Hospice Provides Comfort for End-of-Life Care
Hospice Care is available to individuals at the end-of-life stage to receive care at home, in a hospital, nursing home, or a private hospice facility. Where someone receives hospice, depends on the individual's physical and mental conditions that determine the best place for care.
When patients and family members consciously choose an active part of the dying process, the home is the best place. Most family members say they are grateful for the time spent with a loved one. It's the final days that are the sweetest and can change a family member's level of compassion, forever.
When the family takes an active role in hospice care at home, understand that you're signing up for a tougher transition.
If you've been the primary caregiver for a loved one all along, you've experienced a lot of transitions. Maybe your husband, wife, or parent's been in and out of the hospital and nursing home sometimes. Maybe you've hired a professional caregiver to give care at home. These transitions with a loved one have prepared a family for the final journey.
Hospice Care comes with its set of new caregiving tasks and routines, and most are harder.
Hospice is for both the patient and the family. The loved one's health worsens, which is a marker for the new transition.
Treatments and medications no longer work and add to prolonged suffering. You may have a lot of questions and concerns about what to do. You may also be dealing with many feelings as your family member faces a serious and life-threatening illness or is dying.
If your living through agony of wondering whether a loved one's present care is enough or appropriate for one's condition, here are questions to ask:
What is the prognosis?
What is the expected course of the illness?
What are the goals for care? (Cure or comfort that improves quality?)
About Hospice Care
You've run out of treatment options to cure the disease. Now the focus is comfort and life quality.
Making the choice for hospice care comes a long time after a patient is ready for it. It's delayed because people want to avoid the inevitable, hoping it will disappear. The transition to hospice care is hard to accept. Families and patients fear that choosing hospice care leads to end-of-life.
A well-ingrained myth: Hospice care translates to "nothing more to do for healing a patient." But this is not true. It's a myth. In most cases, patients receiving hospice care receive many helpful and useful services that improve a patient's life and those of family members.
Who decides it's time for hospice care?
You, the family member, and your loved one living with the disease.
It's difficult to decide alone. Reach out to the loved one's health care team, all members of the family, doctors, and professional caregivers. Learn all you can about what hospice offers. Don't decide blindly. Discover its benefits. And don't decide against it out of fear.
Your doctor is the closest to your loved one's health status. They are the first to suggest hospice care.
If the doctor does not broach the topic, bring it up to her. If the doctor is against hospice care, ask her to explain why. If she believes your loved one is not eligible, get a second opinion. Once you choose hospice care, the doctor orders it.
What Services does Hospice Care Offer?
Hospice care does not include treatments and medications that aim to cure. Services offer comfort processes and methods: equipment, support, and care.
Services for patient includes:
- A health care team of doctors, nurses, social workers, chaplains, home care aides and other health care providers comprise the hospice team.
- Access 24 hours a day, seven days a week to care team by phone.
- Medication to relieve nausea, pain, shortness of breath, agitation, and other symptoms.
- Medical supplies and equipment, such as a hospital bed or wheelchair.
- A short-term stay in the hospital when symptoms are too difficult to manage at home.
Services for family support includes:
- Emotional support
- Training on certain health care tasks; injections and changing dressings.
- Short-term respite care-time off for family caregivers.
- Volunteers to provide companionship for the patient.
- Bereavement counseling for family caregivers for a year after the patient's death.
What's the Process of Hospice?
- Hospice staff meets with patient and family - you ask questions to decide if it's the next step in care.
- Sign consent forms. Within a few days, the hospice team begins the work. You can keep working with other aides or helpers you pay for on your own
- Modify furniture in the home to make room for medical equipment.
- Assigned a hospice nurse. The team may include therapists and a part-time aide.
- The hospice team regularly reviews the patient's care - monitors changes in medical conditions and prognosis.
- Give special religious, cultural, or other practices important to patient.
- You're given a 24-hour hospice number - they help you know what to do in a medical emergency.
- Hospice nurse pays close attention to patient health changes and determines if one needs admittance to the hospital for symptom management.
How to Choose a Hospice
Differences between hospice care organizations vary. Some are large, and some are small. Some are nonprofit, others by corporations. Find out about hospice agencies in your area: ask a doctor, hospital, state hospice organization, or health department. Go to the Hospice Directory for a complete list.
Questions to help you better choose a hospice agency:
- Is the hospice Medicare certified? (They follow the state and federal guidelines.)
- Can I speak with hospice staff 24 hours a day, seven days a week?
- Will a nurse or case manager be assigned to us?
- How does the hospice manage medical emergencies?
- How does the hospice manage complaints?
- How much and what kind of equipment will the hospice provide?
Learn their policies on:
- Giving pain medication
- Chemotherapy for symptom relief
- Radiation therapy
- Anti-nausea medication
- Blood transfusions
- Mechanical ventilator support
- Removal of implanted heart devices
Hospice care is voluntary. You can stop it anytime. At anytime, you can re-start it's services.
Paying for Hospice
If the patient has Medicare Part A coverage, the Medicare Hospice Benefit pays for the direct patient services:
- Professional fees
- Medical equipment
Hospice patients can keep getting Medicare benefits to treat health problems beyond the terminal illness.
Most private health insurance plans pay for hospice and follow Medicare guidelines.
Although not required, most state Medicaid programs pay for hospice services. A small co-payment (co-pay) for some hospice services, such as some drugs and respite services, may apply.
Differences of Hospice and Palliative Care
Hospice is not palliative care. Hospice is a kind of palliative care used for patients not actively treated for their disease.
Medicare has special coverage for hospice care, which is only for patients expected to live for 6 months or less. Patients in hospice must stop all treatments for cure.
After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.
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