Is it the right time for hospice?
Many families wait to call hospice until the final days and weeks of their loved one’s life, not knowing they could have started receiving additional specialized nursing care and medications, medical equipment and supplies related to their loved one’s terminal illness at no cost much earlier. Hospice care improves the patient’s quality of life by managing pain and other symptoms of their illness and improves the family/caregiver’s lives by having someone that they can lean on, seek guidance from and receive much needed support during this difficult time.
You should call hospice if your loved one is experiencing any of the symptoms below:
• frequent visits to the ER or hospital admissions
• a decline in their ability to perform daily tasks including eating, • getting dressed, walking, or using the bathroom
• an increase in falls
• changes to their mental abilities
• progressive weight loss
• skin tears, infections, and other signs of deteriorating health
10 Hospice Myths
Myth #1: Hospice is a place.
Fact: Hospice is a philosophy of care providing medical, emotional, and spiritual care that is focused on comfort and quality of life. Hospice care usually takes place where the patient calls home. This may be their personal home, a group home, an assisted living facility or skilled nursing facility. In certain situations, hospice care can be provided in a hospital for a brief period of time.
Myth #2: If you go on hospice, you will die soon.
Fact: Receiving hospice does not mean that death is imminent. Studies have shown that patients who elect hospice care earlier often live longer than those who continue to receive curative treatment. Hospice care is designed for patients who have a life expectancy of approximately six months or less. However, as long as the patient continues to meet hospice requirements, they may continue to receive services – even if this is longer than six months.
Myth #3: Hospice means giving up hope
Fact: Hospice redefines hope and helps patients and their families reclaim the spirit of life. Hospice care focuses on improving the patient’s quality of life allowing them to make the most of the time they have.
Myth #4: Choosing hospice means giving up all medical treatment.
Fact: Hospice makes the patient’s quality of life the focal point of care. Hospice professionals are trained to provide care and treatments that lessen the patient’s pain and other symptoms. Hospice strives to decrease the burden of medical treatment when such measures would not improve the patient’s quality of life. For some patients this may mean decreasing the number of medications taken for chronic conditions.
Myth #5: Hospice provides 24-hour care.
Fact: The hospice team visits on an intermittent basis. This team includes physicians, nurses, social workers, hospice aides, chaplains and other specially trained care providers. The frequency of visits is determined by the patient’s needs. A hospice RN is on call 24 hours a day/7 days a week to answer questions and provide support. After hours visits are made as needed.
Myth #6: You have to have Medicare or Medicaid in order to receive hospice care.
Fact: In addition to Medicare and Medicaid, most private insurance plans, HMOs, and other managed care organizations recognize the value of hospice care and include hospice coverage in their plans. Additionally, some hospices provide charity care to patients who do not have insurance coverage or the ability to pay for their care.
Myth #7: Once a patient chooses hospice, he or she can no longer receive care from their primary physician.
Fact: Hospice works closely with the patient’s primary care physician as a member of the hospice team. The patient can continue to see their primary care physician.
Myth #8: My doctor will tell me when it is time to consider hospice.
Fact: Most physicians have had little hospice training and are uncomfortable talking about death. It is important for you to take control of your healthcare decisions, and seek options when the time is right for you and your loved ones.
Myth #9: The hospital discharge planner, the social worker or my physician selects my hospice agency for me.
Fact: It is the patient’s, or their designated decision maker’s, right to determine when hospice care is right for them and which agency they would like to use. Others may recommend agencies for you to consider, but it is up to you to make the final decision. Not all hospice providers are the same, and it is important to receive the care that best fits your desires and needs.
Myth #10: Once I am on hospice, I can’t change my mind.
Fact: You can stop hospice services at any time and for any reason. You can change your mind and resume aggressive treatment. Then if you wish to return to hospice care later, you can do so as long as you meet the medical hospice admission requirement.
The Realities of Hospice Care
When a doctor “certifies” for hospice care, that triggers a range of services that will be covered by Medicare Part A. In addition to medical and nursing services, also provided are social work, grief counseling and even physical and occupational therapy. The emphasis is on accommodating the entire family and enhancing the patient’s comfort. Here’s how the Medicare hospice care benefit works if you need, and qualify for, it:
• Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill; that is, you’re expected to live six months or fewer. Note: Only your hospice doctor and your regular doctor can certify that you’re terminally ill and have a life expectancy of six months or fewer.
• You accept palliative care for comfort instead of conventional care to cure your illness.
• You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.
• After six months, you may continue to receive hospice care as long as the hospice medical director or hospice doctor recertifies — at a face-to-face meeting — that you’re terminally ill.
