Hospice care, also called end-of-life care, involves treatment for pain and interventions to make life more comfortable after treatments for disease or life-extending interventions have ended. Families looking for hospice care should begin their search early because patients get more benefit out of hospice care if the details are all settled before the need becomes urgent. Hospice care can occur in a patient’s home, in a hospital setting, a nursing home, or in an assisted living facility, depending on the specific needs of the individual.
When Hospice Benefits Begin
Hospice benefits under Medicare start when a patient is expected to live six months or less past the date of entering palliative care. The patient’s regular doctor and a hospice doctor must both certify that the patient qualifies, and the patient must sign paperwork accepting palliative care instead of continuing to treat any diagnosed terminal illnesses.Hospice care can be extended past the initial six-month period, and patients who stabilize or improve without medical intervention can leave hospice if they desire without losing the unlimited benefit of hospice as long as they meet the criteria. For example, if a cancer patient in hospice care decides that a new treatment looks promising, that patient can opt to leave hospice and start receiving cancer treatments again. Because there is some flexibility with regard to hospice, patients and their families should not put off planning based on concerns that the option is permanent or irreversible.
Broaching the Subject of Hospice
Many patients and families wait too long to start contemplating hospice options. If your loved one has recently been diagnosed with a terminal illness, such as cancer, lung disease or a serious heart condition, you should start talking with a doctor about eventual hospice care. Patients who have been diagnosed with conditions that cause rapid deterioration of brain function, such as Alzheimer’s disease or other dementias, should also discuss end-of-life care early in the diagnosis.
In some cases, the disease has already progressed significantly before hospice care is brought up by a family member or doctor. If your loved one is struggling with basic self-care and mobility, exhibiting signs of severe depression or experiencing severe pain, you should initiate the discussion about hospice as soon as possible.
When choosing the right time to go into hospice care, the best indicator is how stable the person’s condition is at the moment. Increasing symptoms and declining health over time both indicate that hospice care might be necessary. If your relative’s condition is fairly stable, living independently or under the care of family members for a while longer might be an option. This doesn’t mean you should wait to discuss hospice care, though. Early preparation simplifies things down the road significantly.
One reason to talk about hospice care early is to determine the wishes of the patient before he or she is unable to articulate those wishes clearly. A terminal patient might feel strongly about maintaining a good quality of life instead of trying to prolong life. If family members know this preference, they might feel better about looking for a hospice care providers early so everyone is prepared for the eventual move into a palliative care setting.
Evaluating Hospice Options Early
In addition to ensuring that the terminal patient’s wishes are being carried out, looking for hospice care early also helps your family make an informed decision about where hospice care should take place. When the need isn’t urgent, you have time to visit various agencies that offer hospice care and ask questions about the type of care provided. You can observe current residents firsthand or talk to home palliative care patients and find out about enrichment programs, such as music or sports therapy, that help fill your relative’s days while in hospice care. Staff members such as dietitians, physical therapists and social workers help create a comprehensive program of care for residents.
An early hospice care search also helps the hospice team prepare for your loved one’s needs in advance. If the team is already in communication with your loved one’s doctor before a crisis, they can ensure that they have any specialized equipment on hand to meet the patient’s needs once the time to enter hospice draws near.
Choosing the Right Hospice Care Provider
A good hospice care provider gives compassionate care during those final months of life and has medical staff on hand to help keep each patient comfortable. Hospice staff should be focused on reducing symptoms such as pain, fatigue and nausea so that residents can live each day to the fullest.
Look for a hospice team that provides support for family members as well. Grief therapists and spiritual counselors can help relatives work through the intense emotions of dealing with their loved one’s end of life journey.
You might also consider the level of communication that a particular hospice provides as part of your decision. Search for a hospice that communicates frequently with patient families and keeps relatives informed about changes in the patient’s condition. Talking to family members of current and former patients might help you determine if a particular hospice is a good fit for your loved one.
When deciding whether hospice care is the right choice, some patients worry that they might not be able to continue seeing their regular doctors. A good hospice care team works with your relative’s existing primary care provider to coordinate treatment, so there is a continuation of care from someone who knows the patient well.
Getting your loved one into hospice care at the right time makes those final months or weeks of life much more relaxed and enjoyable. Hospice often involves specialized nursing care and pain management, and these things are typically covered by Medicare. Delaying hospice care may expose your loved one to more pain and suffering than necessary.
Medication, supplies and medical equipment are all included in hospice coverage, which can take a burden off families concerned with financially supporting a terminal relative. Having everything settled early in the process also helps caregivers manage their own schedules. Instead of being always on call in case of an emergency, family members can relax knowing that their loved one is receiving 24-hour care and support.
