The goal of the hospice movement is to maximize the quality of life for the dying patient and their family and to help them make the most of the remaining time they have together. Ultimately, hospice care is designed to support patients until they die a natural death. There is an emphasis on the comfort of the patient, including appropriate use of medication for control of pain and other symptoms. Hospice also seeks to serve the patient’s family, helping family members to cope with the illness and death of their loved one.
Most hospices offer home care supported by a team of doctors, nurses, physical and occupational therapists, health aides, dietitians, pastoral care professionals, social workers and volunteers. Some hospice programs have their own on-site facilities where dying people can spend the final days or months of life. Other times hospice workers will go into a patient’s home or to a nursing home to supplement the care received there. Hospice is a comforting choice and can be a good option for family members who do not live near their dying loved one. Hospices can also offer “tune-up” services. For example, a patient may be admitted to hospice in order to get her pain and other symptoms under control, to receive help finding a hospital bed for their home, or to secure nutritional guidance or home aid.
If you’re planning to seek hospice care for your grandmother, keep in mind that not all hospice programs or employees necessarily embrace a life-affirming philosophy. Also, the very nature of hospice (providing an environment in which to die) can lend itself to the restriction of medical treatments and procedures, which may make some families uncomfortable. Before making any decisions, try to find out if the ethical views of the hospice you are considering align with your own. If not, ask them if they would be willing to work with you by keeping their treatment consistent with your values and wishes.
In most regions, to receive hospice services the patient, family, and doctors must agree that the patient probably has six months or less to live. Some families, possibly out of an unwillingness to accept the reality of their loved one’s condition, put off this option until death is very near, telling themselves that it is “too soon” to begin hospice care. A better approach is to initiate some level of professional care before a crisis exists. You can begin moving in this direction by arranging introductory home meetings or hospice visits before your grandmother needs regular services so that a support network is in place.
Medicare coverage of hospice care is available under Medicare Part A hospital insurance. To receive Medicare payment, the agency must be approved by Medicare. For more detailed information contact
Medicare and request the booklet Medicare Hospice Benefits.
When checking out hospice programs, competency in making patients comfortable should be the top priority. A hospice’s values and beliefs regarding life, death and the afterlife are also important. To help determine if you are comfortable with their principles you might ask the staff to send you their “mission statement” or “statement of faith” for consideration and ask your grandmother’s physician his or her professional opinion of the hospice. You should also raise questions from the following checklist:
- What area does the hospice serve?
- Does the hospice specialize in dealing only with certain types of illness?
- Will the hospice provide you with a written care plan?
- Who will be on the hospice-care team?
- What are the qualifications of the staff and volunteers?
- What is expected of the family caregiver?
- What resources are available to help you?
- Does the hospice provide family support and bereavement counseling?
- How will emergencies be handled?
- What are the fees and how are they applied?
- Will the hospice handle billing Medicare or private insurance carriers?
- Does the hospice meet state licensing requirements?
- Can the hospice provide references from professionals?
Finally, families should know that even if hospice care is not accessible in their area, or if for some reason they choose not to use a hospice organization, the principles that underlie hospice can be implemented by their dying loved one’s health care team. Most primary physicians would be honored to help develop goals of comfort care and support, and families should not hesitate to address this important topic with their health care professional.
If you’d like to discuss any of this information at greater length, feel free to call Focus on the Family’s Counseling department. They’ll be happy to assist you in any way they can.
Resources
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Referrals
National Association of Area Agencies on Aging
National Hospice and Palliative Care Organization
Articles
