For patients that have a life-limiting illness, hospice care is the best level of care. Hospice focuses on caring, not curing, and in most cases, care is provided in the patient’s home. Hospice care can also be provided in Board & Care Homes, Nursing Facilities, Assisted Living Facilities, and other Long-Term Care Facilities. The main objective of hospice care is to provide the quality of life and dignity for a patient who has a life-limiting illness.

Typically, a family member serves as the primary caregiver and, when appropriate, helps make decisions for the terminally ill individual. The hospice staff members make regular visits to assess the patient and provide additional care or other services. The hospice team develops a care plan that meets each patient’s pain management and symptom control needs. Support for family caregivers is also assessed throughout the care period. While the range of services provided will vary depending on each situation and the specific needs, hospice staff are available by phone 24 hours a day, 7 days a week.

The Medicare hospice benefit covers most people receiving hospice care. This benefit covers virtually all aspects of hospice care with little or no out-of-pocket expense to the patient or family. As a result, the financial burdens usually associated with caring for a terminally ill patient are virtually non-existent. In addition, most private health plans and Medicaid in most states cover hospice services.

Medical equipment and medications needed for the patient’s care are normally covered by hospice, except those that are listed in Medicare’s guidelines for non-covered items. In cases where families opt to continue with some medications not recommended by hospice, the hospice team has discussed and assessed to determine how it will affect the overall outcome of hospice care.

The interdisciplinary team usually consists of:

• The patient’s personal physician
• Hospice physician (or medical director)
• Nurses
• Home Health Aides
• Social Workers
• Spiritual Care Providers or Other Counselors
• Bereavement Professionals
• Speech, Physical, and/or other occupational therapists

No, hospice does not help terminally ill individuals speed up the dying process. In fact, some studies even suggest that hospice care may even extend life. A 2007 report by the National Hospice and Palliative Care Organization (NHPCO) found that patients with certain terminal diseases who chose hospice lived an average of 29 days longer than similar patients who did not receive hospice. Some factors that contribute to this longer survival rate, according to the NHPCO Researchers, are the following:

• Patients are more likely to receive additional monitoring and treatments only available through hospice.
• The patient’s desire to live is enhanced due to the constant attention given by hospice providers to their emotional well-being and physical health (like managing and treating pain).
• Over-treatment is more likely avoided, which poses a huge risk in an individual’s mortality.

The primary goal of hospice is maintaining the dignity and quality of life of the patient. This means that hospice providers have to ensure that every day is a good day for the patient.

No, discontinuing the use of medications that patients regularly take does not hasten death, in general. The goal of hospice care is to maintain the dignity and quality of life of the patient. This includes the evaluation of the patient’s current medication. Any medication taken before hospice care that does not contribute to the patient’s well-being will be discontinued. We don’t want to overwhelm the body’s functions by having all those unnecessary medications. However, every individual has their own uniqueness. Therefore, if the hospice team finds that some medication can still be beneficial to the patient, then those medications can still be continued.

No, morphine does not hasten death if administered properly under the direction of a hospice physician and the support of the hospice team, including family members of the patient. One must understand that when people are nearing their last stage of life, some may experience extreme pain, anxiety, agitation, dyspnea (difficulty breathing), etc., and morphine can effectively alleviate all of these distressing symptoms and provide what most people would want at this stage, which is comfort and quality of life.

No, it is false. An eligible hospice patient has an unlimited number of days to stay on hospice, provided that the patient still meets the eligibility criteria set by Medicare for hospice care. Most likely, this myth became prevalent in the industry due to the numerous times it occurred. Considering the number of occurrences, this myth somehow evolved and became a standard or a truth. While it is true that this is happening in the hospice industry, it doesn’t mean that that is how Medicare’s hospice program works. That is why it is essential to choose the right hospice agency to provide your loved ones the hospice care they need.

No. This kind of behavior is unacceptable. First, there is what we call “Patient’s Rights”. If the PCP doesn’t want to order a Hospice Evaluation order for your mom unless it is the MD’s preferred hospice agency, the MD violated Title 42 CFR Part 418.52, and the MDs behavior is an action reportable to Medicare and a Condition of Participation violation for the hospice agency the MD prefers.

One of the fundamental rights of a Patient is the right to choose which hospice agency he/she will enroll with no matter what the MD tells you. What the MD did (assuming this case scenario is accurate) could be called blackmail, coercion, intimidation etc. That’s why one good indicator in choosing a good hospice agency is to listen between the words spoken. If there is a “push” and/or “condition” before anything else??? Like in your case, run away from these people. Always remember, an MD, case manager, discharge managers, etc., can only recommend. The general rule is these people is to at least give you 3 choices (options).

To be fair on the other end of the spectrum, there are some MDs that “recommends” a hospice agency because of the trust and confidence that the agency earned while serving the MD’s patient in the past. Because of the MD’s past experiences, he would go for people he/she knows that delivers the best result for his/her patient. This is called professional “trust and confidence”.

For St. Liz Hospice, the professional relationship that we’ve developed over years of hard work is the principle that would really enhance patient care. In fact, this scenario is the best because if we fail to meet the MD’s standards of care, then there might not be a “next referral” for us.

If you’re in a situation like this, do give us a call and we’ll be glad to guide and help you through the complexities of hospice admission criteria, insurance, placements, etc.