Hospice Care Questions and Answers
What is hospice and palliative care?Hospice is a compassionate approach to care, the goal of which is to help people with serious illness live life fully, maintain their dignity, and keep control over their lives. In medieval times, hospices were inns of rest which "lodged, cherished and refreshed" the weary traveler, the sick, and the dying. Read More
Why hospice?Unique physical, emotional, spiritual, social and financial needs occur during the final phases of life-limiting illness. Hospices provide experienced, skilled specialists who give needed help and support during this difficult time. The hospice team works with the attending physician and family to develop care that meets the patient/family needs and wishes concerning treatment and lifestyle. Read More
Who is eligible for hospice care?
You can get hospice benefits when your doctor and the hospice Medical Director certify your prognosis as not longer than six months. This applies to anyone of any age, with any type of illness. While patients must have a doctor's referral to enter hospice, the patient, family and friends can initiate the process by contacting a local hospice program.
How long does hospice care last?
Hospice care is intended for people with 6 months or less to live if the disease runs its normal course. If you live longer than 6 months, you can still get hospice care, as long as the hospice Medical Director or other hospice doctor recertifies that you’re terminally ill. Read More
Who uses hospice care?
Hospice programs are for anyone of any age with a life-limiting illness. Hospice care is available for eligible patients having a diagnosis, or combination of conditions, that include: Stroke and Coma, Cardiovascular disease, “old age”, Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease), End-Stage Dementia, Failure to Thrive (adult), HIV disease, Neuromuscular Disease, Liver Disease, Multiple Sclerosis, Parkinson’s Disease, Renal Disease, and Pulmonary Disease.
When is the right time to contact hospice?
At any time during a life-limiting illness, it's appropriate to discuss all of a patient's care options, including hospice. Admission to hospice is based on a physician's clinical judgment that hospice care would be appropriate for a patient, given the expected course of an illness. The following are signs that you may want to explore options with hospice care:
- You've made multiple trips to the emergency room, your condition has been stabilized, but your illness continues to progress significantly, affecting your quality of life.
- You've been admitted to the hospital several times within the last year with the same or worsening symptoms.
- You wish to remain at home, rather than spend time in the hospital.
- You have decided to stop receiving treatments for your disease.
What does hospice care provide to the patient?
Depending on the patient’s circumstances and stage of care, a hospice interdisciplinary team (IDT) may provide any combination of the following services: Read More
How does one get involved with hospice services?
There are two ways. Your doctor or hospital/care facility case manager may call, or you may call. If you or someone from your family calls, the agency will contact your doctor to discuss the illness and verify that hospice is medically appropriate. The patient actually becomes admitted to hospice by signing a consent form electing hospice care.
Can a hospice patient continue with his or her own doctor?
Yes. A hospice Medical Director is available for consultation with the patient's doctor. Hospice nurses will work with the patient's doctor on all aspects of care. If for some reason your physician is unable to visit you, a hospice physician who specializes in comfort care is available to visit you and consult with your hospice care team if you choose.
Does hospice provide 24-hour nursing?
No. Hospice nurses visit weekly or more frequently as the patient's condition dictates. A hospice nurse is also accessible 24 hours a day by phone to assist with questions or emergencies and can make a home visit if needed. Hospice pharmacies are available off-hours to ensure that changing medication needs can be met at any time. Medications are delivered to the patient's residence. The family can also privately hire shift nurses to provide 24-hour nursing if the family has health insurance that will reimburse them over and above hospice or if the family is financially able to privately hire.
Who pays for hospice?
Most health insurances, including Medicare, provide full coverage for hospice care, usually with no co-payments or deductibles. In addition, most Medicaid and commercial insurance plans also offer excellent coverage for hospice services with few, if any, out-of-pocket expenses. Read More
How can I learn more about hospice?
To obtain further information, to apply to be a volunteer, or to inquire about hospice speakers, call Interim Healthcare Foundation, Inc. at (806-722-1968).
What is the story behind the Interim logo?
As we envisioned our logo, our purpose was to communicate a new day with the sun shining. With the brightness of a warm sun with energy, millions or rays of light, and the beginning of a new day with the sun rising, it seemed this was the context of our foundation. We are about a new day, helping others to find resources to continue or begin anew in life’s journey. If we are about anything, it is about hope and finding peace amidst the hurt.
When A Death Occurs
When a death occurs, the order in which things need to be done often depends on where the death occurred. But, one thing should always be remembered: your heightened emotional state upon the death of a loved one. That's why we suggest that you ask a friend for help - someone who is more able to think clearly, and give you the support you need. Read More
Question:In the past weeks, the hospice folks have been rather surprised at how well my brother has been doing. They claim that he has more air moving through his lungs, his appetite and color are excellent and he appears to be responding very well to occupational and physical therapy. They are talking about taking him off hospice and putting him into their home health care service. However, we are getting conflicting answers when we try to get an idea of the difference between the two. One person tells us he will get more therapy, another says less. I do know that we would need to pay for his supplies (diapers, etc.) if he's not in hospice, but everything else is unclear.
