Family - Hospice Care

What is Hospice?
Hospice programs make it possible for terminally ill patients to spend the final stages of their lives at home or in home-like settings with an emphasis on palliative and supportive care that will enable them and their families to cope with this difficult transition. Hospice is a comprehensive, medically-directed, team-oriented program of care that seeks to treat and comfort terminally ill patients and their families, establishing pain management and symptom control as clinical goals, and understanding that psychological and spiritual pain are as significant as physical pain. 
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Hospice is a philosophy of care that accepts death as a natural part of life, seeking neither to hasten nor to prolong the dying process. Hospice is caring that strives to help patients truly "live until they die." The philosophy of hospice care is central to the delivery and effectiveness of its services. The basic elements of hospice care include:

• Care of the patient and family as one unit
• Pain and symptom management
• 24-hour staff availability
• Medical and nursing care
• Social work services
• Counseling, including bereavement counseling for up to one year after the patient's death
• Coordination of medications, medical supplies and durable medical equipment
• Physical, occupational and speech therapy
• Specially trained hospice volunteer support
  
  

Hospice care is most often provided at home. However, patients who have accepted hospice care can continue to receive that same approach to care should an inpatient stay become necessary. Inpatient general care is available when symptoms can't be managed in the home. Inpatient respite care is available on a limited basis to provide short-term relief for the caregiver. Private pay or Medicaid room and board nursing home patients are also eligible for hospice care if the facility has made arrangements with a local hospice provider. With increasing pressure to reduce hospital stays, the dependence on hospice programs will grow. In fact, through hospice support at home, many patients with end-stage illnesses can avoid costly emergency room visits and inpatient admissions.

Many people, even those who may have been a little reluctant to seek hospice services, are surprised by the full spectrum of physical, emotional, social and spiritual support hospice provides. Most families say "we don't know how we would have coped without the help of hospice."

Each hospice patient and family has special needs, therefore each patient/family care program is unique. Hospice is responsible for the coordination of all aspects of the terminal care. Services are provided by an interdisciplinary team of professionals and volunteers. The composition of the hospice team depends on the patient's and family's needs. The team can include: 

• Patient
• Patient's family
• Patient's attending (primary) physician who is responsible for the medical care plan (See Medicare Hospice Benefit Billing Information)
• Hospice medical director who serves as a consultant or, if patient selects, may be the attending physician
• Nurses who direct care and comfort
• Home health aides/homemakers for personal care and light housekeeping
• Physical, occupational or speech therapists as needed
• Social workers for counseling and coordination
• Hospice volunteers specially trained to provide support, companionship and to be a special friend to the patient and family
• Hospice volunteer coordinator
• Pastoral/spiritual care counselor who provides direct counseling when patient/family do not have access to their own spiritual resource. Serves as a consultant to the hospice team and to area clergy who provide direct service
• Bereavement coordinator/counselor who offers grief counseling for the patient and survivors (available for up to one year after patient's death for family)
• Nutritional counselor, as needed
  
  

Early intervention by the hospice team promotes the most integrated and effective array of services for patients and families. Hospice services are not solely for the final days of a patient's life. Hospice care is most effective when there are several weeks, if not months, of interaction to establish trust between the patient/family and the hospice team as well as to create the infrastructure of support for the patient and family at home.

The majority of hospice patients probably receive care under the Medicare Hospice Benefit which has specific eligibility criteria. (See also Medicare coverage.) Indiana Medicaid recipients may also receive hospice care under the Medicaid Hospice Benefit. Most private insurers and managed care programs offer a hospice benefit but the aspects and criteria for eligibility for it vary from program to program. If you have a patient you think would benefit from a hospice program, contact your local hospice agency.