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VNA Hospice
Commonly Asked Questions About Hospice
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When should a decision about entering a hospice program be made?
At any time during a life-limiting illness, it is appropriate to discuss all of
a patient's care options, including hospice.
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Should I wait for our physician to raise the possibility of hospice, or should I
raise it first?
The patient and family should feel free to discuss hospice care at any time
with their physician, other care professionals, clergy or friends. Click here
to read about Michigan's
Dignified Death Act.
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What if our physician doesn't know about hospice?
Most physicians know about hospice. If your physician wants more information,
VNA Hospice can meet with him or her. Information is also available from the
American Academy of Hospice and Palliative Medicine, medical societies, state
hospice organizations, local hospices, or the National Hospice Helpline at
1-800-658-8898. In addition, physicians and all others can also obtain
information on hospice from the American Cancer Society, the American
Association of Retired Persons and the Social Security Administration.
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Can a hospice patient who shows signs of recovery be returned to regular medical
treatment?
Certainly. If improvement in the condition occurs and the disease seems to be
in remission, the patient can be discharged from hospice and return to
aggressive therapy or go on about his or her daily life. If a discharged
patient should later need to return to hospice care, Medicare and most private
insurance will allow additional coverage for this purpose.
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What does the hospice admission process involve?
One of the first things hospice will do is contact the patient's physician to
make sure he or she agrees that hospice care is appropriate for this patient at
this time. (Hospices have access to be able to refer physicians for patients
who have no physician.) The patient will also be asked to sign consent and
insurance forms. These are similar to forms patients sign when they enter a
hospital. The "hospice election form" says that the patient understands that
the care is palliative (that is, aimed at pain relief and symptom control)
rather than curative. It also outlines the services available. The form
Medicare patients sign also tells how electing the Medicare hospice benefit
affects other Medicare coverage for a terminal illness.
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Is there any special equipment or changes I have to make in my home before
hospice care begins?
Your hospice provider will assess your needs, recommend any necessary
equipment, and help make arrangements to obtain it. Often the need for
equipment is minimal at first and increases as the disease progresses. In
general, hospice will assist in any way it can to make home care as convenient,
clean and safe as possible.
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Must someone be with the patient at all times?
In the early weeks of care, it's usually not necessary for someone to be with
the patient all the time. Later, however, since one of the most common fears of
patients is the fear of dying alone, hospice generally recommends someone be
there continuously. While family and friends must be relied on to give most of
the care, hospices do provide volunteers to assist with errands and to provide
a break and time away for major caregivers.
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What specific assistance does hospice provide home-based patients?
Hospice patients are cared for by a team of doctors, nurses, social workers,
counselors, home health aides, clergy, therapists, and volunteers-and each
provides assistance based on his or her area of expertise. In addition,
hospices help provide medications, supplies, equipment, hospital services, and
additional helpers in the home, as appropriate.
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Does hospice do anything to make death come sooner?
Hospices do nothing either to speed up or to slow down the dying process. Just
as doctors and midwives lend support and expertise during the time of child
birth, so hospice provides its presence and specialized knowledge during the
dying process.
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Is the home the only place hospice care can be delivered?
No. Although most hospice services are delivered in a personal residence, some
patients live in nursing homes or hospice centers.
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How does hospice "manage pain"?
Hospice nurses and doctors are up-to-date on the latest medications
and devices for pain and symptom relief. In addition, physical
and occupational therapists along with a dietitian may help
with assessing patients' needs. Hospice believes that emotional
and spiritual pains are just as real and in need of attention
as physical pain, so it addresses these, as well. Counselors,
including clergy, are available to assist family members as
well as patients.
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What is hospice's success rate in battling pain?
Very high. Using a combination of medications, counseling and therapies,
most patients can attain a level of comfort that is acceptable to them.
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Will medications prevent the patient from being able to talk or know what's
happening?
Usually not. It is the goal of hospice to help patients be as comfortable and
alert as they desire. By constantly consulting with the patient, hospices have
been very successful in reaching this goal.
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Is hospice affiliated with any religious organization?
Hospice care is not an off-shoot of any religion. While some religious
organizations have started hospices (sometimes in connection with their
hospitals), these hospices serve a broad community and do not require patients
to adhere to any particular set of beliefs.
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Is hospice care covered by insurance?
Hospice coverage is widely available. It is provided by Medicare nationwide, by
Medicaid in at least 38 states and by most private health insurance policies.
To be sure of coverage, families should, of course, check with their employer
or health insurance provider.
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If the patient is not covered by Medicare or any other health insurance, will
hospice still provide care?
The first thing hospice will do is assist families in finding out whether or
not the patient is eligible for any coverage they may not be aware of. Barring
this, most hospices will provide care for those who cannot pay, using money
raised from the community or from memorial or foundation gifts.
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Does hospice provide any help to the family after the patient dies?
Hospice provides continuing contact and support for family and friends for at
least a year following the death of a loved one. Most hospices also sponsor
bereavement and support groups for anyone in the community who has experienced
the death of a family member, a friend, or a loved one.
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If the patient is eligible for Medicare, will there be any additional expenses
to be paid?
Medicare covers all services and supplies related to the terminal illness for
the hospice patient. In some hospices, the patient may be required to pay a 5%
or $5 "co-payment" on medication and a 5% co-payment for respite care. You
should find out about any co-payment when choosing a hospice.
5 Points to Consider When Initiating Discussions
about End-of-Life Care
Choose the Setting
Find a quiet, comfortable place free from distraction to hold a
one-on-one discussion. A loved one usually wants to share his or
her wishes in a private setting. And plan for the conversation --
this is not a discussion to have on the spur of the moment.
Ask Permission
People cope with end-of-life issues in many ways. Asking permission
to discuss this topic assures your loved one that you will respect
his or her wishes and honor them. (Some ways of doing this could
be: "I'd like to talk about how you would like to be cared for if
you got really sick. Is that OK?" or "If you ever got really sick
I would be afraid of not knowing the kind of care you would like.
Could we talk about this now? I'd feel better if we did.")
Talk about It
You have initiated this conversation because you love this person.
Focus on your desire to help him or her maintain a full and happy
life, even during difficult times. Use a warm and caring manner.
Allow your loved one to set the pace, and use nonverbal communication
to offer support. (Some ways of doing this could be by nodding your
head in agreement, holding your loved one's hand, or reaching out
to offer a hug or comforting touch.)
Be a Listener
This is not a debate. Sometimes just having someone to talk to is
a big help. Be sure to hear what the person is saying. Listen for
the wants or needs that your loved one expresses. Show empathy and
respect by addressing these wants and needs in a truthful and open
way.
Do Your Homework
Before initiating the discussion, learn more about the kinds of
end-of-life care options available in your community. Become familiar
with what these options offer -- especially so that you can determine
if these options will meet your loved one's end-of-life needs.
Doing your homework helps ensure that you will know whom to contact
to meet your loved one's wishes.
Questions to ask your loved one about his or
her end-of-life care
One of best ways to plan for end of life care is to disucss your loved one's goals and wishes. A document called "Five Wishes" is an excellent tool to help guide your discussion. It is also considered a legal document. To order a copy, visit www.agingwithdignity.org.
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