Questions about Hospice
Q: When should a decision about entering a hospice program be made and who should make it?
A: At any time during a life-limiting illness, it’s appropriate to discuss all of a patient’s care options, including hospice. By law the decision belongs to the patient. Understandable, most people are uncomfortable with the idea of stopping an all-our effort to “beat” their disease. Hospice staff members are highly sensitive to these concerns and are always available to discuss them with the patient, family and physician.
Q: Should I wait for our physician to raise the possibility of hospice, or should I raise it first?
A: The patient and family should feel free to discuss hospice care at any time with their physician, other health care professional, clergy or friends.
Q: What if our physician doesn’t know about hospice care?
A: Most physicians know about hospice. If your physician wants more information, it is available from the American Academy of Hospice and Palliative Medicine, medical societies, state hospice organizations, local hospices, or the National Hospice Helpline at 1-800-658-8898.
Q: Can a hospice patient who shows signs of recovery be returned to regular medical treatment?
A: 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 aggressive therapy or go on about his or her daily life.
Q: What does the hospice admission process involve?
A: One of the first things hospice will do is contact the patient’s physician to make sure he or she agrees that hospice care is appropriate for this patient at this time. (Hospices may have medical staff available to help patients who have no physician.) The patient will also be asked to sign consent and insurance forms. These are similar when they enter a hospital. The hospice election form says that the patient understands that the care is palliative (that is, aimed at pain relief and symptom control) rather than curative. It also outlines the services available. The form Medicare patients sign also tells how electing the Medicare hospice benefit affects other Medicare coverage for a terminal illness.
Q: Is there any special equipment or changes I have to make in my home before hospice care begins?
A: Your hospice provider will assess your needs, recommend any necessary equipment, and help make arrangements to obtain it. Often the need for equipment is minimal at first and increases as the disease progresses. In general, hospice will assist in any way possible to make homecare as convenient, clean, and safe as possible.
Q: How many family members or friends does it take to care for a patient at home?
A: There is no set number. One of the first things a hospice team will do is prepare an individualized care plan that will, among other things, address the amount of care giving a patient needs. Hospice staff visits regularly and are always accessible to answer questions and provide support.
Q: Must someone be with the patient at all times?
A: In the early weeks of care, it is usually not necessary for someone to be with the patent at all time. Later, however, since one of the most common fears of patients is the fear of dying alone, hospice generally recommends and requires someone to be there continuously.
Q: How difficult is caring for a dying loved one at home?
A: It’s never easy and sometimes can be quite hard. At the end of a long, progressive illness, nights especially can be very long, lonely and scary. So, hospices have staff available around the clock to consult with the family and to make night visits as appropriate.
Q: What specific assistance does hospice provide home-based patients?
A: Hospice patients are cared for by a team of doctors, nurses, social workers, counselors, home health aides, clergy, therapists, and volunteers. Each provides assistance based on his or her area of expertise. In addition, hospices help provide medications, supplies, equipment, hospital services and additional helpers in the home as appropriate.
Q: Does hospice do anything to make death come sooner?
A: Hospice does nothing to either speed up or slow down the dying process. Just as doctors and midwives lend support and expertise during the time of childbirth, so does hospice provide its presence and specialized knowledge during the dying process.
Q: Is the home the only place hospice care can be delivered?
A: No. Most hospice services are delivered in a personal residence, however, care is also provided to patients who live in nursing homes, assisted living facilities, boarding homes, or adult family homes.
Q: How does hospice manage pain?
A: Hospice nurses and doctors are up-to-date on the latest medications and devices for pain and symptom relief. In addition, physical and occupational therapies assist patients to be as mobile and self sufficient as possible. They are often joined by specialists schooled in music therapy, art therapy, diet counseling and other 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. Counselors, including clergy, are available to assist family members as well as patients.
Q: What is hospice success rate in battling pain?
A: Very high. Using a combination of medications, counseling and therapies, most patients can attain a level of comfort that is acceptable to them.
Q: Will medications prevent the patient from being able to talk or know what’s happening?
A: Usually not. It is the goal of hospice to help patients be as comfortable and alert as they desire. By constantly consulting with the patient, hospices have been very successful in reaching this goal.
Q: Is hospice affiliated with any religious organization?
A: Hospice care is not an off-shoot of any religion. Nor is it a requirement that patients adhere to any particular set of beliefs.
Q: Is hospice care covered by insurance?
A: Hospice coverage is widely available. It is provided by Medicare nationwide, by Medicaid in some 42 states, and by most private health insurance policies. To be sure of coverage, families should of course, check with their employer or health insurance provider.
Q: If the patient is not covered by Medicare or any other health insurance, will hospice still provide care?
A: The first thing hospice will do is assist families in finding out whether the patient is eligible for any coverage they may not be aware of. Barring this, most hospices will provide care for those who cannot pay, using money raised from the community or from memorial or foundation gifts.
Q: Does hospice provide any help to the family after the patient dies?
A: Hospice provides continuing contact and support for family and friends for 13 months following the death of a loved one. This includes information on grief & loss, individual or family grief counseling, and grief & loss education support groups. Most hospices also offer bereavement support for anyone in the community who has experienced the death of a family member, a friend, or a loved one, even if they were not involved with Hospice.
Q: If the patient is eligible for Medicare, will there be any additional expenses to be paid?
A: Medications and equipment not related to the terminal illness are the responsibility of the patient.
(Compliments of the National Hospice and Palliative Care Organization)