It is a good idea to trust your instincts! In hospice, all nursing services, therapies, medications and other supplies must be provided by the hospice. If your brother gets off hospice, then he would again be eligible under the general Medicare benefit, but that doesn't pay for medications or supplies at all. The general Medicare benefit reimburses the home health agency for nursing visits and home health aide visits, but there is no provision for other levels of care such as hospice "continuous nursing care."Read More
My mother developed cancer five years ago. She underwent many rounds of chemotherapy, and has been considered terminal for more than a year. Recently she has refused to take the morphine and forces herself to get up and walk around. Now the RN case manager has suggested that my Mom be terminated from hospice care. We are VERY upset! We don't know what to do. The hospice nurses and home health aides have been a great help to Mom. Can they terminate my Mom from hospice care against her will as the RN suggested?
It is distressful to hear such a recommendation. On the one hand, your Mom has lived longer than perhaps they estimated, but the regulations do NOT say that a terminally ill person has to die within the six month period from the beginning of being certified as having a "terminal" illness. The regulations say that the doctor must certify that the patient MAY die within six months if the disease process runs its normal course. This is a statistical probability given a certain diagnosis, not a prediction of what actually has to happen. There are thousands of hospice patients who have lived longer than six months and there are many who live much less than six months.Read More
My family has concerns regarding my brother and lung cancer. My brother has lung cancer that has spread and is now said to be bone cancer. The bone cancer is in his spine, ribs and hips. We want him to be able to be home and be comfortable. All the doctors do is keep him in the hospital and give him enormous amounts of Demerol. This is no way for a man to live. He's very confused and sometimes hallucinates, because he's all doped up. We don't know what else we can do. We've tried chemotherapy and radiation. Please help us find an alternative way for this man to finish his life with a little dignity.
It is not usual for a cancer patient to be kept in a hospital long term for pain control. Hospices can provide the care which on seeking to help your loved one be as comfortable as realistically possible under the circumstances. It appears that the physicians involved may not be experts in hospice care. Some doctors are not always well-trained in comfort measures for end of life care, although many are. Even though they are the experts in trying to treat the disease and cure it, care directed toward curing is not the same as medical care directed toward what is called "comfort measures" or "palliative care." Hospice care or palliative care is a specialty in the medical field.Read More
My mother has just been enrolled in hospice due to her emphysema and kidney disease. She has severe reactions to morphine and becomes very lethargic, sleepy and confused, and her blood pressure drops. Doctors in the past have warned her never to take it again. Mom told the hospice she does not want morphine, but the hospice doctor has prescribed morphine anyway. We are afraid that this can hasten our mother's death. What can we do?
In every aspect of health care, the patient always has the right to accept or decline any form of treatment, medication or care offered. In the situation as you describe it, your mother has the right to refuse to take morphine and if she clearly refuses it, the hospice cannot force her to take the morphine. In some cases, physicians use morphine for difficulties with breathing that is labored and when there is severe respiratory congestion. Read More
My uncle was hospitalized and they found that he has terminal cancer. It's gone undetected for a long time and our long-time family physician recommended the local hospice in our area and told the nurse in the hospital that we are all agreed that my uncle should go to the local hospice. I came back the next day and found another hospice transferring him out of the hospital to their hospice which is not at all where the doctor and we want him to be. Can they just walk in and take my uncle to their hospice against our wishes and the doctor's recommendation?
This type of problem has been occurring in some areas where there is fierce competition among separate hospice agencies for patients. As unbelievable as it seems, some of the larger hospices which are trying to "take over" a territory and become the only hospice in the area are actually "stealing" terminally ill patients from their hospital beds. They have a social worker or nurse who is friendly to the big hospice tipping them off that a new terminally ill patient has been admitted to the hospital. Then before the local smaller hospice can get there, they sign the patient up for their hospice...and quickly transfer the patient out to the larger hospice.Read More
My brother entered hospice after several months of battling lung cancer. He also has emphysema and suffered a stroke. When he entered hospice we had the understanding that occupational and physical therapy would be provided in an effort to keep him comfortable with the goal of trying to make him stronger.
Today, the occupational therapist came out and said that therapy is not generally permitted for hospice patients because Medicare frowns on providing therapy for what may very well be terminally ill patients.
This doesn't seem right. My brother has been feeling stronger day by day and wants to work at regaining some strength for as long as he's here with us. Is what the therapist said true? Can they simply deny my brother the therapy he wants and needs? Any help you can provide with this would be greatly appreciated.
In hospice, everything done for your brother really is aimed at improving the quality of life he has while he is with you. Managing symptoms is part of hospice, but therapy is also a part of hospice if there is a possible gain to be made. If your brother had a stroke, how much mental function and physical ability does he still have? Certainly, you are correct that hospice must provide occupational therapy if it will increase the quality of life for your brother, even though he is terminal.Read More