facilities to maintain continuity of care?
- Is the program certified by Medicare?
- Are all costs covered by Medicare or other insurance?
Web Resources
- National Hospice and Palliative Care Organization
- Hospice Association of America
- Hospice Foundation of America
You can also check with your local Area Agency on Aging for reputable hospice care providers.
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