Hospice is a philosophy of care. It treats the person rather than the
disease and focuses on quality of life. It surrounds the patient and family
with a team consisting of professionals who not only address physical distress,
but emotional and spiritual issues as well. Hospice care is patient-centered
because the needs of the patient and family drive the activities of the hospice
team.
Roles and responsibilities of a hospice team:
Physician. The physician is responsible for identifying the patient’s
need for hospice and making the referral for hospice services. They are
encouraged to remain involved as a member of the patient care team, and to
actively participate in the hospice plan of care.
Hospice Medical Director. The hospice medical director provides an
oversight of patient care and support to the hospice team. The hospice medical
director attends a team conference to discuss the plan of care by assisting in
establishing goals, and participating in decisions regarding patient care.
Registered Nurse Case Manager. The registered nurse case manager
coordinates the plan of care with the physician and hospice medical director
through initial and ongoing nursing assessments. The nurse visits the patient
two or three times a week, or as needed, to ensure all distressing symptoms are
effectively managed and that patient and family needs are being met. The RN
supervises all care provided by the licensed practical nurse and home health
aide, and coordinates care with the other members of the hospice team to ensure
patient and family spiritual and psychosocial needs are met.
Social Worker. The hospice social worker provides initial and ongoing
psychosocial assessments of the patient and establishes a psychosocial plan of
care. The social worker normally sees the patient once or twice a month to
provide emotional support and ensure patient and family psychosocial needs are
being met. The patient/family or any member of the hospice team can request
additional psychosocial visits as needed. The social worker can provide
assistance to the patient and family such as helping the patient with a Do Not
Resuscitate (DNR) order, assisting with finding community resources, and making
arrangements for nursing home placement or transfer to inpatient care facility.
The hospice social worker can also provide counseling to the patient or family
in times of crisis.
Chaplain. The hospice chaplain provides spiritual support to the
patient and family as needed. The chaplain visits once or twice per month or
more often if requested. The care provided by the hospice chaplain can address
religious issues, however the focus of care is more spiritual, in nature, than
religious. Care by the hospice chaplain is non-denominational.
Bereavement Counselor. The bereavement counselor not only supports and
guides the family through the bereavement period after the loss of a loved one,
but can also help the patient deal with the grief associated with declining
health. The bereavement counselor can provide bereavement services to the
family up to a year, or longer, after a loved passes.
Home Health Aide. The home health aide assists the patient and family
with personal care needs and light housekeeping. They also teach family members
the correct and safe method for providing personal care to the patient. The
home health aide supplements the care provided by the nurse case manager.
Hospice Volunteer. The hospice volunteer provides companionship and
support to the patient and family. All hospice volunteers are required to attend
volunteer training at the hospice. The volunteers frequently perform needed
errands and light housekeeping for the patient and family.
Hospice Myths and FAQ's:
There are many questions, and myths, about hospice. Below are answers
to some the most common questions asked. They will give you get a better
understanding of what hospice is and how it can benefit patients and their
families.
What is hospice care?
Hospice is a philosophy of care. It treats the person rather than the
disease and focuses on quality of life. It surrounds the patient and family
with a team consisting of professionals who not only address physical distress,
but emotional and spiritual issues as well. Hospice care is patient-centered
because the needs of the patient and family drive the activities of the hospice
team.
Is hospice only for people who are dying?
Hospice is for people who have a limited life expectancy. (Actually, we
all have a limited life expectancy, so it is more specific than that.) Hospice
is for patients whose condition is such that a doctor would not be surprised if
the patient died within the next six months. This doesn't mean the patient is
going to die in the next six months--it simply means that he or she has a
condition that makes dying a realistic possibility.
Who is best suited for hospice care?
Hospice patients are those with very serious medical conditions.
Usually they have diseases that are life threatening and make day-to-day living
very uncomfortable—physically, emotionally, or spiritually. Some are in pain.
Others experience difficult symptoms such as nausea, extreme fatigue, and
shortness of breath. These symptoms may be caused by the disease, or they may
have been caused by treatments intended to cure the disease. Often patients
turn to hospice because they are anxious or depressed, or they are feeling
spiritually distressed because of their medical condition. Hospice specializes
in easing pain, discomfort, and distress on all levels. The care provided by
hospice is often helpful for conditions such as cancer, heart disease, COPD
(emphysema), advanced dementia, or a general weakness and "failure to
thrive." Seriously ill patients who have decided that their priority is to
have the best quality of life possible are the people who are best suited for
hospice.
