Dear Aimee - Hospice is Hope
Dear Aimee: My 82 year old father fell three times in the last few months. Each trip to the emergency room takes a great tool on both him and my mother. It seems like we are on a healthcare merry-go-round as we shuttle between the ER and various doctor’s appointments and tests. Are there healthcare options available to manage symptoms rather than trying to seek a cure to what seems like a natural process? — Hopeful in Havertown
Dear Hopeful in Havertown: It sounds like what you are asking is whether or not your father would be hospice appropriate. The word hospice often conjures up images of people lying in bed in a darkened room, with loved ones speaking in hushed voices so as not to disturb the patient. Others may view the term hospice as a last resort, a path taken when death is imminent. Although some do have the above experiences at life’s end, I am here to share the good news that hospice is hopeful and that the dying process can be a beautiful experience.
First, let’s talk finances. From an insurance perspective, hospice is a Medicare/Medicaid benefit. Medical equipment, incontinence products, some medications, physician oversight, inhome skilled nursing care, social work, chaplaincy, music therapy, volunteers, and certificated nursing assistants are among the included services. Private pay insurance hospice coverage is also available depending upon the provider.
To qualify for this benefit, there must be two physicians who certify that a patient’s life expectancy is six months or less based upon meeting specific clinical criteria. Although this timeframe may be true for some, take comfort in the fact that some patients live for years while on hospice. In contrast to the traditional medical mindset with a curative focus, hospice centers on symptom management. As a result, many patient’s experience an increase in their quality of life because they can now comfortably savor time with family and friends rather than as you stated, live on a “healthcare merrygo-round”.
It is common for caregivers to worry that they may be giving up on his or her loved one by considering hospice. For others, it may be a relief to disconnect from frequent emergency room visits, physically/emotionally challenging trips to a doctor’s office, or tests and bloodwork that have no positive impact quality of life. With hospice, the care comes to you in the comfort of your home or care community. They are your new 911 and are available 24 hours a day 7 days a week.
So the question then becomes, how do me or my loved one decide whether or not to move forward with hospice care? Understandably, this step can be emotional and sometimes confusing. A caregiver may choose to initiate a conversation with their loved one’s primary care provider on his or her behalf should they be of diminished capacity. Other times, an individual may decide to pursue hospice for themselves after speaking with a healthcare provider. Another option to consider is to contact a local hospice agency directly and speak with a representative. They can obtain the necessary physician orders as well as provide a timely patient assessment. Even if one does not initially qualify, it may be beneficial to have an application on file in the event that a patient does become hospice appropriate.
Once a hospice agency has been identified an initial assessment would take place in the patient’s place of residence. A nurse case manager, social worker, chaplain, and physician would be assigned creating an interdisciplinary team (IDT) to focus on a patient’s needs. Routine visits these professionals as well as a home health aide would be scheduled. Ideally, the IDT meets biweekly to discuss the care of a patient in additional to the caregiver’s wellbeing. As with all things, this process is a work in progress with the goal being to maximize the safety and comfort of a patient and his or her loved ones.
One final thought, after electing the hospice benefit you or your loved one may choose at anytime to leave this symptom management path and return to the traditional curative approach. No one will deny you the healthcare you seek, rather these are options to consider.
Should you wish to learn more about hospice and the local agencies available please visit: https://www.medicare.gov/hospicecompare/ You can search by zip code, city, or state. Best wishes as you continue to care for your loved one.
About Aimee
For the past 10 years, Aimee J. Gustitis, BSN, RN, JD, has worked in long-term care, home, hospice and hospital settings empowering patients and their caregivers to navigate the complex world of senior healthcare. Additionally, she collaborates with pediatric special needs clients and their families to provide school-based nursing care. Her practice also includes providing legal nurse consulting services to law firms. She is well-versed in elder care case management, electronic health records documentation and interdisciplinary team participation. She has extensive experience determining hospice eligibility and with end of life comfort kit symptom management. Aimee embraces the hospice philosophy that death need not be fearful and painful, but rather can be a beautiful, dignified experience for both the patient and their loved ones. As a Nourish For Caregivers facilitator she combines these areas of clinical expertise into serving those caring for aging, chronically ill and disabled loved ones. She can be reached at 501 Lawrence Road, Suite C3, Broomall, PA 19008; or at 610-724-8950 or aimeegustitis@outlook. com.