How Hospice Care Can Help

Hospice is care that focuses on treating symptoms at the end of life. Choosing hospice does not mean giving up hope. It simply means that treatment will aim to improve the patient's quality of life rather than trying to cure the disease.

Understanding what hospice really means and clearing up any misconceptions you may have can help you decide if this is the right choice for you or your loved one.

This article will explain the goals and benefits of hospice. You'll learn where hospice care is provided, who is eligible, when it's time for hospice, and who pays for these services.

What Is Hospice?

Hospice care focuses on the person instead of the disease. Instead of treatments meant to cure (such as chemotherapy or surgeries), hospice treats the symptoms of an illness, such as pain, nausea, or shortness of breath.

Patients and their families often choose hospice care when it has been determined that the person's disease is no longer curable and is, thus, considered a terminal illness. This means their focus has shifted from quantity of life to quality of life.

Hospice programs may also provide social workers and spiritual counselors to help the patient come to terms with their prognosis and, in some cases, mend relationships between the patient and their loved ones.

Most hospice care is covered by the Medicare Hospice Benefit (MHB). The MHB covers four levels of care, including:

• Routine home care: This includes intermittent nursing services, medical supplies, and physical therapy, among other services that are provided in the patient's home.
• General inpatient hospice care: This includes care for distressing symptoms that can only be provided in a hospital or other setting where intensive nursing and other support is available outside of the home.
• Respite care: This is short-term inpatient care designed to relieve the primary caregiver temporarily. The stress of caring for a loved one can lead to caregiver burnout.
• Continuous home care: Continuous care supports the patient and their caregiver through brief periods of crisis, providing nursing, home health aide, and housekeeping services for 8-24 hours a day.

Redefining Hope

People who choose hospice care are not giving up hope; they are redefining it. Although there may no longer be a possibility of curing their illness, they redirect their hope into mending and restoring relationships, spending quality time with those they love, and finding peace and comfort.

Some people may turn to their religious faith at this time and settle financial affairs or other parts of their lives that they don't want to leave unresolved.

Most patients spend about one to three weeks in hospice, but, in retrospect, families may feel the person should have entered hospice earlier in the disease process and had more time to experience the benefits.

Where Is Hospice Care Provided?

Hospice is not a physical place, but an overall philosophy of caring for someone at the end of life. That said, there are free-standing facilities that provide hospice care when it is not possible for someone to live in their own home. Either way, hospice typically involves a team of nurses, social workers, health aides, and more.

At-Home Hospice Care

Most hospice care is provided where the patient lives, whether it is their private home, a nursing home, or an assisted living complex. Being surrounded by one's familiar belongings and surroundings is a core tenet of hospice care.

Hospice Facilities

Free-standing hospice facilities may be operated by a hospice agency that also offers in-home care, or they may be independently owned. For patients who don't have caregivers to care for them at home, or those who need more advanced physical care 24/7, a free-standing hospice may be a good choice.

Who Is Eligible to Receive Hospice Care?

People who qualify for hospice are usually expected to die in six months or less, but that doesn't mean dying is their focus. Many people live much longer than six months, in fact. You can stop and re-start hospice care anytime.

The physician has to determine that your life expectancy is six months or less before Medicare will reimburse for hospice care. People with serious illnesses, like cancer, dementia, heart disease, liver disease, kidney disease, lung disease, and others, can benefit from hospice care as they near the end of life.

Children and adolescents can also receive hospice care. However, the rules and regulations regarding hospice services and coverage for this younger group are different than those for adults.

When to Choose Hospice

Choosing hospice means choosing to focus on living as fully and comfortably as possible during the time you have left. You may have reached a point when treatment is unlikely to be effective or continuing treatment has become too burdensome.

Usually, once someone has chosen hospice, they have been through a lot already. Multiple hospital admissions, chemotherapy and radiation, and invasive tests and treatments can leave patients feeling sick and tired. Hospice care can prevent people from living out the end of their lives in pain and exhaustion.

By choosing hospice, patients focus on how well they can live the rest of their lives rather than on how long they can keep living, especially if living longer means living with stress and without time to engage in the activities that really matter. With this view in mind, it's clear that choosing hospice is about choosing quality over quantity.

What Hospice Allows

Hospice patients who are still mobile and energetic may use the time that was once consumed by doctor's appointments and hospital stays to take family vacations, travel to places they've always wanted to see, and enjoy the company of loved ones.

If and when a patient is no longer able to leave home (or a hospice facility), the hope is that the patient will be able to spend meaningful time with the important people in their lives and leave much of the hands-on caregiving to the hospice team. The team helps with bathing the patient, giving them medications, preparing food, and even helping with paperwork.

In hospice care, patients have access to healthcare professionals with expertise in pain management and the care and medications that can alleviate discomfort. Dying patients also have access to emotional, social, and spiritual support from social workers and chaplains.

As a person nears the end of life, they may worry about what will happen after they die. They may also have “unfinished business” that they want to resolve. Social workers and spiritual counselors may help with this and also help them let go of any guilt or shame they may feel about things that happened during their lives.

Services Provided by Hospice

Hospice services focus on managing the main illness for which someone needs care and vary depending on each patient's needs. Services provided by hospice care can take many forms:

• Care team time and services, such as visits to the patient's location made by the hospice physician, nurse, medical social worker, home health aide, and chaplain/spiritual advisor
  
• Medication for symptom control, such as pain relief
• Medical equipment, which may include a hospital bed, wheelchair or walker, and medical supplies like oxygen, bandages, and catheters
• Physical and occupational therapy
• Speech-language pathology services
• Dietary counseling
• Other Medicare-covered services for pain or symptom management recommended by the hospice team
• Short-term inpatient care
• Short-term respite care
• Grief and loss counseling for the patient and loved ones, which can be provided to family members for up to 13 months after a death
  

How to Pay for Hospice

Generally, most people who enter hospice are eligible for Medicare. Medicare fully covers hospice care and services. Small co-payments may be required for prescription medications and respite care, however. Medicaid offers similar hospice coverage in most states.

A private health insurance plan may also cover hospice care. Private plans can be obtained through an employer or on a state or national exchange. What is covered under these plans may be different than what Medicare covers.

Military families can get hospice coverage through Tricare. Veterans with the VHA Standard Medical Benefits Package are eligible for hospice services and have no co-payment.

Private payments may be an option for people who are uninsured. With self-pay, you are fully responsible for the costs of care.

Summary

For people with serious illness and a life expectancy of less than six months, hospice can make the end of life more comfortable. Instead of focusing on curing an illness, hospice services revolve around treating the symptoms and caring for the person.

While choosing hospice care means that you've accepted that your illness is no longer curable, it does not have to mean giving up hope. It's about redefining hope. In addition to receiving medical services, people in hospice also have access to emotional, social, and spiritual support.

Medicare usually covers hospice services, but other coverage options are also available. Talk to your healthcare provider about the level of hospice care recommended for you or your loved one. In some cases, hospice services can be provided in the home. In others, care can be provided only in a hospice facility.