Hospice is not a place, it is a concept of palliative care. Although there are some in-house hospices, about 80% of hospice care in the U.S. takes place in the patient’s home, a family member’s home, or in a skilled nursing facility.
Hospice Team
Hospice is a team approach. The team is comprised of the patient, a willing and able caregiver (usually a family member), other family members, and a group of specially trained professionals such as nurses, doctors, social workers, clergy and volunteers. The plan of care is decided upon by the group and changes must be approved by the group.
Palliative, Not Curative
The care is palliative, not curative. The focus is on quality of life and controlling the patient’s symptoms such as pain and any other symptoms of discomfort such as shortness of breath, nausea and vomiting, and constipation which may result from the terminal illness, co-morbid illnesses, or from medications.
The hospice team also focuses on the emotional, social and spiritual effects of the illness on the patient and the family and works with them to ease these effects and bring about a peaceful passing. Counseling and bereavement support begins with admission to hospice care and can continue for six months to a year after the passing for family members.
Medicare, medicaid and most private insurance plans cover the cost of hospice care which is all-inclusive for expenses related to the terminal diagnosis. Other care such as for routine illness or injury can be continued as desired. Any out of pocket copays for non-hospice covered care and medications is the responsibility of the patient. All of this will be covered in detail by the admitting hospice nurse.
Hospice Diagnosis
Criteria for hospice care includes a terminal diagnosis with a prognosis of six months or less. The diagnosis does not have to be cancer. Other illnesses work, such as end stage heart disease, kidney/renal disease, lung disease, dementia and Alzheimer’s, and a general debility or decline in health status as patients grow old. General decline has certain criteria that have to be evident and measurable.
The hospice team can make an evaluation visit to assess for the appropriateness of hospice care at this time. If hospice is not yet indicted, the team can recommend other avenues of care such as home health care. A physician’s order is required for the evaluation.
When curative measures are no longer working, or their toll is significantly impacting the quality of life, hospice may be the care of choice. It is not necessary to wait until the patient is actively dying to elect hospice care. Nor does it mean patients have to climb into a hospital bed and get ready to die. Hospice allows for a prognosis of six months or less.
Hospice Most Effective When There's Time Left
Although it is an emotionally difficult decision, hospice care is actually most effective when there is significant time to achieve symptom control and allow the patient to have quality time with their loved ones. Patients who are already actively dying when hospice care is elected don’t always achieve symptom control and quality of life and their families aren’t as well prepared for their passing as those who elect early on.
It is not entirely uncommon for patients to live beyond the six months, and as long as they continue to meet criteria, hospice care continues. Sometimes, patients improve and elect to revoke hospice care. Hospice can resume again if and when their condition declines.
Further Reading and Resources:
National Hospice and Palliative Care Organization
Withholding Food and Fluid in Terminal Patients
Kathy Quan - Kathy Quan RN BSN has been a home health/hospice nurse for over 30 years. She has authored five books and writes for several online ...
