What Is Hospice... Font Size: F F
What are some questions that you should ask when looking for a hospice
program? Hospice care is a philosophy of care that accepts dying as a natural
part of life. When death is inevitable, hospice seeks neither to hasten nor
postpone it. Below is a list of questions you should consider when looking for a
hospice program.
• What Are Some Interesting Hospice Facts?
• When Should You Begin Hospice Care?
• How Can You Afford Hospice Care?
• How Does Hospice Serve Patients and Families?
• What Role Do Volunteers Play In Hospice?
• Who qualifies for Hospice Care?
• Where Is Hospice Care Provided?
• What Is The Role of the Medical Director?
• What Is The Role Of The Attending Physician in Hospice?
• What Are Advance Directives?
• How Does The Hospice Admission Process Work?
• How Does Hospice Manage Pain?
• Is There Any Association With A Religious Organization?
• What Are Some Myths About Hospice?
Hospice is professional, end-of-life medical care delivered to patients suffering the advanced stages of serious illness.
Hospice care is for the patient whose illness no longer responds to curative treatment. In this case a palliative approach is more suitable. Therefore, the goal of hospice is to provide care with compassion, focusing on pain management and symptom control while providing comfort, dignity and quality of life.
Hospice evaluates the patient's physical condition, pain, support system and environment. Since each patient has unique needs, the hospice teams works with the family to develop a personalized care plan right in the patient's home, be it a private residence, assisted living apartment or nursing home.
What Are Some Interesting Hospice Facts?
Hospice VS. Home Health
| Hospice | Home Health |
|
|
Hospice Is Growing
| Year | Patients |
| 1985 | 158,000 |
| 1987 | 177,000 |
| 1989 | 186,000 |
| 1990 | 210,000 |
| 1992 | 246,000 |
| 1994 | 340,000 |
| 1996 | 450,000 |
| 1998 | 540,000 |
| 2000 | 700,000 |
| 2001 | 775,000 |
| 2002 | 885,000 |
| 2003 | 950,000 |
Where Americans Died
Although more and more terminal patients are choosing hospice care, most people still die in the hospital either in the ER or in Acute Care.
Most Hospice Patients Died At Home
When patients and families learn about the benefits that hospice provides, they often choose to die at home, pain free and among their loved ones where the quality of life can be best maximized.
Hospice Serves the Non-Cancer Patient Too
Cancer still ranks as the most common condition for which the patient was referred to hospice. Cancer accounts for 49% of all hospice deaths, down 1.5%.
Increasingly, physicians recognize that other non-cancerous conditions also qualify a person for hospice and refer. In these cases curative treatment was no longer the patient's choice or option.
When Should You Begin Hospice Care?
The decision to start hospice is not easy. But beginning hospice care early is key to getting the best benefit from the services provided. In many cases, patients are admitted to hospice while they are still ambulatory and require only occasional assistance.
Length of Service:
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36.9% of hospice patients died in 7 days or less.
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The average length of service (ALOS) was 55 days, up from 50.6 days.
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The median length of service (MLOS) was 22 days, up from 20.9 days.
How can you afford hospice care?
Eighty percent of people who use hospice care are over the age of 65, and are thus entitled to the services offered by the Medicare Hospice Benefit. This benefit covers virtually all aspects of hospice care with little out-of-pocket expense to the patient or family. As a result, the financial burdens usually associated with caring for a terminally ill patient are virtually nonexistent. In addition, most private health plans and Medicaid in 45 states and the District of Columbia cover hospice services.
How does hospice serve patients and families?
Hospice care is a family – centered approach that includes, at a minimum, a team of doctors, nurses, social workers, spiritual counselors and trained volunteers. They work collaboratively focusing on the dying patient’s needs, be they physical, psychological, or spiritual. The goal is to help keep the patient as pain-free and lucid as possible, with loved ones nearby until death.
What role do volunteers play in hospice?
Because round-the-clock, hands-on care is the hallmark of the hospice experience, hospice provides trained volunteers to aid the family and patients. Most hospice volunteers are trained to relieve the primary caregivers, run errands and offer respite (short term). Perhaps the most important task, however, is their ability to be “good listeners.”
Who qualifies for hospice care?
Hospice care is for any person who has a life-limiting illness. Most reimbursement sources require a prognosis of six months or less if the illness runs its normal course. All hospice consider the patient and family together as a unit of care. Patients with both cancer and non-cancer illnesses are eligible and include:
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Heart Disease: Congestive Heart Failure, Cardiomyopathy
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Pulmonary Disease: Chronic Obstructive Pulmonary Disease (COPD), Emphysema, Asbestosis, Pulmonary Fibrosis, etc.
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Neurological Disease: Parkinson's, ALS (Lou Gehrig's Disease), Stroke
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Liver Disease
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Renal Disease
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HIV/AIDS
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Dementia
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Alzheimer's
Hospice care is provided by Medicare, Medicaid and TRICARE (military health program). In addition, most insurance plans and managed care plans cover hospice services. Benefits are available for patients with a prognosis of six months or less. Patients who live beyond the six months are re-certified by their Medical Director and continue to receive benefits, as long as the patient meets criteria for services. Hospice services related to the terminal illness are generally covered at 100%. (There may be a small co-payment for certain equipment and prescriptions for private insurance plans.) These services include:
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Physician direction, nursing services, home health aides, social workers, spiritual counselors, volunteers
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Physical, occupational and speech therapy
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Prescription and over-the-counter medication for pain and symptom management
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Medical supplies and equipment
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Short term inpatient care for crisis management and respite
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Continuous in-home care in times of crisis
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Bereavement services for the family for up to one year
Where Is Hospice Care Provided?
