What is hospice?
Hospice is a special way of caring for loved ones in the final stages of life. It's not a place, but a philosophy of care providing terminally ill persons and their families with the medical, emotional and spiritual care they need. This philosophy focuses on comfort and quality of life. About 80 percent of all hospice care is provided in private homes, nursing homes, independent and assisted-living environments.
Hospice providers work with the patient and the patient's family to help provide support, compassionate care, pain and symptom management, as well as spiritual and bereavement care. Hospice care is available 24 hours a day, 7 days a week. Hospice care neither hastens nor postpones death, but affirms life. Comprehensive symptom control is emphasized to allow the individual to live each day as fully as possible.
When should a decision about entering a hospice program be made and who should make it?
The number one response in a survey of hospice families was "I wish we had started this earlier." Hospice care is most beneficial when there is sufficient time to stabilize a patient's medical condition and establish a trusting relationship. With pro-active symptom management and support, many hospice patients continue to lead productive and rewarding lives. Starting hospice is appropriate at the time of the terminal prognosis, regardless of the patient's physical condition. Any time during a terminal illness, it's appropriate to discuss all of the patient’s care options, including hospice care, with the patient's physician. By law, the decision belongs to the patient. Referral to hospice is obtained from the hospital, nursing homes, friends, family, clinics and many more.
Should I wait for our health care provider to raise the possibility of hospice, or should I raise it first?
The patient and family should feel free to discuss hospice care at any time with the patient's primary physician, other health care professionals, clergy or friends. Individuals may also contact Avera@Home for information.
Who is eligible for hospice care?
Patients must meet a specific set of medical criteria and have a health care provider's order indicating they have a life-limiting illness, with a prognosis of six months or less. Although the majority of hospice patients are older, Avera@Home serves patients of all ages, including children.
What if your health care provider doesn’t know about hospice?
Most physicians know about hospice. If your physician wants more information, it's available by contacting Avera@Home.
Is hospice only for cancer patients?
No. Anyone whose illness is known to be life-limiting and has six months or less to live is eligible for hospice care. Hospice goes beyond cancer care to serve a broad range of diseases, including congestive heart failure, dementias, COPD, renal failure, ALS, and other cardiovascular, pulmonary and neuromuscular diseases.
When does a patient start receiving hospice care?
One of the first things hospice will do is contact the patient’s health care provider to make sure he or she agrees that hospice care is appropriate for this patient at this time. The patient will also be asked to sign consent and insurance forms - similar to the forms patients sign when they enter a hospital. The hospice election form says that the patient understands that hospice care is palliative rather than aimed at seeking a cure. It also outlines the services available.
The form Medicare patients sign also explains how electing the Medicare hospice benefit affects other Medicare coverage for a terminal illness.
Is the home the only place hospice care can be delivered?
No. Although our hospice services can be delivered in a personal residence, many patients receive hospice care in a nursing home or long-term care facility.
How many family members or friends does it take to care for a patient at home?
There is no set number. One of the first things our hospice team will do is prepare an individualized care plan that will, among other things, address the amount of care a patient needs. Hospice staff visit regularly and are always available to answer questions and provide support.
Does hospice do anything to make death come sooner?
Hospice neither speeds up nor slows down the end of life process. Hospice caregivers provide their presence and specialized knowledge during the end of life process. According to recent research studies, patients that receive hospice care commonly live longer than expected because of expert symptom control and relief from stress.
Can a hospice patient who shows signs of recovery be returned to regular medical treatment?
Certainly. If improvement in the condition occurs and the disease seems to be in remission, the patient can be discharged from hospice and return to therapy and treatment, as needed.
How does hospice manage pain?
Hospice nurses and health care providers are up-to-date on the latest medications and devices for pain and symptom relief. In addition, physical and occupational therapists are available to assist patients to be as mobile and self-sufficient as possible. They can also be joined by other professionals in speech, dietary and massage therapies.
Hospice believes that emotional and spiritual pain are just as real and in need of attention as physical pain, so it addresses these, as well.
What is hospice’s success rate in reducing pain?
Very high. Using some combination of medications, counseling and therapies, most patients can attain a level of comfort that is acceptable to them.
Will medications prevent the patient from being able to talk or know what’s happening?
Typically not. The goal of hospice is to help patients be as comfortable and alert as they desire. By constantly consulting with the patient, hospice has been very successful in reaching the patient's pain goal.
Is hospice affiliated with any religious organization?
Hospice care is not an organization of any religion. While some religious organizations have started hospices, these hospices serve a broad community and do not require patients to adhere to any particular set of beliefs.
How is hospice care paid for?
When a patient chooses hospice, payment for 100 percent of prescription and nonprescription drugs related to the terminal disease is covered under Medicare. Many insurance policies include hospice coverage for all or a portion of related costs. Contact your insurance provider to learn more about your specific coverage.
Can I keep my own health care provider during hospice care?
Your primary care or designated provider will continue to be an active member of the hospice team. By ordering hospice services, you can rely on our expertise for your plan of care, but continue to have final approval for all medication changes. In addition your provider will receive regular updates from our hospice team. You may schedule an appointment with your physician at any time.
How long can someone be on hospice care?
According to Medicare, and most private and commercial insurance guidelines for hospice, patients must have a life expectancy of six months or less. However, if the patient lives beyond the initial six months, he or she can continue receiving hospice care as long as the attending physician recertifies that the patient meets the criteria of having a terminal prognosis and is recertified with a limited life expectancy of six months or less.
Can we ever stop hospice or re-elect hospice?
Patients always have the right to revoke hospice and pursue traditional care at any time, for any reason. If a qualified patient requests to restart hospice care, Medicare, Medicaid and most private insurance will allow readmission. A doctor's order is required.
Are all hospice programs the same?
All licensed hospice programs must follow federal and state guidelines in the services they provide. However, unlike other hospice providers, Avera@Home is a non-profit, faith-based program operating from a set of core values.
How much does home hospice care cost?
Avera@Home hospice services are covered 100 percent under Medicare and some Medicaid plans. This includes hospice provided in the resident's home, nursing homes, independent and assisted living environments. In addition, most private insurance, and other managed care organizations offer hospice care as a benefit.