Hospice care comes in when a patient has a terminal diagnosis and is expected to live less than six months. The hospice team will help manage end of life care and comfort. This is undoubtedly a difficult period for everyone involved. Questions and concerns abound.
There are many unknowns with hospice, and end of life care in general.
If you or your loved one is receiving hospice care, you might be wondering what hospice does not tell you. Do the nurses know something they’re not saying? Are there questions they can’t answer?
During my time working in long-term care in nursing facilities and assisted living facilities, I have seen hospice come in to the facility to provide care many times. I also attended numerous hospice trainings during that time. Despite everyone’s wishes when receiving hospice care, there is often a need to accept the unknowns.
Before we get into what hospice medical providers can tell you and what they cannot, it’s important to first understand exactly what hospice is.
What Hospice Is
Hospice is specialized, end of life care from an interdisciplinary team that focuses on managing symptoms and maintaining quality of life right until the individual’s death. That team is comprised of nurses, social workers, volunteers, etc. Care is most often delivered where the person resides, whether that is at home or in a long-term care residence. Comfort is the goal, so the team comes to the person where they live, allowing the individual to stay in a familiar setting. The care is available 24 hours a day and 7 days a week.
The care team uses a collaborative process to focus on the patient’s physical, psychological, and spiritual needs. Hospice care is “person centered,” meaning they develop a care plan that is unique to the individual (and their family) receiving care. So, for example, if the individual receiving care is a devout Catholic, their pastor may be invited in as part of the coordinated care.
Hospice is developed from the philosophy of palliative care. These services improve the quality of life by treating the complete spectrum of symptoms and offering psychological, emotional, and spiritual support throughout the course of the illness rather than treating the condition.
Hospice focuses only on the patient’s comfort rather than offering endless procedures and therapies. The palliative care aspect of therapy may provide a variety of painkillers without directly addressing the underlying cause of the terminal illness.
For instance, if a patient had cancer, they would only be given strong painkillers, not radiation or chemotherapy. In general, patients can avoid making frequent trips to hospital emergency departments.
Hospice care is also provided to the family, natural caregivers, and friends involved in the process. They are connected with support groups and offered bereavement care. Bereavement care is seen as a crucial component of hospice, so it is offered for up to 13 months after the individual has passed. In many ways, hospice care is not just support for the dying person, but for everyone involved.
How Hospice Services Help
Seasoned hospice clinicians bring a unique skill set and in-depth understanding of the dying process to the table. Team members use a holistic, non-medical approach to patient and family communication.
They are concerned with quality-of-life issues that medical professionals may ignore or are ill-equipped to handle. They aid in resolving outstanding medical or personal issues and are knowledgeable of what to expect when the end of life draws near. They are adept at addressing the concomitant concerns and uncertainties that death instills in all of us as well as knowing how to begin the painful dialogues delicately.
In the best-case scenario, hospice medical staff work with families to help patients die peacefully. They demonstrate that it is possible to exit this world without experiencing any pain or suffering and how much solace consciousness may provide to the sufferer and their loved ones. These encouraging outcomes motivate hospice professionals worldwide to complete their vital service.
Who Qualifies for Hospice
A person can qualify for hospice if they have a terminal diagnosis and a doctor’s order indicating they have six or fewer months to live. The order is an indication that medical care is moving from trying to “cure” the patient to accepting their diagnosis is fatal and managing the pain and comfort until the person has passed.
According to Statista, in 2019, roughly 62% of hospice patients were 85 years or older, 52% were between 75 and 84, 41% were 65 to 74, and 29% were under 65.
Medicare Coverage for Hospice
Medicare and most private health insurers cover hospice care. Given the typical patients’ age, Medicare coverage is the biggest reimbursement source for hospice providers. To have Medicare cover hospice the following conditions must be met:
- The doctor certifies that the person is terminally ill and has a life expectancy of 6 months or less).
- The patient accepts that there will no coverage for curative treatments.
- The patient signs a statement that they are choosing hospice care instead of curative care.
Most private insurers align with Medicare’s requirements for hospice coverage, but check with your private insurance company if this applies to you.
Medicare covers all hospice costs. However, if you live in a care facility are admitted to a hospital, those costs will be separate from hospice. You may still have a modest copay for prescriptions.
What Hospice Does Not Tell You
Hospice providers are very honest and open, but hospice cannot tell you when the patient will die. This is not because they don’t want to, it’s because they can’t always determine it. Clearly there are cases where death is imminent, when all of the signs of imminent death are present, and hospice will tell you if that’s the case so that family can gather around and pay final respects and the individual, if desired, can die surrounded by loved ones.
The objective of your hospice team is to assist you in becoming ready for a few situations that might arise just before your loved one passes away. When a patient is terminally sick, death is never predictable.
However, a mix of symptoms and signals lets them know when the moment is near. These warning indicators won’t manifest at once, and some might never do. The body uses all of the symptoms as a means of getting ready for the end of life.
A common hospice misconception is what staff directs and controls. The hospice staff do not impose any unnecessary interventions that the individual (or family) does not wish, nor do they decide how you should use their services. It is not a pervasive advantage.
Hospice care keeps patients comfortable by controlling their pain and other symptoms, such as shortness of breath or agitation. Hospice does not hasten death or aid in patients’ passing. In reality, when patients decide to undergo hospice care, doctors occasionally discover that they survive longer than anticipated. Making sure the patient is free of the signs of their terminal disease is the goal of hospice care.
Hospice is a benefit, just like other health insurance benefits, but sadly, not everyone is aware of this, and many providers do not make referrals to hospice when they should. This is unfortunate as it can rob the dying individual of a more peaceful, comfortable departure. Of course, fear and denial of death is real, and some people see hospice as giving up hope, and refuse services on those grounds.
