Where is hospice care received?
Hospice care is received wherever the patient is living. Hospice care can take place in a patient’s home, a nursing home, assisted living facility, independent living facility, hospital, group home, or the Angela Hospice Care Center.
When is the right time to consider hospice care – and who should make the decision?
At any time during a life-limiting illness it is appropriate to consider all of a patient’s care options, including hospice. By law the decision belongs to the patient. Hospice care is premium quality comfort care specifically for patients with a terminal illness. The essential criteria for electing hospice care is:
A physician and hospice medical director’s certification that a patient is terminally ill -and- if the terminal illness runs its natural course, life expectancy is six months or less.
Many physicians are concerned about the difficulty predicting a six month life expectancy. As a result, a majority of patients are referred to hospice care when actual life expectancy is only weeks or days (a period many physicians feel they can more easily judge). Although all patients receiving hospice care experience high quality comfort care as soon as hospice begins, those patients receiving it at a more advanced point in their disease do not receive as many of the benefits of hospice care as those referred earlier in the progression of disease. Perhaps this is the reason recent studies have shown that patients who receive hospice care earlier in their diagnosis typically live longer and more pain free lives than those who receive it later. For more information on this subject, see the section entitled “Is it time for hospice?”
Do we have to stop treatment of the disease if we choose hospice care?
Hospice care is comfort care for terminally ill patients. One criteria for selection of hospice care under Medicare guidelines is the choice to forego treatments and medicines intended to cure the diagnosed terminal illness. For many with terminal illnesses, choosing to forego physically distressing treatments or medicines which may disrupt sleep and eating patterns is often a relief in itself. This guideline, however, does not mean that treatment is discontinued for medical conditions which are not part of the terminal illness. Those treatments are typically covered under Medicare Part B or the patient’s secondary health care plan.
Who pays for hospice care?
Hospice care is covered by most private insurers and HMO’s. In addition, it is a Medicare Part A benefit to all eligible Medicare recipients age 65 and older. As a result, Medicare pays for all hospice-covered benefits, including costs for the interdisciplinary medical team (services of the doctor, nurses, social workers, hospice aides), costs for medical supplies and equipment (such as wheelchairs, walkers, bandages and catheters), as well as medications for symptom control and pain relief – all related to their hospice diagnosis. The only hospice related expense not covered by Medicare would be room and board if the patient is living in a nursing home or hospice residential facility – such as our Angela Hospice Care Center. In addition, Medicaid eligible patients and some with hospice coverage in their private health insurance may receive additional benefits such as reimbursement or coverage for room and board.
Isn’t considering hospice care like giving up hope?
Because hospice care is designed for terminally ill patients, many family members feel broaching the subject of hospice is like admitting defeat or losing hope for a cure or a miracle of healing from a terminal disease. Since it is possible to leave hospice care if a cure or new treatment for a disease is found, hope for that solution can endure throughout much of the hospice process. Indeed, while in hospice care, patients’ diseases have been known stabilize or stop progressing. Some patients have recovered to the point of leaving hospice to carry on with their normal daily lives. At the same time, while in hospice care, many families find their hope does not dissipate, but becomes redirected. They begin to change the things they hope for. Perhaps they find new hope that longstanding pain and suffering can be reduced, or a hope to spend good quality time with their family, or hope to attend an upcoming family event, or find closure to strained relationships or unfinished business. With pain well-managed, new hopes can finally emerge.
Can a patient leave hospice care if a cure is found or new curative treatments are desired?
Yes. A patient always retains the right to leave or discontinue hospice care.
Can a patient who has left hospice care come back?
Yes. A patient does not lose the ability to return to hospice care if their condition continues to warrant it.
Can a patient be “kicked out” of hospice care?
At Angela Hospice, if a patient’s decline continues, we will continue to provide hospice care. For example, we have had patients at Angela Hospice whose diseases have caused a slow decline over the course of years while they remain steadily in our care. If improvement in the patient’s condition occurs, it is possible the patient may be discharged from hospice, allowing them to return to rehabilitative therapy, aggressive therapy or simply go on about his or her daily life. Naturally, if the progression of the disease returns, the patient will again be able to elect hospice care.
Does hospice remove food and water from patients?
Hospice care does not hasten death. In fact, studies show the opposite is most frequently true; that in hospice care, patients most often live longer lives than their counterparts who do not choose hospice care. While hospice care does not hasten death, it is also not designed to artificially prolong life. Hospice is a system of care intended specifically to comfort and ease physical, emotional, psychological or even spiritual distress and pain in terminally ill patients. With Angela Hospice, patients are allowed to eat or drink as long as they desire. Sometimes, because of the disease, food or liquids can begin to cause distress in the patient. When that happens, we will do whatever is possible to satisfy the patient’s desire while continuing to provide exceptional end-of-life comfort care.
Will medications prevent a 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.
Do Angela Hospice patients need to be affiliated with any particular religion?
No. Hospice care itself is not an offshoot of any religion. And while Angela Hospice is a Catholic sponsored ministry in the Franciscan Felician tradition, we are honored to serve the entire community of southeastern Michigan regardless of religious affiliation.
What if my family needs more information?
There are many ways you can obtain additional information. One of our home care nurses or social workers would be more than willing to meet with you, your family, the patient or whoever may have questions about hospice care and your specific circumstances. There is no obligation, implied or otherwise, in a meeting of this kind. It is for information only. Therefore, these meetings are often a great time to ask general questions of a hospice professional about the scope and objectives of hospice care. They are an opportunity to express a family’s hopes for care and for the future; an unpressured and comfortable forum exploring what hospice is able to bring to patients and families during the most challenging time of life. You may simply wonder what steps may be available to you, or the role of Medicare coverage. A candid discussion with one of our experienced registered nurses or social workers may go a long way toward putting both spoken and unspoken concerns to rest. Many family members report they feel a weight lifted from their shoulders as soon as they have had a person-to-person discussion with our compassionate Angela Hospice team members.
In addition, you are welcome to request additional literature or speak with us via telephone as often as you like to learn more about the exceptional medical benefit of hospice care – and the even more exceptional ways Angela Hospice has touched patients and family members with that care in our community for over 25 years.
Finally, the U.S. Department of Health and Human Services is available 24 hours a day to answer questions concerning hospice Medicare benefits. You may visit them on the web at www.medicare.gov or telephone 1-800-MEDICARE (1-800-633-4227). TTY users can reach the department by calling 1-877-486-2048.