Hospice care is delivered by a team of physicians, nurses, aides, social workers, spiritual care givers, counselors, therapists and volunteers – all of whom are trained to help manage pain and symptoms during the last stages of a person’s life, usually in the person’s home. Dying at home is very important to many people because being in a hospital can separate them from grandchildren and beloved pets.
The team also gives support to the family. This might include time off so that the main caregiver can rest, making sure the patient is not alone, giving advice by phone, and helping the family learn to cope with loss of income and the finances related to caregiving. Also, hospice care offers families at least one year of grief counseling, usually in the form of support groups, after the patient’s death.
Before giving care, the hospice staff, the hospice doctor and the patient’s personal doctor review the patient’s medical history, symptoms and prognosis. The hospice team then meets with the patient and the family to discuss advance directives, hospice services, pain management, equipment needs and other issues.
When enough information is gathered, the hospice team develops a “plan of care,” which is regularly reviewed and revised to meet the patient’s changing needs. For example, if the patient’s physical pain worsens, the prescription may change from oral painkillers to patient-controlled intravenous (through a vein) pain medication, painkiller patches that go on the skin, an epidural catheter or sedatives. If necessary, a cancer patient in hospice may also receive drugs or radiation to shrink a tumor that is pressing on nerve endings and causing pain or discomfort. In this case, the radiation or chemotherapy is considered palliative (meaning for comfort reasons and not meant to cure).
Although hospice team members see the patient daily, the patient’s family members or other caregivers are asked to help feed, bathe and turn the patient, and give medications, according to the HFA. Caregivers are also responsible for notifying the hospice team of any changes in the patient’s condition.
Who is eligible for hospice care?
Hospice care is for patients whose illnesses are no longer responding to treatments meant to cure or slow the illness. More than 500,000 people in the United States receive hospice care each year and there are more than 3,000 hospices nationwide. Hospice is best suited for patients who are in the last several months of their life. A physician’s referral is required to receive hospice care,
Who pays for hospice care?
Many private medical insurance providers cover hospice care. In most states hospice also is covered by Medicaid, and Medicare has a hospice benefit for patients whose life expectancies are six months or less.
According to the National Hospice and Palliative Care Organization (NHPCO), one of the first things a hospice will do is help determine whether the patient is eligible for insurance coverage. If there is no coverage or only partial coverage, most hospices will provide care for anyone who cannot pay using money raised from the community or from memorial or foundation gifts.
Although people are entitled to six months of hospice care, the average amount of time patients spend in hospice is often fewer than 20 days.In many cases, the doctor may not suggest hospice care unless the patient or patient’s loved ones bring it up first. Patients and families should not be reluctant to ask their doctors about enrolling in hospice. A Canadian study in the journal Cancer found that physicians appear to overestimate the duration of life of terminally ill cancer patients, particularly those patients who die early in the terminal phase and who may potentially benefit from earlier participation in palliative care programs.
How do I find a hospice?
Hospices can be found in the phone book, through your physician or by calling the Hospice Foundation of America (HFA) toll-free at (800) 854-3402 or the NHPCO toll-free at (800) 658-8898. The HFA encourages patients, families and physicians to call a licensed hospice provider as soon as a terminal illness is diagnosed. Hospice services are available around the clock and are normally given at the patient’s home. However, the hospice team can deliver care to patients in nursing homes, hospitals, residential hospices or other settings.