Hospice Is Not a Dirty Word

By Peter Galvin, MD

Hospice is a specialized model of medical care for people with terminal illness. The goal of hospice is to provide compassionate care to maximize a person’s comfort and quality of life during the natural dying process. Hospice care teams are composed of doctors, nurses, social workers, chaplains, and other individuals who work together to address the physical, emotional, social, and spiritual needs of people with a terminal illness and to support their families. This generally includes alleviating symptoms (such as pain, shortness of breath, or anxiety), establishing a comfortable and peaceful environment, and facilitating meaningful time with loved ones.

When a person has a serious illness in the terminal stages and wants to focus on living as comfortably as possible, they may benefit from hospice. People are eligible for hospice if they have a life expectancy of six months or less and their goal is to focus on comfort and quality of life rather than extending the duration of life. Hospice can be appropriate for people of any age and with any life-limiting illness that is in its final stages. Common diagnoses of people in hospice care include cancer, dementia, heart failure, emphysema, and kidney disease. Typically, people who enroll in hospice have decided not to pursue invasive or hospital-based treatment (such as surgery or chemotherapy) but continue to receive medicines for comfort and quality of life. Hospice care can be provided for periods longer than six months as long as a doctor recertifies that the person continues to meet hospice eligibility criteria. People can also disenroll from hospice if it no longer meets their goals of care.

Hospice care can be provided wherever a person lives, including their home, a nursing facility, an assisted living center, or a dedicated hospice facility. It can also be provided in a hospital. Hospice services vary depending on an individual’s needs and the hospice agency. In general, the hospice team develops a plan according to a person’s goals and symptoms. Hospice is covered by insurance, including Medicare, Medicaid, and private insurance, so out-of-pocket expenses are usually low. Hospice support can include the following:

• Comfort-focused medical services such as nurse and doctor visits, medications to manage symptoms, and medical equipment (such as hospital beds, oxygen, and wheelchairs).
• Spiritual support
• Caregiver support such as a 24-hour-per-day helpline to call for guidance, education, practical tips, and resources to manage caregiving tasks, as well as grief counseling for the family for up to a year after a loved one’s death.

Typically, hospice does not provide hour-to-hour attendant care. Most people in hospice have their personal needs (bathing, toileting, dressing, eating) provided by family, friends, or privately hired caregivers, either at home or at a facility. Hospice usually does provide a health aide who may provide a few hours per week (generally one to two visits) of help with personal care. Individuals or family members interested in hospice should reach out to their clinician. A hospice referral can be sent by any doctor for a patient who meets hospice criteria. Finally, anyone considering hospice care should have a valid living will and provide durable power of attorney. For more information go to Hospice Foundation of America at www.hospicefoundation.org

Please direct questions or comments to editor@rockawaytimes.com