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Learn About Hospice Care from Our FAQ
When looking into hospice, it’s important to consider all the available information. We have compiled this list of frequently asked questions to serve as a reference for you. Should you have further questions, please feel free to contact us.
When should a decision about entering a hospice program be made and who should make it?
Any time during a life-limiting illness is an appropriate time 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 aggressive effort to “beat” their disease. Altus 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 the family should feel free to discuss hospice care at any time with their physician, other healthcare professionals, clergy or friends.
What if our physician does not know about hospice?
Most physicians are fully informed about hospice. If your physician wants more information, Altus Hospice has personnel available 24 hours a day to answer any questions physicians or the community may have. In addition, they can arrange a consultation by calling the Altus Hospice office.
Can a hospice patient who shows signs of recovery be returned to regular medical treatment?
Certainly. If improvement in condition occurs and the disease seems to be in remission, the patient can be discharged from hospice and return to aggressive therapy or go on about his or her daily life. If a discharged patient should 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?
It is easy! One of the first things hospice will do is contact the patient’s physician to make sure he or she agrees that hospice care is appropriate for this patient at this time. The patient will also be asked to sign consent and insurance forms. These are similar to forms patients sign when they enter a hospital. The Hospice Election Form states that the patient understands that the care is for comfort — that is, the care is aimed at pain relief and symptom control rather than reaching a cure. 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 terminal 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 help 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, clean and safe as possible.
How many family members or friends does it take to care for a patient at home?
There is 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 caregiving a person needs. Hospice staff visits regularly and is always accessible to answer questions and provide support.
Must someone be with the patient at all times?
Care needs are based on the individual’s level of function. In the early weeks of care, it may not be necessary for someone to be with the patient at all times. Later, however, hospice generally recommends someone be there continuously since one of the most common fears of patients is the fear of dying alone. While family and friends must be relied on to give custodial care (ongoing physical care), hospices do provide volunteers to assist with errands and provide a break and time away for primary caregivers.
How difficult is caring for a dying loved one at home?
It is never easy and sometimes can be quite difficult. At the end of a long progressive illness, nights especially can be long, lonely and scary. With that in mind, hospices have staff available, usually by phone, around the clock to consult with the family and to make night visits as appropriate. Respite Care can be arranged to give family members a break.
What specific assistance does hospice provide home-based patients?
Hospice patients are cared for by a team, which consists of doctors, nurses, social workers, counselors, home health aides, clergy, therapists, and volunteers. Each provides assistance based on their area of expertise. In addition, hospices help provide medications, supplies, equipment, hospital services and additional helpers in the home as appropriate. Hospice does not provide 24-hour care in the home unless there is a crisis which constitutes temporary around-the-clock care.
Does hospice do anything to make death come sooner?
No. Hospices do nothing either to speed up or to slow down the dying process. Just as doctors and midwives lend support and expertise during the 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. Although most hospice services are delivered in a personal residence, some patients live in nursing homes, assisted-living facilities, hospitals or hospice centers.
How does hospice “manage pain?”
Hospice nurses and doctors are up to date on the latest medications and devices for pain and symptom relief. Hospice believes that emotional and spiritual pain are just as real and in need of attention as physical pain, so we seek to address these as well. Counselors, including clergy, 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 is happening?
Not usually. 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?
No, hospice care in general is not affiliated with any one religion. While some religious organizations have started hospices, sometimes in connection with their hospitals, 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 widely available. It is provided by Medicare nationwide, by Medicaid in 42 states, and by most private health insurance policies. To be sure of coverage, families should check with their 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 finding out whether the patient is eligible for any coverage they may not be aware of. Most hospices will provide care for those who cannot pay, using money raised from the community or from memorial or foundation gifts.
Does hospice provide any help to the family after the patient dies?
Yes. Hospice provides continuing contact and support for family and friends for at least one year following the death of a loved one. Some hospices also sponsor bereavement and support groups for anyone in the community who has experienced the death of a family member, a friend or a loved one.
If the patient is eligible for Medicare Will there be any additional expenses to be paid?
