When Is It Time to Call Hospice?

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A common question asked by those considering hospice care for a loved one is, “When is the right time?” A growing number of caregivers are finding the correct answer to this question: as early as possible.

Special needs are best handled by specialists. Hospice professionals specialize in end-of-life care and should be called upon during the first stages of a terminal illness to ensure the patient and their family members can benefit from all the services hospice has to offer.

To navigate end-of-life care, it is important to understand how one can qualify for hospice and the specific services a hospice organization can provide.

Hospice Eligibility Criteria

A person of any age is eligible for hospice care after being certified by a physician as having a life expectancy that may be six months or less, depending on the course of their disease. Another requirement is that patients who elect hospice must forgo curative treatment, either because they no longer wish to receive it or because it is no longer effective.

For example, if a patient is diagnosed with advanced cancer and given four months to live, in order to receive services, they must only receive care for symptom management and the enhancement of their quality of life. This “comfort care” is provided in lieu of aggressive interventions such as chemotherapy and/or radiation therapy.

Of course, even terminal health conditions do not progress in a predictable manner. If a patient lives beyond six months after admission into a hospice program, they can continue receiving services as long as a physician continues to document their eligibility. In some rare cases, individuals have remained eligible for and received hospice care for a year or longer.

Hospice services are covered by Medicare, Medicaid and most private health insurance plans, although many non-profit palliative care providers generally offer services regardless of a person’s ability to pay.

How to Begin Hospice Care

Anyone, whether it is a family member, a friend, a member of the clergy, or a physician, can refer someone to hospice. Most patients are referred by a health care professional, but a call to your local hospice provider can begin the referral process as well. Once this formal request is made, most palliative care organizations begin providing care within a day or two.

Making the Most of the Final Stages of Life

Hospice endeavors to make the transition from life to death as comfortable and easy as possible. Individual care plans are developed to ease both physical and emotional pain and to meet spiritual needs if desired. This can help the patient and family “put their lives in order” and make the last stage of life very meaningful and intimate.

This type of care enables families to navigate the end of life together, in the setting that is most comfortable for them. In most cases, the patient remains at home, close to family and friends while under professional medical supervision. An interdisciplinary care team is assigned to each hospice patient, which may include a physician, nurses, a pharmacist, a social worker, a bereavement counselor, a chaplain, massage, art and music therapists, and volunteers. Each team member is entirely focused on the person, not their illness. Their goal is making sure that all physical, emotional and spiritual needs are met.

Management of Pain and Other Symptoms

Addressing pain and other symptoms in the early stages, rather than waiting until they become severe, is a priority. Therefore, it is crucial to begin hospice care as soon as one is ready and meets the eligibility requirements. Hospice care teams always work to manage the patient’s pain as expediently and efficiently as possible.

In addition to determining the appropriate medications for pain and other symptoms, members of the care team also get creative when identifying the best ways to administer the treatments. Finding new therapies, new uses for conventional medications and new techniques for improving comfort care is an ongoing goal for these medical professionals, therapists and volunteers.

Enhancing Quality of Life

Whether a patient is receiving care at home, at an inpatient hospice house or in another health care facility, hospice workers ensure that their environment is accessible, meets their needs and adds to their quality of life.

While it may not seem feasible for a dying person who requires intensive care to receive it in their own home, hospice programs excel in supplying care and equipment in nearly any space. For some patients, a hospice-provided portable oxygen tank gives them greater mobility and freedom to stick to their daily routines. An adjustable hospital bed at home may be essential for a good night’s sleep. Regardless of a patient’s personal needs, the earlier one enters hospice care, the sooner they can receive these services, medications and supplies to help them maintain their dignity and comfort.

Hospice also provides for special wishes to make each day count. Care team members are quite creative, and each day they consider how they can make a difference in their patients’ journeys. I can recall one woman in particular who was receiving care in one of our hospice houses. Sadly, she was unable to attend her daughter’s wedding. But, in a day’s time, her care team invited her family and friends to the facility, provided a wedding cake, rolled the patient’s bed into our chapel, and one of our chaplains conducted the wedding ceremony at the foot of her bed.

It is important for families and other health care professionals to understand that hospice opens the door to a quality of life that would otherwise be unavailable to many who are nearing the end of life. Our goal is to do everything we can to support our patients and their families. We provide the equipment, care and support that patients need to continue being as active and comfortable as possible for as long as possible.