We bring hospice care to wherever the patient needs it. Hospice services delivered by a caring team, come right to the patient's home whether that home is a private residence, a nursing facility or assisted/independent living setting. We provide instruction, assistance and support for the family. The family is encouraged to participate by regular visiting, bringing favorite music or food and by providing as much hands on care as possible such as feeding, reading, or just being present.
In a nursing facility, attention is paid to making the environment and care planning as patient-friendly as possible. As always, we strive to control pain, manage symptoms and to provide comfort, dignity and quality of life.
What Is The Role Of The Medical Director?
The hospice Medical Director reviews, coordinates and takes responsibility for the management of the clinical and medical care for all patients in the program.
The Medical Director:
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Consults with the attending physician regarding pain and symptom control
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Reviews patient eligibility for hospice services
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Acts as a medical resource for the interdisciplinary team
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Acts as a liaison with physicians in the community
What Is The Role Of The Attending Physician in Hospice?
The attending physician may benefit his/her patient by providing the primary medical care. The attending physician is usually the patient's family doctor.
The hospice interdisciplinary team supports the attending physician:
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Interdisciplinary team assessment
- Professionals should continue to utilize and seek out clinical judgment and team
collaboration -
Education for patient/family caregiver
- Disease State
- Anticipated symptoms
- Non-pharmacologic measures
- Medication counseling
- Psycho-social and spiritual factors -
Medication monitoring and counseling
- Documentation of usage and dose information
- Common and uncommon side effects
- Determine and document patient/caregiver level of understanding of information -
Documentation of all pertinent information
- Assists in prognostication
- Decision making
- Patient/family/caregiver contact and involvement
- Individualization of goals and interventions
Advance directives are documents which state your choices about medical treatment or name someone to make decisions about your medical treatment. if you are unable to make these decisions yourself. They are signed in advance to let your doctor and other health care providers know you wishes concerning medical treatment.
Generally there are four recognized types of advance directives:
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A Living Will
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A Health Care Power of Attorney
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A Mental Health Care Power of Attorney
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A Pre-Hospital Medical Care Directive
All of our social workers are knowledgeable in the area of advance directives and provide advice and counsel to patients and families who need assistance. This advice is part of the benefit of hospice care provided by any of our branches.
How Does The Hospice Admission Process Work?
When a patient is referred to hospice, that branch contacts the physician first to make sure that he/she agrees that hospice care is appropriate. Then the patient and family are contacted to set up an in-person appointment. At this meeting, we will describe services and explain palliative care including comfort measures and symptom control. The rights and responsibilities of the patient/family are discussed.
The patient will also be asked to sign admission/consent forms. These are similar to the forms that patients sign when they enter the hospital.
Patients can continue to see their same physician if they wish. A patient can revoke hospice services at any time. Should they wish to resume curative measures, the patient can be re-certified by their Medical Director to continue hospice care, as long as the patient meets criteria for continued hospice services.
All of our branches recognize both physical and emotional/spiritual pain as very real and addresses both. Hospice physicians and nurses are up-to-date on the latest pain medications and alternative measures for symptom relief. Physical, occupational and speech therapy can also be utilized as well as music therapy, aroma therapy, massage and diet counseling. The spiritual counselor will work with the patient/family clergy to assist with spiritual concerns.
By utilizing combinations of medications, counseling and therapy, patients can achieve their desired level of comfort.
Medications utilized will generally not interfere with the patient's ability to remain alert. Constant communication with the patient assures this. Effective utilization of medications contribute in helping patients remain lucid and comfortable, all to enhance the quality of life.
Is There Any Association With A Religious Organization?
No. All of our branches provide premier hospice care to patients without discrimination based on the patient's religious, ethnic, cultural or economic background. Patients are not required to adhere to any particular set of beliefs about death or dying. We respect and support religious and cultural differences, beliefs and practices with regard to its end-of-life care and grief support.
We offer spiritual support services to explore any religious concerns or need. Ours is a ministry of friendship and presence. Spiritual counselors are assigned for each patient and family regarding spiritual, moral, ethical or religious issues through out the hospice service including times of crisis, and for the family during the bereavement period.
What Are Some Myths About Hospice?
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Hospice is a Place...Not so!
Hospice is not a place. Hospice services go wherever needed...home, nursing home, hospital room or freestanding hospice house. -
Hospice is Just for Cancer Patients...Not so!
In 2002, 50% of hospice patients had cancer. The rest had heart, lung, kidney, liver, brain disease, Alzheimer's or other serious illnesses. -
Hospice is Expensive...Not so!
Hospice is Medicare-certified and there are few, if any, out-of-pocket expenses. Many insurance plans cover hospice. Most hospices often have indigent-care plans to cover the uninsured. -
Hospice is Only For People Who Have Family to Care For Them...Not so!
Many hospices coordinate care plans with other community resources to provide in-home care for people with no family.
© 2006 - National Hospice Management Inc.