Hospice is one of those words that evokes a great deal of emotion in people, most of it negative. For many it signifies the end, giving up. For that reason, I usually talk about hospice in terms of the services provided, rather than using the word hospice. It is not abandonment, but instead a shift in medical priorities. But for terms of definition, it is usually defined as specialized care for people in life’s final moments, and emphasizes dignity, comfort, and pain management, and seeks to address the patient’s social, emotional, spiritual, and physical well-being, as well as their family members. As a professional treatment modality, hospice is still in it’s infancy in America, only about 25 years old, but it is becoming more and more accepted as Americans continue to age. There are two categories of hospice companies, profit and non-profit, but there are few differences when it comes to services provided. Companies are usually reimbursed on a daily fee basis which is not based on their organizational structure. Hospice care is usually delivered at home, but can also be provided in a hospital, nursing home, or assisted living facility, or at another family member’s home.
The typical treatment team includes the patient’s attending physician and the following hospice team members:
Medical Director
Registered Nurse
Social Worker
Certified Nursing Assistant
Chaplain, and
Volunteers
Hospice typically provides medicines, medical supplies, and equipment related to the illness, as well as professional nursing services. The primary reimbursing sources of payment for these services are medicare, medicaid, and private insurance, but patients are accepted for hospice based on need, not the ability to pay, so most hospice organizations will work with the family in dealing with payment options.
Hospice care is usually instituted with the diagnosis of a terminal illness and a physician’s referral and prognosis that the patient has six months or less to live. Many end stage illnesses qualify for hospice care, but the most prominent ones include: cancer, congestive heart failure, ALS, HIV, AIDS, COPD, renal failure, liver disease, end stage stroke, and Alzheimer’s and related dementias including Parkinson’s. I mention Alzheimer’s spefically because many people don’t think about Alzheimer’s qualifying until the very end days, but if you have a good physician who is adept at identifying stages you can usually qualify in stage five and six, with seven being the end stage. This brings up an important point. Most people don’t consider hospice care early enough, and when they do, it’s because the physician brings it up. They think that if they discuss the topic it is admitting defeat, so instead it’s easier for them to remain in denial. I seldom see anyone who felt they received hospice services too early, but I hear all the time about those who waited until the last few weeks before accepting help, often wishing they had done it earlier. So you don’t have to wait for the doctor to bring up the topic. Be proactive. The earlier a patient accepts hospice services, the more the patient and family members benefit.
