Hospice is end-of-life care provided by skilled medical professionals and volunteers who provide medical, psycho-social, spiritual, and volunteer support to patients and their loved ones. Hospice care focuses on palliative or comfort care at the end of life when further life-sustaining treatments are either not warranted or are not desired by the patient and their loved ones.
Hospice is aimed at helping terminally ill patients to have peace, comfort, self-determination, and dignity at the end of life. Hospice provides much needed support, resources, and bereavement services not only to patients, but also to their loved ones. Bereavement support and counseling services are offered to family and friends even after a patient’s death. The support of the hospice Physicians, nurses, social workers, chaplains, nurse assistants, and volunteers provides the patient with quality care and gives them and their loved ones the opportunity to spend their final months in comfort in whatever environment they choose.
There are 4 different types of hospice care, and they are classified by Medicare as “levels of hospice care”. The 4 different levels of care are described below:
The first type or level of hospice care is routine home care. Routine home care is the level of care given to patients who are not in crisis. Patients can receive routine home care at a home, at a skilled nursing facility (SNF), memory care, or an assisted living facility. The goal of routine home care is to increase the comfort and quality of life of the patient as much as possible. This is achieved through different services such as pain management, symptom control, emotional and spiritual counselling for the patient and family, assistance with daily tasks, nutritional services, and therapeutic services.
The second type or level of hospice is continuous home care. Continuous home care is provided to patients who are experiencing a medical crisis or when the patient’s symptoms require more intensive management. Patients can receive continuous home care in any home setting that is not an inpatient facility. An inpatient facility includes hospitals, skilled nursing facilities, or hospice inpatient units. Continuous home care includes nursing care on a constant basis for patients for a short period of time until the medical crisis has passed or the patients symptoms are controlled and no longer require such frequent skilled intervention.
The third type or level of hospice is inpatient respite care which is provided at an approved inpatient facility, usually a skilled nursing facility or other medical inpatient unit. The hospice will provide for up to 5 consecutive days for the patient to be cared for in a respite facility in order to provide relief for their caregivers. Inpatient respite care offers round-the-clock assistance as well as pain and symptom management to patients.
The fourth type or level of hospice is general inpatient care. General inpatient care is the level of care given to patients who choose to receive hospice care in an inpatient facility for pain control or symptom management that cannot be done at home. This is short-term placement with the goal being to control severe pain and/or stabilize symptoms.
There are several benefits of hospice care, according to the Centers for Medicare and Medicaid Services (CMS). CMS states that the benefits are centered on reducing the pain or the severity of the disease and also managing life-limiting illness and related conditions. Some of the benefits of hospice care include:
Hospice provides comprehensive comfort care not only for the patient but also for the family. This is because patients who require hospice are those with terminal illnesses. Terminal illnesses include cancer, heart disease, lung disease, dementia, chronic kidney disease like kidney failure, and chronic obstructive pulmonary disease. Hospice end-of-life care also provides counselling, respite care, and practical support for the patient’s family members.
Hospice care is 100% covered by Medicare, Medicaid, and some private insurances. For Original Medicare, a patient with Medicare Part A is qualified for hospice care duration as long as the hospice Physician and the patient’s Physician certify that the patient is terminally ill. In rare cases where a medical supply like a drug is not covered by hospice benefits, the hospice provider can check if the patient’s Medicare Part D covers it. The hospice provider is required to inform the patient of any drugs or services that are not covered by hospice care.
The quickest way to find a Hospice care facility near you is to call Specialized Home Care directly. If you are from other states in the US, Medicaid provides an online directory where patients and their families can find hospice care teams and hospice care institutions closest to you. These hospice teams and hospice care institutions are certified by Medicare, and patients can find them by filling out their street, ZIP code, city, or state. Patients and their families can also input the name of the hospice agency to find out if it has facilities in the area.
The official data sets that can be found on the Medicaid website are provided by the Centers for Medicare and Medicaid Services. The Centers for Medicare and Medicaid Services can provide the datasets by downloading them from their website. These datasets can be utilized by patients and their families by comparing the quality of care provided in Medicare-certified hospices across the United States.
There are several differences between hospice vs. palliative care. Here is a summary list of the differences:
A study published in the Journal of Palliative Medicine in 2014 determines how long hospice patients live. The results show that 93.6% died within 6 months. There are several variables that contributed to an increased possibility of passing away within six months. The first is that patients who were admitted to a hospice unit or hospital were more likely to die within six months. The second is patients who are less than 65 years old are more likely to die within six months. The third is that male adult patients are more likely to die within six months compared to female patients.
The study also used a Palliative Performance Scale (PPS) that gives a score for each patient. The scores are in multiples of 10 from 0 – 100, which higher numbers mean better function. The PPS uses five criteria such as ambulation (range, bed-bound to full), activity (unable to work to normal), self-care (completely dependent to completely independent), intake (mouth care only to full diet), and level of consciousness (drowsy or coma to fully alert). Patients with lower PPS scores are more likely to die within six months. On the other hand, patients with cancer upon admission have a high chance of passing away within six months, regardless of the PPS score.
Yes, someone can come back from hospice as long as the hospice doctor and the patient’s doctor re-certifies that the patient is no longer terminally ill with a prognosis of six months or less. Hospice can also discharge a patient if the patient and the family elect to stop hospice care. The patient and the family may also choose to return to hospice care at any time.
The hospice may discharge a patient for other reasons, including the death of the patient, revocation of the hospice benefit by the patient, move or transfer out of patient from one hospice to another, and discharge for cause as stated in the hospice’s policy.
It is time for hospice if the patient has any of the following terminal illnesses, like cancer, cardiac and circulatory disease, dementia or Alzheimer’s disease, respiratory disease, stroke, liver or kidney disease, amyotrophic lateral sclerosis (ALS), and other degenerative neurological diseases.
The next factor to consider if it is time for hospice is if the patient’s doctor certifies that the patient has six months to live or less. Other things to consider are the ineffectiveness or worst effects of curative treatments, loss of body weight, presence of co-morbid conditions, and decline in physical activity and mental alertness.
Patients may also choose to receive hospice care and stop the curative treatments. They can decide whether to continue their treatment or manage the pain and symptoms they are experiencing. The patient’s preferences can also be crafted by hospices into an advanced care plan (ACP). The ACP contains the living will, durable power of attorney for healthcare, and a Five Wishes document.
People with terminal illnesses can receive hospice care. Hospice care is a medical care given to patients who are expected to live for six months or less as certified by the patient’s physician. Patients who receive hospice care can live better and longer because it manages pain and symptoms brought on by life-threatening sickness.
Hospice care also benefits the patient’s family members because it gives them opportunities to recuperate and rest. Family members can experience a decreased burden and also the likelihood of having complicated grief because hospice care prepares them for their loved one’s death.