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VNA Hospice

Commonly Asked Questions About Hospice
  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.


  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.