Anybody who meets the criteria can use the hospice benefit, not just those with premium insurance policies. Even those without insurance are eligible for hospice care from any organization that is not-for-profit or financed by the government, including Medicare, Medicaid, and practically every HMO.
How Long Does the Average Hospice Patient Live?
The patient’s diagnosis will determine the length of time they require hospice care. Most hospice patients wait to sign up until they are nearly terminal since they don’t think they will live more than six months. However, six months is the longest period of eligibility.
Many patients, nevertheless, survive through this point, at which time they could be qualified for extra hospice care or might be allowed to leave the hospital. The average length of time spent in hospice is now 78 days, up from 74 days in 2018, per a report by Trella Health. This is considered excellent news for patients because many individuals only spend a short time in hospice.
Only 12% to 15% of patients may reasonably expect to survive for more than six months, and nearly half pass away within three weeks. While individuals assigned to hospice care right away after a lengthy hospital stay had a death rate of ~95% during the first six months of their care process, patients under the age of 65 had a higher chance of living longer.
Men are more likely than women to pass away within six months, with an 88.4% vs. an 85.1% mortality rate. The cause of a patient’s admission to hospice is also important; patients with dementia or a stroke had a lower overall death rate in hospice than those with other illnesses.
Hospice Team and Caregivers
Family members (and others) are often abruptly thrown into the position of caretaker when someone is dying, frequently without any planning or awareness of what to anticipate. Hospice staff members assist the caregiver by educating them and responding to their inquiries. They can help comfort a widower, widow, or any loved one dealing with the grief.
Additionally, caregivers receive helpful suggestions, counsel, and methods to lessen the heavy load of providing care. Many caregivers claim that merely knowing they were never alone and could call hospice at any moment with a question, concern, or aid significantly reduced their anxiety.
Terminal Illness: A Hospice is Not Only for People With Terminal Cancer
Hospice patients are mostly affected by non-cancer conditions. Hospice patients diagnosed with terminally ill cancer as the main diagnosis make only a few percent. Congestive heart failure, dementia, lung cancer and stroke or coma are common non-cancer conditions in hospices. As caretakers in hospices, they are excellent at managing a patient with a disease. By definition though, hospice patients are terminally ill patients.
Hospice Doesn’t Immediately Give Patients Medications Like Morphine
Hospice providers don’t immediately prescribe patients morphine. Pain management has multiple facets that aim to alleviate a patient’s pain. Team members can even use psychological therapy to help with discomfort, including meditation or relaxation. Only when the hospice staff have exhausted all options can patients be prescribed morphine.
Top 3 Things Hospice Might Not Tell You
- Hospice may not tell you how much time they will or will not spend with the patient. Each provider and situation is different, so you must investigate and understand the daily care plan. Kaiser Health News inspected 20,000 hospice care facilities in the US during 2016. During their study, researchers have concluded that people who die at home suffer from neglect. In 2012 it was reported that more than 750 government departments were found guilty of failing in inspection procedures.
- Hospice does not tell you their complete scope of services. In some cases, senior massage and other options may be available.
- Hospice care can’t tell a patient when they will die. Hospice can help determine the length of time patients have for life, but the exact prognostic value is difficult. A professional hospice care provider specializes in the treatment of the dying patient. Hospice personnel can provide valuable emotional help for patients and their caregivers at both the beginning and the end of their hospice care.
Is Hospice a place or a type of care?
Hospice is not a physical location, it is a description of the type of care meant to keep a terminal patient as comfortable as possible.
How old do you have to be to enter Hospice care?
There isn’t an age requirement, but always check with your insurance carrier. What is needed is a Doctor’s recommendation for hospice treatment indicating that the patient has a terminal illness with less than 6 months left to live.
How much does hospice care cost?
Medicare covers the cost of hospice services, and most private health insurance plans follow medicare’s guidelines. But, this isn’t always the case, so you must investigate your insurance plan’s covered services. Also, other care or treatments, such as prescription co-pays and being admitted back into the hospital, would not be covered or covered separately.
Do hospice services end after 6 months?
No, the 6 month mark does not automatically mean you will no longer be eligible to receive hospice services. The 6 months are actually two 90 day benefit periods, and you are still eligible for hospice care for an uncapped number of 60 day extension periods if your doctor or hospice care provider certifies that there is still a terminal illness.
Does hospice force people to stop eating and drinking?
Hospice does not make you stop eating and drinking. Your hospice care team will consult you on what is best for the patient to help them with pain relief. While hospice care was meant to comfort a dying patient, some patients were forced to eat or drink. Sometimes hospice care is misunderstood as a term used by many to describe withdrawing food or water from an individual’s diet. Although certain conditions may restrict our ability to eat food, hospice programs seek to provide food as a matter of convenience so the patient can enjoy the benefits of a soft foodstuff or liquid.
Can you leave hospice care?
Yes, you can leave hospice care, it is not a final decision. You always have the right to leave hospice care at any time.
Do I have to give up my primary care doctor in order to receive hospice care?
Thankfully, you do not. Your primary care doctor should be a core part of the hospice team, working alongside other caregivers to provide the best care possible. The goal of hospice is to no longer treat your illness, but to make your last days as pain free as possible.
Life is difficult. Death is even more so. If you need additional resources, consider a support group for emotional support or even grief counseling. The following books may also offer some comfort, along with more information on hospice care and hospice organizations.
- Duncan, Katie (Author)
- English (Publication Language)
- Butler, Katy (Author)
- English (Publication Language)
- Jimenez, Gabrielle Elise (Author)
- English (Publication Language)
Do you have experience with hospice? What, if anything, did hospice not tell you? How was your experience? Please share in the comments section.