Medicare is actually fairly generous on what it covers, paying for “any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness and related conditions, as recommended by your hospice team.”
Frequently Asked Questions
Will I have my own hospice team and how often will they visit?
Every person receiving hospice has access to a registered nurse, social worker, hospice aide, and chaplain (also known as the interdisciplinary team) and volunteers. The hospice team will work with you and your family to create a plan of care that will outline the actions and goals for your hospice care.
All visits are based on you and your family’s needs in the care plan and your medical condition during the course of the illness. The frequency of volunteers and spiritual care is often dependent upon request and the availability of these services. Travel requirements and other factors may cause some variation in how many individuals each hospice staff serves.
What happens if I can’t be cared for at home?
A growing number of hospice programs have their own hospice facility or have arrangements with nursing homes, hospitals or inpatient residential centers that care for people who cannot be cared for at home. However, the cost to live in these settings may not be fully covered by your insurance so it is best to find out if insurance covers this type of care before you call hospice.
Can I be cared for by hospice if I reside in a nursing facility or other type of long-term care facility?
Hospice services can be provided to a person who has a life-limiting illness wherever that person lives. This means a person living in a nursing facility or long-term care facility can receive specialized visits from hospice nurses, home health aides, chaplains, social workers, and volunteers, in addition to other care and services provided by the nursing facility. The hospice and the nursing home will have a written agreement in place in order for the hospice to serve residents of the facility. The Medicare Hospice Benefit will cover the care related to your terminal illness, but it does not cover daily room and board charges of the facility. If you are eligible for Medicaid, Medicaid will cover room and board charges.
Start by calling us at (enter phone number) or completing the form on this page. After the initial hospice patient referral, a Anvoi representative will meet with the patient and caregiver for an informal visit, to:
• Have a Anvoi nurse evaluate the referred patient to see if hospice care is the best course of action at this time.
• Provide an overview of our available programs and services.
• Collect consents and admissions.
The Anvoi Hospice patient referral process has been designed to ensure that patients receive the care they need. In many cases, end-of-life care is recommended too late for patients. That’s why our hospice referral process works to get the right patients into hospice care as quickly as possible.
Fill out the form to refer a patient to hospice.
Hospice care may be considered for anyone doctors believe to have a life expectancy of less than six months. Usually at the point, active treatment aimed at recovery stops and hospice care is initiated. Hospice care focuses on producing the best possible quality of life in the patient’s remaining time.
Different diseases and conditions each have their own guidelines for hospice admission. The most common of these diseases or conditions include ALS, cancer, dementia, heart disease, HIV, kidney disease, liver disease, lung disease, Parkinson’s disease, stroke and coma. Sometimes a patient does not “fit” into the guidelines but still has a life expectancy of six months or less and therefore may be eligible for hospice.
In order to be eligible to elect hospice care under Medicare, an individual must be entitled to Part A of Medicare and certified as being terminally ill by a physician and having a prognosis of 6 months or less if the disease runs its normal course.
Each person’s end-of-life experience is unique, as it is influenced by such factors as the specific illness, medications being taken, and the person’s overall health. In some cases, these changes may occur over a period of weeks; for others, the process lasts just a few days or hours.
However, a number of end-of-life changes are fairly common, as a person’s bodily functions naturally slow and stop. The following changes are often signs of this process, though not every patient exhibits all of these end-of-life signs.
• Less interest in eating or drinking. The person may only need enough liquid to keep their mouth from becoming too dry.
How to help: Offer, but don’t force, food, liquids, and medication. In some instances, the person may no longer feel pain they had previously felt.
• Not passing fluids regularly. As bodily functions decline and the person eats and drinks less, their output of fluids will also decrease.
How to help: Do nothing. However, if the patient is not passing fluids but feels the urge to do so, contact their nurse for advice.
• Speaking and moving less. Activity usually decreases significantly in one’s final days and hours. People may not respond to questions and show little interest in their surroundings.
How to help: Allow your loved one to rest and remain peaceful. Offer reassuring words and touches, but don’t pressure the person to interact.
• Sleeping much more than usual. It is natural to sleep more, including during the day, at the end of life.
How to help: Let your loved one sleep. At this point, it is more important to be with, rather than to do for, your relative.
• Difficulty communicating. Vision and hearing may become impaired, and speech may be hard to understand. Lack of oxygen reaching the brain (due to decreased circulation or other causes) may contribute to these changes.
• Gurgling with each breath; a dry, encrusted mouth. Patients often breathe through their mouth, causing secretions to collect at the back of the throat. This can cause gurgling, coughing, choking, or even vomiting. These secretions may also coat the mouth, or drain if the person is lying on their side.