For many, the word "hospice" is synonymous with death and hopelessness. It's a place to go when nothing else can be done. But that couldn't be further from the truth. Good hospice care is about celebrating life and making the most out of each day with loved ones and family.
Hospice care is a relatively new field and didn't appear in the United States until the mid-1970s. Before then, doctors did little to comfort and prepare dying patients and their families. Instead, many terminally ill patients continued difficult treatments that often neither relieved symptoms nor extended or enhanced the quality of their lives. As a result, many dying patients spent their final days in hospital beds, sometimes alone and in pain.
What is hospice care?
Hospice care offers terminally ill patients the opportunity to live out their days as comfortably and pain-free as possible. Likewise, palliative care concentrates on reducing the severity of symptoms or slowing a disease's progress for the chronically ill, rather than trying to find a cure. Both forms of care ultimately have the same goal: to relieve suffering and improve the patient's quality of life, however long that may be.
Hospice care takes a holistic approach and aims to treat the "whole person," not just the signs and symptoms of illness. That means supporting a patient not only physically, but also emotionally, spiritually and mentally.
"Quality hospice programs have interdisciplinary teams consisting of nurses, social workers, chaplains, certified nursing assistants, volunteers and physicians," says Christopher MacInnis, Senior Vice President of Hospice and Home Health for PruittHealth. "Together, team members combine their expertise to develop an individualized care plan that addresses the unique needs of each patient and family."
In a traditional hospital setting, it is often doctors making recommendations and care decisions. But in a hospice care setting, team members work together to address problems as they arise. For example, if a patient's pain worsens, nurses and doctors may tweak medications, while a social worker may provide mind-body coping techniques. Or if a patient feels depressed or hopeless, doctors may prescribe antidepressants, the chaplain may offer pastoral support and social workers and volunteers can offer emotional support. For loved ones and caregivers of patients, this type of multidisciplinary support can also provide a respite from being the sole source of comfort and stability.
Types of hospice care
"Many people think receiving hospice care involves moving to an assisted living facility, but that is only one option," says MacInnis for PruittHealth. "Each type of hospice care is designed to meet the needs of the hospice patient and family."
There are four different levels of hospice care:
- Routine hospice care (home and health care center): If a patient has a loved one or family member who can stay home and help manage care, they may choose routine hospice home care. In this situation, a hospice team member will make regular visits and provide care as needed. But patients who need long-term care can seek routine hospice care at health care centers (also known as nursing homes). Health care center and home patients are offered all the same multidisciplinary services, education and support.
- Inpatient Care: Inpatient care is designed for pain control and symptom management that cannot be fully addressed at home or health care centers. Usually, once symptoms are under control, the patient may return home or back to the health care center.
- Continuous Care: Continuous care provides skilled nursing during times of crisis or for pain and symptom management. It may be provided at home or in a health care center, and its goal is to avoid patient hospitalization.
- Respite care: Respite care offers the home caregiver a break from their duties. Medicare will pay for five consecutive days of respite care at a time.
Payment and eligibility
Anyone dealing with a life-threatening illness is a potential candidate for hospice care, including, but not limited to, those dealing with cancer, heart, liver or renal failure, pulmonary lung disease, Alzheimer's disease, HIV and ALS.
For a patient to be eligible for hospice care, he or she must:
- Meet regulatory guidelines certified by a physician stating that the patient has six months or less to live.
- Have a referral written by the patient's attending physician.
- Be evaluated by a hospice admission nurse.
- Meet guidelines established by Medicare.
Most people do not realize that hospice care services may be covered by Medicare. These services include those provided by a case manager, social worker, chaplain and certified nursing assistant (CNA) along with prescription medications, as well as all the equipment and specialized medical supplies related to that terminal illness. However, if a patient improves significantly or decides to pursue aggressive curative treatment, he or she will forfeit their hospice benefits.
If you or a loved one is struggling with chronic or terminal illness, and treatment isn't working anymore, talk to your doctor about hospice services. If you think your loved one could benefit from hospice care, don't be afraid to start the conversation. Seeking hospice care is anything but giving up. It can help ease your loved one's pain and allow you and your loved ones to live as fully and joyfully as possible.