Hospice is called when patients feel aggressive treatment is no longer a viable or attractive option. It offers them a way to stay connected to their family without fear of pain, losing control, or becoming a burden.
First Steps When Hospice is Called
People put off hospice because they feel it is a last resort, like they are giving up on their chance of a cure. In reality, picking up the phone opens new opportunities. The program’s medical, psychological, and spiritual resources allow patients to take charge of their care, facing life in a manner they see fit.
When hospice is called, the hospice representative will begin by asking about the patient’s condition.
- What is the patient’s prognosis?
- Are they on medication?
- Where is the patient currently living? Where would they prefer to receive care? At home? An assisted living facility? A nursing center?
- What are their goals?
- Who will be the patient’s primary caregiver?
Hospice works best when called early. Do not wait until the disease enters its final stages. Reach out as soon as possible. Though not every question can be answered over the phone, gathering information ahead of time will help you make the right decision later on.
Qualifying for Hospice
Once the call is complete, the team will contact the primary care provider and obtain an order to evaluate. This is an essential step. Hospice is covered by Medicare, Medicaid, and private insurance, but only if the right criteria are met.
- The patient’s physician has diagnosed them with a terminal illness.
- If the disease runs its normal course, the patient has a limited life expectancy.
- The patient is no longer seeking aggressive treatment.
- Both the primary care and hospice physician agree the patient is eligible.
Because it deals with such serious ailments, hospice evaluations are carried out rapidly. Once the primary care provider has given permission, the hospice nurse will visit and assess the patient the same day, often within an hour.
Developing the Patient’s Care Plan
As soon as the patient has been approved, the case manager will meet to create a care plan. The case manager oversees treatment and the other team members. During their first visit, they will perform a head-to-toe examination. Skin, eyes, lungs, heart, they go over every system in the body. Then they will review the patient’s medical history and make notes. They will ask about medication, the patient’s ailments, and explain the range of services available to them.
Care plans explain how symptoms will be managed, frequency of visits, equipment is required, and which medications will be prescribed. It is based on the patient’s preferences and can be modified at any time as the disease progresses.
Naming a Primary Caregiver
In addition to the patient, the case manager will also meet the primary caregiver. This person is chosen by the patient to act on their behalf. Working alongside the case manager, they ensure the plan is in line with the patient’s wishes. If the patient is receiving hospice at home, the case manager will train them on the basics of care. Typical tasks include filling prescriptions, giving medication in proper doses, and changing bandages. The case manager will also walk the caregiver through the patient’s equipment (oxygen machine, hospital bed) and teach them how to track the patient’s condition. Primary caregivers are part of the hospice team. When the staff meets, the case manager will invite them to give feedback.
Addressing Family Dynamics
After the case manager, the family will be contacted by the team chaplain and social worker. They provide bereavement care and social counseling, helping everyone navigate the emotional and spiritual issues surrounding the end of life. They assist with funeral arrangements, mediate conflicts, help patients find meaning, and support families through the grieving process.
Both team members are required to reach out when hospice is called. Their services extend for up to 13 months after the patient passes. Families may draw on them as much or as little as they choose.
Negotiating with Healthcare Providers
Normally, when seeking care, patients approach doctors through their insurance company. If they need a bed or a wheelchair, it must be authorized through a management review, which may take weeks. But because their mandate is comfort not cure, hospice operates under a different model.
Take, for example, a patient who is short of breath. Though he is in pain, standard practice demands the doctor run tests instead of prescribing oxygen. Because of legal liabilities, his concern is diagnosing, treating, and curing the patient’s condition. He might be required to order x-rays, antibiotics, and blood tests before being allowed to treat symptoms. On the other hand, when hospice is called, the patient is given oxygen directly. By law, their chief responsibility is to keep patients free of pain. This mandate allows them to circumvent the normal bureaucracy. It is a hotline that puts them in immediate contact with nurses who work to resolve the problem straightaway.
When Hospice is Called
The purpose of hospice is comfort, not cure. It allows patients to stay alert, comfortable, and close to their loved ones during the final stages of life. Choosing hospice gives them the freedom to decide what constitutes good care. When dignity, comfort, and connection matter most, you will want to consider making the call.
Jose Escobar is the Hospice Executive for Parentis Health. He works with patients and families across Southern California, providing support and education, in order to alleviate the pain and suffering of chronic and terminal illness.