When To Call Hospice: What Families Should Know About Timing
Hospice care is end-of-life care for patients with a terminal illness. Getting the timing right for entering hospice can be difficult. Unfortunately, many people wait too long or never receive beneficial hospice care at all.
In this article, we will help patients with life limiting illnesses and their families:
- Understand what hospice is and what it offers
- Learn about eligibility and why people often wait too long
- Know when it’s time for hospice
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What Is Hospice?
Hospice is a type of medical care that focuses on comfort for dying patients. Generally, it’s intended for patients who have a life expectancy of six months or less. Hospice care is often confused with palliative care. The primary difference is that palliative care is appropriate for patients at any stage of a serious illness, like dementia or cancer.Â
Hospice services start with a care plan. It may include symptom management, emotional and psychological support, spiritual support, and practical assistance. A hospice team may also provide education and resources, care coordination, and legal and financial guidance. They provide respite care and bereavement care for families.
Hospice services can be provided anywhere a patient lives: as home care, in a nursing home, or in an assisted living facility. Hospice staff can also deliver services in a hospital.
Hospice patients receive care from a team made up of several hospice providers. This includes a hospice physician to direct care and typically a hospice nurse as well. Additional members of the team may include a hospice aide, a social worker, therapists, hospice volunteers, and spiritual counselors.Â
Who Is Eligible To Receive Hospice Care?
Medicare covers hospice care services for patients who meet these requirements:
- The patient must have Medicare Part A.
- A hospice physician and primary physician must certify that the patient with a terminal illness has six months or less to live.
- The patient must agree to receive this care and stop receiving medical treatments for curative care.
- The patient must sign an agreement choosing a hospice program over other treatments.
Although the patient must agree to give up curative treatments, patients can leave hospice care and begin those treatments again. They’re not locked into hospice if they don’t want that service any longer.
The Medicare benchmark of six months does not mean patients cannot enter hospice sooner. A patient can self-refer to hospice services at any time. There is no hospice eligibility rule for self-referring.
If the patient does not meet the Medicare hospice referral requirements, they must pay for hospice in another way. They can pay out-of-pocket or use private insurance.
Patients Often Wait Too Long To Enter Hospice
There are many benefits of hospice care and palliative care. As a type of comfort care, it helps patients feel better physically and emotionally at the end of life. Patients in hospice are more likely to have effective pain relief than patients not in hospice, for example. They are less likely to need visits to the emergency room or repeated hospitalizations.
Families of loved ones in hospice report greater satisfaction with end-of-life care than those whose loved ones did not receive hospice care. Hospice benefits both the patient and their family.
In spite of these benefits, research shows hospice is under utilized. It also shows that many people wait longer than necessary to begin hospice care. This can be explained by a lack of awareness and education about hospice.
One common misconception about hospice is that it speeds up the dying process. In fact, patients in hospice live longer on average because they are receiving good care.Â
How To Know When To Call Hospice
Don’t wait to get the benefits of hospice. You do not have to wait until your loved one only has days left to live. They can and should benefit from care sooner. Hospice helps many patients live longer. It helps all patients live more comfortably in the time they have remaining.
Even with this information, it can be difficult for a patient or their family and caregivers to choose hospice. These are some important signs that it’s time to think about hospice care:
The Patient’s Health Is Declining Significantly
If, despite treatments, your loved one’s health and well-being continue to decline, it may be time for hospice. Signs that they are declining include increased pain, significant weight loss, extreme fatigue, difficulty breathing, and increases in symptoms specific to their condition.
Treatments Cause More Harm Than Good
Terminally ill patients reach a stage at which curative treatments no longer help slow or manage the disease. In many cases, the treatments cause pain and other uncomfortable side effects. At this point, it may no longer make sense to continue curative care.
Their Mental Health Is Suffering
Being seriously and terminally ill is more than just physically uncomfortable. It also takes a toll on mental health. As your loved one nears the end of life, the symptoms and treatments may cause increasing anxiety, depression, stress, and fear. Hospice care can help.
Dementia patients are particularly vulnerable to difficult mental declines with age and disease progression. Your loved one will become more confused and distressed. They will find it increasingly difficult to perform ordinary daily tasks and need assistance.
Caregivers Are Struggling Too
It’s also important to look to caregivers and family members when timing hospice care. As the need for hospice approaches, caregivers often struggle more and more. They may be struggling to get tasks done or to make their loved one comfortable. They may also be having a difficult time emotionally, experiencing more stress, anxiety, or depression.
The Patient Is Being Hospitalized Frequently
Frequent hospitalizations are a sign that your loved one’s condition is getting worse. They are also a sign that their treatments are no longer effective. Being hospitalized does not contribute to a good quality of life. Your loved one would be more comfortable at home with home health care and comfort care.
Their Doctor Recommends Hospice
Your loved one’s primary physician may recommend hospice if they believe they have a life expectancy of six months or less. Most doctors use the six-month guideline to recommend hospice care, regardless of whether the patient uses Medicare.
Of course, no one can know for certain how much time someone has left. But, your loved one’s primary doctor is in the best position to make an accurate estimate. If they’re nearing this stage of their illness, there is no reason to delay hospice care.
If your loved one has a terminal illness and is declining, it’s likely time to have a difficult conversation about hospice care. Bring it up with your loved one’s doctor if they have not yet recommended home hospice care. Hospice timing should be an informed decision made by the patient, their family, and their doctor.
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