Hospice 101

    Hospice 101
    Hospice and Palliative Committee

    What is Hospice?

    Hospice is for end-of-life care that focuses on the patient and their family rather than the illness. Hospice offers medical, emotional, social and spiritual support centered on quality of life considerations.

    Philosophy

    Hospice is a specialized program that offers help, comfort and support to people with serious illness and their families. When a patient reaches the point in his or her illness where cure is no longer the focus of care, but instead comfort and quality of life become primary, hospice can help. Far more than just the medical needs of the patient, hospice focuses on all factors that contribute to the highest possible quality of life – physical, emotional and spiritual.

    Services typically provided by hospice include medical care delivered by specially trained physicians, nurses and other clinicians, as well as hospice aide services, social work services, spiritual care, volunteer support, and grief counseling. The focus is on meeting the needs of both patient and family and promoting full and meaningful life when time matters most.

    What is Palliative Care?

    Hospice care, sometimes referred to as palliative care, focuses on treating a person’s symptoms to increase the quality of life when the disease no longer responds to treatment to cure the illness.  Palliative care neither speeds up nor slows down death, but offers relief from pain and other symptoms and support for the family at the end of their loved one’s life.

    Palliative Care

    To palliate means to make comfortable by treating a person’s symptoms from an illness. The goals of palliative care are to improve the quality of a seriously ill person’s life and to support that person and their family during and after treatment. Many hospitals,  skilled nursing facilities and visiting nurse agencies provide palliative care.

    Palliative care can also be provided when the patient is seeking aggressive symptom treatment for a chronic illness.  The patient could be then followed under the home health benefit during this care.  Palliative care is an area of healthcare that focuses on relieving and preventing the suffering of patients. Unlike hospice carepalliative medicine is appropriate for patients in all disease stages, including those undergoing treatment for curable illnesses and those living with chronic diseases, as well as patients who are nearing the end of life.

    What Makes Hospice Care?

    Hospice care is provided by a team of professional caregivers who work closely with patients and their families to address individual pain and symptom needs through physical, psychological, spiritual and social intervention.

    Family caregivers can receive support as well. All Massachusetts hospice programs must be licensed by the State.

    Who is Eligible for Hospice?

    Hospice is available to those diagnosed with a terminal illness with a life expectancy of six months or less.  Hospice is for any person who is with a life limiting illness, not only for people with cancer.  Hospice care is provided regardless of diagnosis, age* gender, nationality, race, creed, sexual orientation, or disability.

    For a person who:

    • Has a life expectancy limited to months rather than years,
    • A physician certifies that the prognosis is 6 months or less if the disease runs its normal course.
    • Is no longer seeking curative treatment of the disease process
    • Requests pain and symptom management as the goal of care

    When is Hospice Appropriate?

    Hospice is appropriate for those with a terminal illness when a goal of treatment begins to shift from curing the illness to quality of life.  This time may come well before a physician indicates that the patient’s life expectancy is likely six months or less.  Sadly,many people (and physicians) wait until the final days of life to involve hospice.  By contacting hospice earlier, patients and families have time to better understand their options and choose the path that will have the most positive impact on their quality of life.  A patient may change his or her mind at any time and can pursue other care options for any reason with notice to the Hospice provider.  Some hospices also provide specialized programs or services such as massage, reiki, pet therapy and music therapy.  Some hospices offer pediatric services as well.

    What is the Medicare Hospice Benefits?

    If you have Medicare, the Medicare Hospice Benefit pays for hospice care for all Medicare beneficiaries who qualify for hospice and choose or elect in writing to receive this special care.Medicare rules specify the requirements for certifying whether a person is eligible or qualifies for the benefit.

    Who Pays for Hospice Care?

    Payment for hospice services may come from Medicare, Medicaid, Health Maintenance Organizations (HMOs) or other private insurance plans.  If you are unsure if the hospice benefit is available through your insurance plan, speak with your insurer, a hospice representative, or your human resources representative at work.  Hospice is a managed care approach to end of life care.  It is a special coverage item as part of your insurance benefit and is required by all insurers in Massachusetts.  You must get care from the hospice provider you chose.  All care that you get for your terminal illness must be given by or arranged by the hospice team.

    Where is Hospice Care Provided?

    Hospice may be provided in many settings including the patient’s home, skilled nursing or assisted living facilities, hospitals or other facilities.  Hospice care can be provided during short-term inpatient hospital stays if necessary to manage severe symptoms.  Respite can also be available for short-term to give caregivers a brief rest from the responsibility of caring for the patient.  Care is generally provided in the home, for some, the Home may mean an extended care facility such as a nursing home or assisted living facility. In addition some Hospices have hospice residences.

    Early Referrals

    The decision to start hospice can be difficult for both the patient and family. However,when referrals are made very late in the illness, often there is barely enough time for the hospice interdisciplinary team to address pain and other physical symptoms, let alone the psychosocial and spiritual issues that may be present. Hospice professionals agree that ninety days is the optimum time needed for the implementation of the most effective hospice plan of care. Over the past five years, approximately 35% of patients admitted to hospice had lengths of stay seven days or less. Another 28% averaged eight to twenty-nine days. Earlier referrals have the potential for improved patient and family care, increased patient and family satisfaction, and increased hospice staff satisfaction.

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