Medicare covers all services and supplies related to the terminal illness for the hospice patient. In some hospices, the patient may be required to pay a 5 percent or $5 “co-payment” on medication and a 5 percent co-payment for respite care. You should find out about any co-payment when choosing a hospice.
Myths of Hospice Care.
MYTHS OF HOSPICE CARE
Because hospice is an unfamiliar experience for many, there are several common misconceptions that exist about hospice care. We have identified a few to further deepen your knowledge of what hospice truly entails.
Hospice is a place.
Reality: Hospice care usually takes place in the comfort of an individual’s home, but can be provided in any environment in which a person lives, including a nursing home, assisted living facility, or residential care facility.
Hospice is a program not a place. The program is available to provide end-of-life physical, emotional and spiritual care to individuals who have been determined to have a terminal illness. Inpatient hospice is for short-term critical care when the patient’s symptoms can no longer be reasonably treated in another setting. Treatments such as pain control, medication adjustment, observation, stabilizing treatment and symptom control can be more easily provided in an inpatient facility. Or for patients whose family members are unwilling to permit the needed care in the home, general inpatient care is a short-term level of care and is not intended to be a permanent or even semi-permanent solution to a negligent or absent caregiver.
All hospice programs are the same.
Reality: All licensed hospice programs must provide certain services, but the range of support services and programs may differ. In addition, hospice programs and operating styles may vary from state to state depending on state laws and regulations. Like other medical care providers, business models differ. Some programs are not for profit and some hospices are for profit.
It is true that all hospices have core services that they must provide. Those services are the four levels of care that must be available (routine home care, respite care, continuous care, and inpatient care). All hospices must provide core staff (physician, nurses, nurse aides, social worker, chaplain and volunteers). The difference between hospices is staff experience, longevity of staff, length of time in operation, and the administration of the hospice in meeting the state and federal guidelines that are set forth for hospices to abide by.
There are several different hospices operating in this area. Like anything else you may be considering, it is wise to be a good consumer by researching your options. One medium to use when searching for a hospice is the Department of Aging and Disability or DADS. They provide a Website that displays the survey results from the federal and state surveys required of hospices. The surveys provide information on how well the hospice is performing. When they are not performing well, that information is also listed on this Website in the form of citations. Visit www.facilityquality.dads.state.tx.us for further details, hospices are listed under home healths.
Hospice provides 24-hour care.
Reality: The hospice team — which includes nurses, social workers, home-health aides, volunteers, chaplains and bereavement counselors — visits patients intermittently and is available 24 hours a day/7 days a week for support and care. As a part of their core services, hospices should provide “continuous care,” but the hospice patients must meet certain criteria outlined by Medicare, Medicaid and insurance providers.
Continuous Home Care is provided during a period of crisis to maintain the individual in the home setting. It is not intended to replace the care provided by the caregiver for long periods of time. Hospice does not provide sitters. Volunteers are sometimes available to sit with the patient for short periods of time to give the caregiver a break.
Hospice is only for cancer patients.
Reality: Hospice can be utilized with any end-stage organ disease or with end-stage neurological diseases such as Alzheimer’s, dementia, or strokes. A large number of hospice patients have congestive heart failure, chronic lung disease, or other conditions.
Patients can only receive hospice care for a limited amount of time.
Reality: The Medicare benefit, and most private insurance, pays for hospice care as long as the patient continues to meet the necessary criteria. Patients may come on and off hospice care and re-enroll in hospice care as needed.
A patient needs Medicare or Medicaid to afford hospice services.
Reality: Although insurance coverage for hospice is available through Medicare and through Medicaid in 44 states and the District of Columbia, most private insurance plans, HMOs, and other managed-care organizations include hospice care as a benefit. In addition, through community contributions, memorial donations, and foundation gifts, many hospices are able to provide patients who lack sufficient payment with free services. Other programs charge patients in accordance with their ability to pay.
A physician decides whether a patient should receive hospice care and which agency should provide that care.
Reality: The role of the physician is to recommend care, whether hospice or traditional curative care. It is the patient’s right, or in some cases the right of the person who holds power of attorney, and decision to determine when hospice is appropriate and which program suits his or her needs. Before entering a hospice, however, a physician must certify that a patient has been diagnosed with a terminal illness and has a life expectancy of six months or less.