Isn't using hospice the same as "giving up"?
Not at all! Although your loved one's condition may have reached a
point that a cure is not likely—or not likely enough to be worth the side
effects of treatment—that does not mean there is nothing left to do. In fact,
an emphasis on quality of life and easing pain and distress often allows the
patient to spend his or her last months focusing on the things that are
ultimately the most important and meaningful. As one man put it, "I'd
rather spend my time with my children and grandchildren than waste my limited
time and energy driving to the treatment center and recovering beside the
toilet bowl." With the expert guidance of a nurse and case manager, as
well as the assistance of bath aides, social workers, and chaplains, patients
and families find they can focus on their relationships, healing old wounds and
building wonderful memories together. Far from giving up, hospice helps
families truly live well and support each other during a stressful, but, in the
end, very natural family life passage.
Should we wait for the doctor to suggest hospice?
You can, but oddly enough, doctors often wait for families to bring it
up. This is part of the reason that people often receive hospice care so late
in the process. If you think your loved one and family might benefit from the
support of weekly home visits from staff who specialize in pain control and the
easing of distress, ask your doctor if hospice might be something to consider
now, or in the near future. If, when you are truly honest with yourself, you
realize that you would not be surprised if your loved one were to die in the
next six to twelve months, ask the doctor if he or she would be surprised. If
the answer is anything close to "No, I would not be surprised," then
maybe it's a good time to begin a discussion about hospice. If you would like
more information, please feel free to call us toll-free 1-888-603-MORE (6673).
We would be happy to talk with you or to do an informational home visit—no obligation
or strings attached.
When is the best time to start hospice care?
Most patients and families who receive hospice care say they wish they
had known about it earlier, that they needed the help much sooner than they
received it. Research has shown that hospice can increase both the quality of
life and how long a patient lives. Families who receive hospice near the very
end--just a few days to a week--have been shown to have a harder time adjusting
during the bereavement period than do those whose loved one receives hospice
care for weeks and months before passing on. If you even think that your family
and the person you care for could benefit from pain or symptom management,
assistance with bathing and grooming, emotional and spiritual support, and
telephone access to caregiving advice, ask your physician if hospice might be a
service to consider. Experts agree that at least two to three months of care is
optimal. It is better to ask sooner rather than later so you do not regret
having missed the support that hospice has to offer.
Who pays for hospice?
If the patient has Medicare and meets hospice eligibility requirements,
then the government will pay as much as 100% of the cost. In such a case, there
is no deductible and no copayment. Not only are the services of the hospice
staff entirely covered, but medical supplies and prescriptions relating to pain
and comfort management are also covered. Individuals who do not have Medicare
coverage but have coverage from private insurance should talk with their insurance
company to find out about eligibility and what deductibles and copayments may
apply. Medicaid provides coverage, but it varies by state.
Once you begin hospice care, you cannot leave the program?
A person may sign out of the hospice program for a variety of reasons,
such as resuming aggressive curative treatment or pursuing experimental
measures. Or, if a patient shows signs of recovery and no longer meets the 6
moth guideline, he or she can be discharged from hospice care and return to the
program when the illness has progressed at a later time.
Is hospice a place?
Hospice is not just a place – it’s a service. Hospice brings physical,
emotional, and spiritual care and support to wherever our patients call home.
Does hospice only care for cancer patients?
Hospice is not just for cancer patients. Crossroads Hospice cares for
patients with any life-limiting illness. Among the illnesses our patients have
had are cardiac and respiratory diseases, renal disease, and neurological
illness including Alzheimer’s disease, Lou Gehrig’s disease, AIDS, Cirrhosis,
and others.
Is hospice only for housebound or bed-ridden people?
Hospice is not only for those who are housebound or bedridden; most are
living their day-to-day lives. Care is given where ever the patient
lives; in their home, long-term care facilities, assisted living or retirement
communities, rest homes and hospitals.
Hospice over-medicates so they become addicted or sleep all the time.
When patients have a legitimate need for pain medication, they do not
become addicted to it. Crossroads Hospice has the expertise to manage pain so
that patients are comfortable yet alert and are able to enjoy each day to the
fullest extent possible, given their medical condition.
Heather Ligus
Provider Relations
Crossroads Hospice
216-654-9300
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