Hospice Also Cares for Caregivers

Hospice provides a critical service for caregivers as well: Medicare-covered respite. During short-term respite care, a patient stays in a Medicare-approved facility, such as a hospice house, hospital or nursing home. The stay may last up to five days at a time, and there is no limit to the number of stays a family can use. Respite is invaluable to many caregivers who spend countless hours sitting vigil with their loved ones.

Additional support for patients and their caregivers is also available from many providers in the form of a 24-hour on-call staff. Nurses, home health aides and other professionals are available to make house calls, answer questions, adjust medications, schedule other treatments and assist with personal hygiene and care. While some patients require occasional home visits by their care team, others may require continuous care during periods of medical crisis, which hospice can provide as well.

There is no pre-determined checklist of services that every hospice recipient receives, and there are no real limits on how providers meet the needs of their patients and families. The care and support that these organizations provide is entirely personalized and invaluable to many. While the decision regarding when to begin care is highly personal and variable, seeking a referral sooner rather than later will help ensure that one passes comfortably and with dignity.


Samira K. Beckwith, LCSW, FACHE, is president and CEO of Hope Hospice and Community Services in Fort Myers, Florida.

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27 Comments

@ jerico,
near the end of my mothers life, a week ago, she could feel her body dying and was clamoring to climb out of bed. in hindsight she was trying to get away from her dying body . . her digestive system had shut down and sepsis was poisoning her. upon seeing the first signs of terminal agitation hospice started giving her liquids morphine and ativan. she lost conciousness and died in a matter of hours. what would be the point of letting her suffer for several days as more organs and systems shut down? they helped mom get out of that dying body and im fine with it..
Not all Doctors will refer you to hospice. I care for a 98 year old with CHF and ALZ to name a few. I had a nurse that came to the house once a week because she was in the hospital due to the CHF. And she agreed with me that it was time for her to have hospice come in instead of them because she is not going to get better she is going to continually get worse. I had to bring it up to him again about needing hospice for her and for myself the caregiver! He still didn't want to he kept saying it was a death sentence to go to hospice. He even has her daughter thinking the same way. When in fact they are not a death sentence, they are hope and help!! I think this doctor just wanted me to bring her back and forth to him so he could bill medicare for seeing and treating her. He kept saying they would take her off all her meds and then for sure she would die. Hospice in no way will take her off all her meds unless they feel she is getting no benefit from them and the caregiver and family also need to agree. So don't wait till the doctor wants to put them with hospice, if you really feel that it is the time to have such services then you need to do the talking. And if the doctor is un willing to do so then call Hospice yourself and they will let you know if this is the right time for them to have this service. Grandma is slowly going down hill, she just might go past 6 months. But they can still be with hospice even after the 6 months. Her BP goes way up and down for no reason, her oxygen goes up and down too. There are days she has no energy or even cares to get dressed. And then there are days she feels pretty darn good! She has lost another 6 pounds in just a couple of weeks and is now 118lbs, from 140lbs when she first came to live with me. Most of this weight loss has been over the past 6 months. My MIL still thinks that this (hospice) is too good to be true, and still has that feeling that it is a death sentence. Sometimes I think she is the one who has lost all reality, this woman will not be here forever and she is so lucky to have her for as long as she has! And giving her drugs and the such just to keep her alive when the quality of life for her is just about nothing is just so wrong! I live with this woman and hear her cry that nobody cares (my MIL only sees her maybe once a week if were lucky) and asks why am I still here. Nobody should live this long and at times she tells me to just kill her or that she just wants to die! She can't walk without help, eat, use the bathroom, get dressed. Her mind is not real good anymore either. And the worst part is she know that!! Small walks take the best of her, and she sleeps most of the time. I know in my heart and from past experience that hospice is the best thing for her at this time in her life. It is in no way a death sentence!! Its a way to leave this world in dignity, with the best care and with all the special equipment that she may need. And it is the best way to help me care for her all the way around!
Hospice was a life saver for me. My 90 year old mother was in a nursing home because of dementia and then diagnosed with brain cancer. They came the day the physician sent in the order. My only suggestion for improving hospice services would be a support group for the caregivers when the loved one/patient is still alive. Hospice offers group counseling after the death of the patient. I think it would be helpful to have somebody else to talk to who is also "in the middle of it" with you. I am an only child of a widowed mother and had no one to help me with decisions.