Hospice care is delivered in the home or an inpatient setting and is provided by a medically directed interdisciplinary team. Each team includes a physician, registered nurse, social worker, clergy, hospice aide, therapist (if needed) and any number of volunteers. Bereavement support is provided to both families and caregivers. The type and scope of services provided is based on ongoing needs assessments and is unique to each patient and family.
Hospice emphasizes palliative rather than curative treatment; quality rather than quantity of life. The dying are comforted. Professional medical care is given, and sophisticated symptom relief provided. The patient and family are both included in the care plan and emotional, spiritual and practical support is given based on the patient’s wishes and family’s needs. Trained volunteers can offer respite care for family members as well as meaningful support to the patient.
Those involved in the process of dying have a variety of physical, spiritual, emotional and social needs. The nature of dying is so unique that the goal of the hospice team is to be sensitive and responsive to the special requirements of each individual and family. Hospice affirms life and regards dying as a normal process. Hospice neither hastens nor postpones death. Hospice provides personalized services and a caring community so that patients and families can attain the necessary preparation for a death that is satisfactory to them.
When should hospice services be considered?
Hospice care can be discussed at any time. Often, the discussion about hospice services takes place when the patient and his or her loved ones learn that:
- The disease is no longer treatable and that additional therapies will not provide any benefit
- Live expectancy may be six months or less
- A physical decline and exhaustion are likely to be permanent
- Treatment is no longer desired by the patient
Many physicians hesitate to bring up the subject of hospice because they do not want patients to think that they have given up. There may come a time when you think that hospice care should be considered, but are not sure how to start this conversation. If this is the case, a member of the Glory Hospice & Palliative Care can help you define what options are available.
What types of care are provided?
Hospice care includes:
- Nursing care, specifically pain management
- Hospice Aides , who help with bathing, grooming and other personal care
- Social Workers, who provide emotional support, guidance, decision-making assistance and connections with other resources
- Chaplains, who provide spiritual support
- Volunteers, who spend time with patients reading, playing games, etc.
- Respite care, so family caregivers can take a break
- Homemakers who provide light housekeeping, laundry and shopping
Sometimes the patient is ready to consider hospice care before his or her loved ones are. In other cases, the family may want to start services. Often, the decision is made together by the patient and his or her loved ones. If you are struggling with the decision about hospice care, talk to a health care provider, medical social worker, licensed counselor or member of a faith-based organization about your feelings and concerns.
It is generally the patient’s right to make this decision unless he or she is unable to communicate. However, if a patient cannot communicate his or her wishes, a spouse or other family member may be asked to decide. The health care team or a medical social worker can help you find out what hospice care is available in your community and how to arrange for it.
In order to start hospice services, a physician must sign a “referring order” that certifies that the patient’s life expectancy is six months or less if the advanced disease runs its expected course. If a person in hospice care lives longer than six months, hospice benefits can be continued if a physician states that the person’s life expectancy is still less than six months.
How does hospice care work?
Hospice care is flexible and can be molded to fit the different needs and lifestyles of patients and their caregivers. Care is primarily focused on making the patient as comfortable as possible when a cure can no longer be expected.
The different levels of hospice care include:
- Home care is provided in a private home, nursing home, assisted living facility or other group home. The hospice staff offers hands-on care, assessment of your loved one’s condition and symptom management. They also help you and other caregivers learn how to provide day-to-day care. Hospices services include updates about what is happening and assisting the patient and caregivers to plan for the future.
- In-home crisis care (also called continuous care) is short-term care that is available in the home when symptoms cannot be managed by the usual caregivers. Under some health insurance plans, between 8 and 24 hours of nursing support for crisis care can be provided in the home each day for a limited number of days. The hospice provider determines when such care is needed and for how long. Depending on the needs of the patient, he or she might remain at home or be hospitalized for pain or symptom management following in-home crisis care.
- Inpatient hospice care is delivered in health care facilities such as a hospital, nursing home, or hospice facility. This type of care is used to manage pain or other symptoms that cannot be addressed at home. The length of stay depends on how long it takes to control the symptoms. If needed after the symptoms have been controlled, hospice can help make arrangements for continued care in another care setting.
- Respite care provides time for home caregivers to rest while the patient is cared for in an inpatient setting or nursing facility for up to five days.
In some very advanced cases, the majority of hospice care is provided at home though the patient or loved ones choose that death occur somewhere else. Though this is likely to be a very difficult subject to discuss, it may be best to make a decision like this early enough so that everyone is comfortable with what occurs during the final days and hours.
Who are the professionals that provide hospice services?
Hospice care is a team effort. Caregivers work with trained health care professionals who will assist with the care of the patient as they guide the patient and his or her loved ones through the hospice care. The following table provides an overview of hospice professionals and their roles.
|Hospice Professionals||Roles and Responsibilities|
|Hospice registered nurse||
|Chaplain(Pastoral counselor or other spiritual advisor)||
|Grief and bereavement counselor||
How are hospice care services paid for?
Most health insurers have a hospice benefit that pays for all or most of the costs associated with the types of hospice care listed below. This means that families usually pay very little, and often nothing, for this end-of-life care. Some costs are not covered by insurers when hospice care is given in a retirement or nursing facility such as rent, meals and routine care services provided by the facility.
Hospice benefits typically pay for:
- Physician services
- Nursing care
- Medical equipment (like wheelchairs and walkers)
- Medical supplies (like bandages and syringes)
- Medications for symptom control and pain relief
- Short-term care in the hospital (including respite and inpatient care for pain and symptom management)
- In-home crisis care (as determined by staff) for short-term 24-hour nursing care to manage difficult symptoms
- Hospice aide and homemaker (housekeeping) services
- Physical and occupational therapy
- Speech therapy
- Social work services
- Dietary counseling
- Grief support to help you, your family and other loved ones
Insurers that provide a hospice benefit include:
- Medicare – The Medicare Hospice Benefit
- Medicaid (in most states) – The Medicaid Hospice Benefit
- TRICARE (military health system)
- Most private health insurance companies
Can I still see my own doctor?
A patient can continues to see their own doctor and the hospice team follows the doctor’s orders.
Where do people receive this care?
Hospice care is provided wherever the patient lives, whether at home, in a nursing home, retirement community or assisted living facility.
What types of assistance are available from hospice programs?
Hospice services can help with everything from insurance and other financial matters to routine chores. Some hospice organizations provide light housekeeping as part of their covered services.
The hospice staff will provide information about things to do to keep the patient comfortable. Needs will change over time, and hospice will help you understand and watch for these changes. If you have any questions, you can contact a member of the Glory Hospice & Palliative Care staff at 706-507-5445.
A hospice social worker can help with many practical concerns such as:
- Explaining and helping to complete advance directives, if requested
- Identifying and explaining insurance benefits
- Explaining what services hospice benefits pay for
- Setting up a system for staying organized
- Linking caregivers and family to community resources
- Setting up services with a licensed counselor or support group
- Arranging for respite care to give caregivers time off
- Contacting friends and relatives
- Assisting with funeral arrangements
The best time to learn about hospice is before you need it. At anytime during a life-threatening illness, it is appropriate to discuss all of a patient’s healthcare options, including hospice. For more information on hospice and our services, please call 706-507-5445 or email us at email@example.com if you have any questions or need assistance