Finding support
Hospice care can offer comfort at the end of life
It was announced Feb. 18 that former President Jimmy Carter has entered hospice care. But what is hospice care, and how it can provide comfort and support? In fact, the goal of hospice is to provide comfort during the final months and days of life.
Services are provided by a team of health care professionals who maximize comfort for a person by reducing pain, and addressing physical, psychological, social and spiritual needs. To help families, hospice care also provides counseling, respite care and practical support.
Unlike other medical care, the focus of hospice care is not a cure; the goal is to support the highest quality of life possible for whatever time remains. Who can benefit from hospice care? Hospice care is for a terminally ill person expected to have six months or less to live. But such care can also be provided for as long as the person’s doctor and hospice care team certify that the condition remains lifelimiting.
Many people who receive hospice care have cancer, while some have other serious or advanced medical conditions, such as heart disease, dementia, kidney failure or chronic obstructive pulmonary disease.
Enrolling in hospice care early can help you live better. Hospice care decreases the burden on family, decreases the family’s likelihood of having a complicated grief ,and prepares family members for their loved one’s death. Hospice also allows a patient to be cared for at a facility for a period of time, not because the patient needs it, but because the family caregiver needs a break. This is known as respite care. Where is hospice care provided? Most hospice care is provided at home — with a family member typically serving as the primary caregiver. However, hospice care is also available at hospitals, nursing homes, assisted-living facilities and dedicated hospice facilities.
Who is involved in hospice care? If you’re not receiving hospice care at a dedicated facility, hospice staff will make regular visits to your home or other setting. Hospice staff are on call 24 hours a day, seven days a week.
A hospice care team typically includes:
DOCTORS: A primary care doctor and a hospice doctor or medical director will oversee care. Patients can choose to have their prior primary care doctor or a hospice doctor as their main physician.
NURSES: Nurses will come to your or your relative’s home, or other setting to provide care. They are also responsible for coordination of the hospice care team.
HOME HEALTH AIDES: Home health aides can provide extra support for such routine care as dressing, bathing and eating.
SPIRITUAL COUNSELORS: Chaplains, priests, lay ministers or other counselors can provide spiritual care and guidance for the entire family.
SOCIAL WORKERS: Social workers provide counseling and support, and can also provide referrals to other support systems.
PHARMACISTS: Pharmacists oversee medications and may suggest the most effective ways to relieve symptoms.
VOLUNTEERS: Trained volunteers offer a variety of services, including providing company or respite for caregivers, and helping with transportation or other practical needs.
OTHER PROFESSIONALS: Speech, physical and occupational therapists can provide therapy as needed.
BEREAVEMENT COUNSELORS: Trained counselors offer support and guidance after the death of a loved one in hospice.
How is hospice care financed?
Medicare, Medicaid, the Department of Veterans Affairs and private insurance typically pay for hospice care. While each hospice program has its own policy regarding payment for care, services are often offered based on need rather than the ability to pay. Ask about payment options before choosing a hospice program.
How do I select a hospice program?
To find out about hospice programs, talk to doctors, nurses, social workers or counselors, or contact your local or state office on aging. Consider asking friends or neighbors for advice. The National Hospice and Palliative Care Organization also offers an online provider directory.
To evaluate a hospice program, consider asking:
Is the hospice program Medicarecertified? Is it reviewed and licensed by the state, or certified in some other way? Or is it accredited by The Joint Commission?
■ Who makes up the hospice care team and how are they trained or screened? Is the hospice medical director board certified in hospice and palliative care medicine?
■ Is the hospice program not-forprofit or for-profit?
■ Does the hospice program have a dedicated pharmacist to help adjust medications?
■ Is residential hospice available? What services are offered to a terminally ill person? How are pain and other symptoms managed?
■ How are after-hours hospice care services provided?
■ How long does it take to be accepted into a hospice care program?
■ What services are offered to the family? What respite services are available for the' caregiver(s)? What bereavement services are available?
■ Are volunteer services available?
■ If circumstances change, can services be provided in different settings? Does the hospice have contracts with local nursing homes?
■ Are hospice costs covered by insurance or other sources, such as Medicare?