Did you know?

  • Approximately 80% of Americans would prefer to die at home, if possible.
  • Despite this, 60% of Americans die in acute care hospitals, 20% in nursing homes and only 20% die at home.
  • A minority of dying patients use hospice care and even those patients are often referred to hospice in the last days to weeks of life.

What is hospice?

Hospice care is given by a team of professionals who are specially trained in dealing with issues in a dying person’s life.

The team consists of nurses, a doctor, a medical social worker, a spiritual care coordinator, counselors and a hospice aide. The team is available 24/7, and care can be provided in the home, hospital, nursing home, assisted living or wherever a person calls home.

Who is eligible?

  • A person with a life limiting illness that, given the natural course of the disease and expected therapy, will probably die from this illness within six months
  • Who is not seeking further aggressive or curative treatment related to the terminal illness
  • Quality of life and symptom control are the goals of care

Hospice Offers Hope

  • Hospice affirms life and offers hope for care. It honors the wishes and goals of the patient and family, and offers dignity and support during a difficult time.
  • Hospice does not hasten death or prolong dying.

What Do Patients Hope for at the End of Life?

  • Quality of life and relief of pain and suffering
  • Relief of burdens on the family
  • That worldly affairs can be put in order
  • To maintain a sense of control
  • Mending and strengthening relationships with loved ones

Hospice Cares for Persons in the End Stages of:

  • Cancer
  • Pulmonary disease
  • Heart disease
  • Renal disease
  • Stroke and coma
  • Alzheimer’s disease
  • ALS
  • Liver disease
  • HIV disease

…And many other diagnoses

When Should Hospice Be Considered?

  • Hospice can provide valuable support and care for dying patients and their families, and early referral is beneficial.
  • A majority of physicians overestimate life expectancy for dying patients. This may result in missed or delayed referrals to hospice.

General Guidelines for Hospice Admission

  • Decline in overall physical/mental status
  • Weight loss in the last six months
  • Frequent hospitalizations or ER visits
  • Repeat infections (pneumonia, bronchitis, severe UTIs)
  • Profound weakness or fatigue
  • Difficulty swallowing

General Guidelines for Hospice Admission

  • Shortness of breath or chest pain at rest
  • Recurrent edema/swelling
  • Requires continuous oxygen
  • Uncontrolled pain or vomiting
  • Requires assistance with most activities

Getting Services Started

  • The guidelines on the previous slides are very general
  • Anyone can initiate a referral for a hospice evaluation
  • A physician’s order is required
  • The order for “hospice to evaluate” can be obtained from the patient’s primary physician, a consulting physician, an ER physician or a hospice medical director
  • Consents are obtained prior to the nursing assessment. The nurse examines the patient and consults with the patient’s attending and hospice physician to confirm eligibility.
  • The patient’s physician and the hospice medical director use their best clinical judgment to certify that the patient is terminally ill with a life expectancy of six months or less, if the disease runs its normal course.

The Hospice Team

  • Medical Director (and the patient’s own attending physician if desired)
  • RN case manager
  • Social Worker
  • Hospice Aides
  • Spiritual Care Coordinator
  • Bereavement Coordinator
  • Volunteer Coordinator and Volunteers

Hospice Services Include:

  1. Nursing visits
  2. SW, SC, HA, volunteer and bereavement visits
  3. Durable medical equipment
  4. Coverage of medications related to the terminal illness
  5. Supplies
  6. Bereavement services for 13 months following death

Financial Considerations

  • Medicare covers the cost of all hospice services under the Medicare Hospice Benefit using a per diem rate that is intended to cover virtually all expenses related to the patient’s terminal illness.
  • Medicaid, private insurance and the VA also provide reimbursement for hospice care.

What if the Patient Lives Longer Than Six Months?

  • If the patient survives longer than expected, he or she may stay in hospice provided the hospice physician certifies that life expectancy is still six months or less.
  • Each person’s course of illness is different.
  • If the patient improves and their life expectancy becomes more than six months, he/she must be discharged from hospice and return to traditional care.

Takeaways

  • Hospice is about help during the dying process, but it’s really more about living.
  • Hospice treats the person, not the disease.
  • Hospice is about comfort and relief of pain.
  • Hospice enhances the quality of life for the person with the life-limiting illness and offers support for the family and caregivers.
  • Hospice is about dignity and hope.