lily, flowerThoughts on Hospice Care

Discussing a family member’s end of life scenarios is understandably difficult, however hospice care has been designed to make it easier for families facing this situation. According to Wikipedia, hospice care began to evolve in the 1700’s but the modern practices of palliative (relieving pain) hospice care really started in the 1950’s. Contemporary hospice practice is to essentially provide medical care to a patient who has less than six months to live due to one or more medical conditions or even old age. Care may be provided in a hospital-type setting, nursing home or the patient’s own home.

 

What Does Hospice Do?

Hospice care itself is provided by numerous companies, many of whom have contracts with government agencies and insurance companies. Most provide nurses or, at minimum, trained caretakers who routinely visit a patient to monitor their health condition, make sure the necessary equipment is available and coordinate medical treatment.

Why Would A Family Use Hospice?

Many patients would prefer to pass away in the privacy and serenity of their own home or a nursing home as opposed to a hospital setting where their last days can become a jumble of constant interruptions and noise as well as lack of privacy, sleep and personal touches. Family members and friends tend to find maintaining a hospital regiment to be uncomfortable, arduous, time consuming and frustrating. Enter hospice. By providing end of care at home, the family’s schedule can see less disruption and the patient is allowed to experience the calmness, comfort and security a home can provide during their final days.

Who Pays for Hospice?

Typically hospice is paid by the government through Medicaid, Medicare and/or private insurance. In many instances Medicaid and Medicare may pay 100% of the cost. Patient co-pays may apply and there may be limits to the amount private insurance providers will pay leaving families to pick up the tab, however the cost is usually significantly less than a hospital stay.

What can a Patient Going on Hospice Expect?

If the patient is alert and oriented one of the biggest problems they may face is the psychological consequences of being placed on hospice. After all, many people associate hospice with death. People die while under hospice care. The key here is that yes, by very nature of the program, people die while on hospice care, but generally not BECAUSE of hospice care. The family should be prepared to help the patient adjust and assist them through this time by reinforcing their love and commitment to the patient.

What can a Family Expect?

Most health medications and life-assistive devices are removed when a patient enters hospice care. This can cause major changes in the patient’s health and mood. For example, in many cases medications to control blood pressure, heart conditions, respiratory problems and the like are no longer prescribed. Pacemakers and defibrillators will most likely be turned off. With the removal of medications and life-assistive devices the patient may pass away much sooner than initially anticipated. Medications to control pain will usually be increased under a “no pain” goal. This elevation may cause stupor, increased sleep and even unconsciousness.

What are Some Family Fears?

The biggest fear by most patient’s families is the time of death. Most of us are uncomfortable talking about it, much less witnessing the event. The patient is usually strongly medicated to remove pain and thus many times passes softly as breathing and heart rate become slower and eventually stop. There may be some snoring type respirations, possibly some last gasps, but for the most part the event is will most likely occur without incident.
Once the patient has passed, the family should call the hospice on-call worker and notify them. Most of the time the worker will come to the home and confirm death then contact the doctor for the death certificate.

What if the Patient’s Condition Worsens?

The purpose for hospice is to provide palliative care until death. The patient’s condition is expected to deteriorate with the removal of medications and assistive devices along with the time of death approaching. However, if the patient is in pain, hospice can alter the amount of narcotics the patient receives to decrease the pain. The family should never call an ambulance or seek medical care outside of hospice’s directives. If the family has questions they are always encouraged to call the on-call worker. In many instances, if the family seeks medical care outside of the hospice directive the resulting bills will not be covered by their insurance, Medicaid or Medicare.

What are Some Other Considerations?

Some people do not desire to have the memory of a family member passing away in their home. This is understandable and should be a consideration when contracting with hospice. Many hospice agencies also have nursing-home like accommodations which may be more appealing in this situation.

Caring for a dying family member is a lot of work. The family should be prepared to shoulder the majority of the patient’s care and provide for their needs on a 24-hour basis if the patient is at home. If the family is unable to provide this level of care then they should consider nursing homes or other facilities.
The family member may die sooner under hospice care. Whatever the medical condition is, it is expected to result in the patient’s death. Prolonging the inevitable may not be in the patient’s best interest and may even increase the stress and burden of the family. However, if the patient is relying on medication or a medical device for life, then death may be hastened when these items are removed.

Summary

For decades hospice has been a huge help to many families by allowing people to pass away with dignity and peace while providing a major support structure for the family to lean on. If a family is facing the passing of a loved one, they should consider all of their choices, including hospice, and discuss these options with the patient’s doctor.

 

 

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