Hospice & Palliative Care
What is hospice?
Hospice is a philosophy of compassionate and comprehensive care for dying persons and their families that addresses the medical, psychosocial, spiritual and practical needs of the individual and the related needs of the family and loved ones throughout the periods of illness and bereavement. Hospice is a good choice when curative treatment is no longer effective or no longer wanted and when life expectancy is measured in months or weeks.
What is palliative care?
Palliative care focuses on comfort, but prolonging life may be part of the goal. It’s provided by hospice and palliative care teams of doctors, nurses, social workers, and other counselors. Palliative care is provided most often in hospitals but moving into homes, nursing homes, and other settings.
Where is hospice care provided?
Hospice services can be provided to a terminally ill person wherever they live. While home is the most common and the preferred place for many patients, it is not always possible or even desirable for all hospice patients. Individual patient, family and caregiver needs determine the location for delivery of hospice care. Patients can receive the services of the hospice team at home, in a nursing facility, an inpatient residential hospice, a long-term care or other residential facility.
What services does hospice provide?
Hospice works with the patient’s physician providing care under a plan of treatment designed by the team in conjunction with the patient and the family. Services include:
- Intermittent home and hospital visits by nurses and other health care professionals
- Management of pain and symptom control
- Medical treatments as prescribed
- Instruction and supervision of family members in patient care
- Personal care and household services
- Providing or arranging for respite or continuous care
- Assistance in obtaining medical equipment, supplies or medications
- Physical, occupational and speech therapy
- Short-term inpatient care for respite or symptom management
- Counseling and emotional support for patient and family
- Spiritual support
- Companionship and practical services by lay volunteers
- Information and guidelines regarding insurance, financial aid, in-home support and transportation agencies, community agencies
- 24 hour, 7 day a week on-call emergency/crisis assistance
What does it cost?
Hospice care is covered by Medicare, the Oregon Health Plan and private insurance. Through Medicare and most insurance plans, the hospice program manages the total care and costs of treating the terminal illness. Medical services, outpatient drugs and biologicals, counseling and bereavement and attending physician or Nurse Practitioner services are paid for by the hospice provider.
Patients may be asked to meet co-pay or other uncovered costs. However, no one will ever be turned down for financial reasons.
How long does hospice last?
There is no limit under Medicare, and the physician and hospice program medical director will periodically re-certify that patient has a life expectancy of six months or less, if disease follows its normal course.
Why would hospice stop?
Sometimes patients get better while on hospice care, or they wish to resume curative measures in their care. Hospice patients also have a “right” to stop anytime and resume their regular Medicare benefit.
How are people referred to hospice care?
Most patients admitted to a hospice program are referred by their physicians. Others come themselves or are referred by the hospital, a community agency, or by a friend or relative. Family members may request counseling even if the patient does not wish to be admitted to the program.
Why are referrals to hospice delayed?
Sometimes doctors wait for their patients to bring up the subject of hospice care, while patients assume their doctor will tell them when they need hospice care. Doctors are afraid to talk about dying, too! Also, some patients demand more treatment, not realizing treatment options may no longer be effective.
What happens when hospice referrals are delayed?
Patients are more likely to have futile treatment and more likely to have unrelieved pain. Patients and their families are likely to suffer unnecessary crisis.