For patients facing liver failure or end-stage liver disease, hospice care helps ease symptoms and improves quality of life. Liver disease can develop with long-term alcohol abuse or be the result of genetic disorders, cancers or a viral illness. No matter the ultimate cause, patients with liver disease who have a life expectancy of six months or less may benefit from hospice for liver failure.

Liver disease may progress slowly over years, so it can be difficult to determine when hospice is appropriate. In general, liver damage is considered end stage when the surface of the liver has accumulated scarring to the point of reduced function. This condition, called cirrhosis, is fatal without a liver transplant. As the liver fails, the body becomes unable to efficiently filter out toxins, and other organs may develop signs of serious illness.

The main criteria for hospice care is an expected life span of less than six months. Specific liver disease symptoms may indicate that the end of life is drawing near. Some criteria that could indicate a need for hospice services include:

Functional decline is another indication of a need for hospice or palliative care. This might include increased difficulty carrying out daily activities, such as personal grooming or household tasks. Individuals with severe functional decline may become immobile, remaining in a chair or bed for most of the day. Weight loss, reduced appetite and cognitive impairment can also be signs of functional decline.

Patients entering hospice also should have ceased curative treatment for liver disease or any co-occurring conditions. The exception to this is a patient with an end-stage liver disease diagnosis who wishes to remain on the transplant list. Hospice or palliative care is available to these patients until a donor organ becomes available.

Choosing to enter hospice is a decision between patients, doctors and the caregivers already helping the patient maintain day-to-day activities. The patient’s primary care physician is typically the person who makes the initial hospice care referral. Caregivers may include a spouse, adult children or family friends.

Liver disease often progresses slowly, so determining exactly when to enter hospice can be complicated. A doctor can monitor disease progression to help patients and family members decide whether further treatment or hospice care is more appropriate at a given time. Patients who don’t qualify for hospice services may consider palliative care, which provides many of the same benefits for patients who are still seeking treatment for liver disease.

It’s generally a good idea to start the discussion about hospice care early. A patient with a recent diagnosis of cirrhosis may not be ready for hospice services right away, but the nature of liver disease means that eventually the body will be unable to sustain normal functioning. Advance planning can help the patient and family caregivers decide what criteria merit a hospice referral and at what point the patient may wish to cease pursuing treatment for liver disease.

Patients who choose hospice often experience fewer emergency hospitalizations than liver disease patients who wait to enter hospice. Relying on hospice professionals for care and support also eases the burden on loved ones and improves the patient’s quality of life during this difficult life stage.

Entering hospice isn’t a matter of giving up on life but a recognition of the body’s limitations and a way to ease the burden of end-of-life care. Upon being admitted to hospice, the patient receives a comprehensive assessment to determine what services they’ll require. Care is tailored to the individual, ensuring a personalized experience that takes into account the patient’s health needs, abilities and wishes.

Family caregivers benefit from hospice as well. Often, family members are the primary caregivers for patients with liver disease, but constant caregiving can lead to burnout. Hospice helps relieve the burden and lets family members spend more quality time with their loved one.

Hospice staff provide essential information about liver disease progression and symptom management for caregivers to better help their loved one.

Sometimes, family caregivers need a break. Respite care involves temporary 24-hour care designed to allow family members to take care of other responsibilities for a short while.

Three Oaks Hospice provides up to 13 months of bereavement services for family members after a patient’s death. This can include visits with counselors and clergy members to process grief.

A liver transplant is a common treatment for advanced liver disease, but in some cases, the procedure fails. Hospice services may be an option if the patient has chosen not to pursue further treatment after a transplant failure.

Because finding an organ donor can take months or years, patients who are on the transplant list but otherwise fit the criteria for hospice may access hospice services. If a donor organ is located and a transplant is performed, the patient becomes ineligible for further services. Some patients enter and leave hospice multiple times.

Medicare, Medicaid and most insurance providers cover hospice services for patients who meet the eligibility criteria. Your hospice or palliative care team can help you navigate the financial paperwork necessary for coverage and ensure access to care remains consistent.

If you feel you or a loved one is in need of hospice care for liver failure, contact us at Three Oaks Hospice for an evaluation and to learn more about our services.