When Is It Time to Call 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.

Pain Management

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.

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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.
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!
@ 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..