Here are some questions that are most often asked about hospice. We hope they will help you understand the hospice concept better. Feel free to contact us to find out any other questions or for further details.
When should a decision about entering a hospice program be made; and who should make it?

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. Understandably, most people are uncomfortable with the idea of stopping an all-out 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.

Should I wait for our physician 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 their physician, other healthcare professionals, clergy, or friends.

Why Are Referrals Often Delayed?

Patients are referred to hospice late or not at all, partly because physicians and nurses may delay discussion about end-of-life care. Underlying this may be: 
  • Personal discomfort with death & grief
  • Sense of failure due to inability to prolong life
  • Perception that hospice is only a "last resort" measure
  • Concerns that patients will feel abandoned
  • Uncertainty about services covered by hospice
  • Hesitation about appropriate time for referral
  • Reluctance to share patients with hospice providers
  • Doubts that hospice offers hope to patients & families
When referrals are made in the midst of crisis, hospice staff are forced to care for the dying & grieving, with little time to know the history & preferences of everyone involved. There is time only to manage symptoms and control pain. Late referrals leave little time to provide bereavement and spiritual counselling to help patients & their families finish important tasks, say final goodbyes, heal broken relationships, distribute precious objects, and complete a spiritual journey. 

The patient's attending or family physician, in coordination with the hospice team and its plan of care, oversees hospice care. However, the hospice medical director may also serve as the attending physician. 

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 aggressive treatment therapy or go on about his/her life.

If a discharged patient should later need to return to hospice care, Medicare and most private insurance will allow additional coverage for this purpose.

What does the hospice admission process involve?

One of the first things hospice will do is contact the patient's physician to make sure he/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 to the forms patients sign when they enter a hospital.

The so-called "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 life-limiting illness.

Is there any special equipment or changes I have to make in my home before hospice care begins?

Your hospice provider will assess your needs, recommend any necessary equipment, and 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 it can to make home care as convenient and safe as possible.
How many family members or friends does it take to care for a patient at home?

There's 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 visit regularly and are always accessible to anser questions and provide support.

Must someone be with the patient at all times?

In the early weeks of care, it's usually not necessary for someone to be with the patient all the time. Later, however, since one of the most common fears of patients is the fear of dying alone, hospice generally encourages someone be there. While family and friends must be relied on to give most of the care, hospices do provide volunteers to assist with errands, and to privide a break and time away for major caregivers.

How difficult is caring for a dying loved one at home?

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 avabilable around the clock to consult with the family and to make night visits as appropriate.

What specific assistance does hospice provide home-based patients?

Hospice patients are cared for by a team of doctors, nurses, social workers, counselors, certified home health aides, spiritual care givers, therapists, and volunteers: each provides assistance based on his/her area of expertise. In addition, hospices help provide medications, supplies, equipment, hospital services, and additional helpers in the home, as appropriate.

Does hospice do anything to make death come sooner?

Hospices do nothing to either speed up or to slow down the dying process. Just as doctors and midwives lend support and expertise during time of childbirth, so hospice provides its presence and specialized knowledge during the dying process.

Is the home the only place hospice care can be delivered?

No. Many patients are cared for in nursing homes, assisted livings, hospice centers, or personal residences.
How does hospice "manage pain"?

Hospice nurses and doctors are up-to-date on the latest medications and devices for pain and symptom relief. In addition, physical and occupational therapists schooled in music therapy, art therapy, pet 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 spiritual care givers, are available to assist family members as well as patients.

What is hospice's success rate in battling 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?

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.

Is hospice affiliated with any religious organization?

Hospice care is not an off-shoot of any religion. While some religious organizations have started hospices (sometimes in connections with their hospitals, these hospices serve a broad community and do not require patients to adhere to any particular set of beliefs.

Is hospice care covered by insurance?

Hospice coverage is widelly available. It is provided by Medicare nationwide, by Medicaid in some 47 states, and by most private health insurance policies. To be sure of coverage, families should check with tier employer or health insurance provider.

If the patient is not covered by Medicare or any other health insurance, will hospice still provide care?

The first thing hospice will do is assist families in fiding out whether the patient is eligble for any coverage they may not be aware of. Barring this, hospice will often provide care for those who cannot pay.

Does the hospice provide any help to the family after the patient dies?

Hospice provides continuing contact and support for family and friends for at least a year following the death of a loved one. Most hospices also provide supportive services for anyone in the community who has experienced the death of a family member, a loved one, or a friend.

What does Medicare cover?

When a Medicare-eligible patient recieves services, Medicare pays almost the entire cost.
In general coverage includes:
  • Physician services
  • Nursing care
  • Social work services
  • Medical appliances and supplies as appropriate
  • Drugs for symptom management and pain relief
  • Short-term inpatient and respite care
  • Homemaker services and home health aides
  • Physical and other therapies
  • Grief and bereavement services

The time to learn about hospice is before illness strikes

Experts agree that the time to learn about hospice is before a life-limiting illness occurs. This greatly reduces stress, should the time come when hospice services may be needed. Moreover, the earlier hospice is involved, the more it can make the patient's final days, weeks, and months as confortable and satisfying as possible.

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