When Is It Time to Call Hospice?
By Samira K. Beckwith, LCSW, FACHE, President and CEO, Hope Hospice
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 that the correct answer to the question is, "As early as possible," as they discover all of the advantages hospice has to offer the patient as well as the caregiver.
Special needs require the services of specialists. Hospice professionals are specialists in end-of-life care, and should be called upon during the first stages of a terminal illness.
Six Months or Less to Live
A person of any age is eligible for hospice after being certified by a physician as having a life expectancy that may be six months or less, depending on the course of the disease. If a patient lives beyond six months after admission they can continue to receive services as long as a physician continues to document the patient's eligibility.
Hospice services are covered by Medicare, Medicaid and many types of insurance, although many not-for-profit hospices generally provide services regardless of the person's ability to pay.
Everyone – family member, friend, clergy, physician, can refer someone to hospice. Most patients are referred by their physician or other health care professional. A discussion with the patient's physician or a call to your local hospice can begin the referral process.
Hospice endeavors to make the transition from life to death as comfortable and easy as possible. Individual care plans are developed to ease the 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 even more meaningful.
Making the Most of the Final Stages of Life
Hospice care enables the individual and their families to experience the final stage of life together, in the setting most comfortable for them. In most cases, the person remains at home, close to family and friends while under professional medical supervision. Hope Hospice, like many hospices around the country, assigns a care team to each hospice patient. The hospice interdisciplinary team may include a physician; nurse; a pharmacist; social worker; bereavement counselor; chaplain; massage, art and music therapists; and volunteers. Each team member is focused on the person, not the illness, making sure that all physical, emotional and spiritual needs are met.
Hospice has a unique approach to pain management – another advantage of entering hospice care earlier. The care team always works to manage the patient's pain as expediently and efficiently as possible. Addressing pain and other symptoms in their early stages, rather than waiting until they become severe, is a priority.
In addition to determining the appropriate medications for pain and other symptoms, members of the care team identify the best ways to administer the medication to the satisfaction of the individual patient. Finding new therapies, new uses for conventional medications and new techniques are ongoing goals in hospice care.
Quality of Life
Whether the patient is at home, in a hospice house or another health care facility, hospice workers ensure that the dying person's environment is accessible, meets their needs and adds to their quality of life. For some patients, a hospice-provided portable oxygen tank gives them greater mobility. For others, a lift chair means they don't have to ask someone to help them to stand up or sit down. A hospital bed at home may be essential to a good night's sleep. The earlier the patient is entered into hospice care, the sooner we can provide 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 look each day at how they can make a difference. For example, at Hope Hospice, we cared for a patient in one of our hospice houses who was unable to attend her daughter's wedding. In a day's time, her care team invited family and friends, 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.
An important part of hospice involves helping families and other health care professionals to understand that hospice opens the door to a quality of life that would otherwise be unavailable. The goal is to do everything to support the patient, the family and the physician in the referral process. Through this collaborative effort, more people can receive the end-of-life care they need in a timely manner.
Respite for Caregivers Through Hospice
Another critical service of hospice is respite for the caregiver, which is covered by Medicare. During the time of respite care, the patient is cared for 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.
To provide additional support for the patient and caregiver, many hospices have an on-call staff available to make visits whenever needed, 24 hours a day. Home health aides, to assist with the patient's personal hygiene and care, and homemakers also help to provide comfort for the patient.
There is no pre-determined checklist and no real limits in meeting the needs of hospice patients and their families. While some patients require regular home visits by their care team, others may require continuous care during periods of medical crisis, which hospice can provide. Many families experience a financial crisis as a result of the illness, and hospice can help ease the burden by providing the needed medications, equipment, supplies and professional services, and eliminating some co-pays.
Samira K. Beckwith, LCSW, FACHE is President and CEO of Hope Hospice and Community Services in Fort Myers, Florida.