When facing a life-limiting illness, it’s appropriate to discuss all of a patient’s care options, including hospice. By law the decision belongs to the patient. Most hospices accept patients who have a life-expectancy of six months or less and who are referred by their personal physician if the disease process follows its normal course.
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 health care professionals, clergy or friends.
Is all hospice care the same?
No, many communities have more than one hospice. Medicare requires certified hospices provide a basic level of care but the quantity and quality of all services can vary significantly from one hospice to another. To find the best hospice for your needs, ask your doctor, healthcare professionals, clergy, social workers or friends who have received care for a family member.
Can a hospice patient who shows signs of recovery be returned to regular medical treatment?
Yes, if the patient’s condition improves and the disease seems to be in remission, patients can be discharged from hospice and return to aggressive therapy or go on about their daily lives. If a discharged patient should later need to return to hospice care, Medicare and most private insurance will allow additional coverage for this purpose.
What does our hospice admission process involve?
One of the first things we will do is contact the physician to make sure he or she agrees that hospice is the right choice for this patient at this time. (We also have medical staff available to help patients who have no physician.) The patient will be asked to sign consent and insurance forms. These are similar to the forms patients sign when they enter a hospital. The form Medicare patients sign also tells how electing the Medicare hospice benefit affects other medicare coverage.
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 equipment, and help make arrangements to obtain anything necessary. Often the need for equipment is minimal at first and increases as the acute needs progress. In general, we assist in any way we can to make care as convenient, clean and safe as possible.
How many family members or friends does it take to care for a patient at home?
There is no set number. One of the first things our team will do is to prepare an individualized care plan that will, among other things, address the amount of care giving needed by the patient. Our staff visits regularly and is always accessible 24 hours a day/7 days a week.
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, we generally recommend someone be there much more often. While family and friends do deliver most of the care, we may have volunteers to assist with errands and to provide a break and time away for primary caregivers.
Does hospice do anything to make death come sooner?
No, we neither hasten nor postpone dying. Just as doctors and midwives lend support and expertise during the time of child birth, hospice provides its presence and specialized knowledge during the dying process.
Is a private home the only place end-of-life care can be delivered?
No, our hospice patients receive care in their personal residences, nursing homes, assisted living facilities, hospitals, hospice units and inpatient hospice centers.
How do we “manage pain”?
We believe that emotional and spiritual pain is just as real as physical pain, so attention is given to each. Our nurses and doctors are up to date on the latest medications and devices for pain and symptom relief. In addition, therapists can assist patients to be as mobile and self sufficient as they wish. Finally, various counselors, including clergy, are available to assist family members as well as patients.
What is Halifax Health – Hospice’s success rate in battling pain?
The success rate is very high. Using some combination of medications, counseling and therapies, most patients can attain a level of comfort that is acceptable to them.
Will medications prevent the patient from being able to talk or know what’s happening?
It is the goal of hospice to have the patient as pain free and alert as possible. By constantly consulting with the patient, hospices have been very successful in reaching this goal.
Is hospice affiliated with any religious organization?
No, we respect all spiritual and cultural wishes of our patients and families.
Is hospice care covered by insurance?
Hospice coverage is widely available. It is provided by Medicare nationwide, by Medicaid in Florida and by most private insurance providers.
If the patient is eligible for Medicare, will there be any additional expense to be paid?
The Medicare Hospice Benefit covers the full scope of medical and support services for a life-limiting illness. Our care also supports the person’s family and loved ones through a variety of services. This benefit covers almost all aspects of end-of-life care with little expense to the patient or family.
Does Halifax Health – Hospice provide any help to the family after the patient dies?
We provide continuing contact and support for caregivers for at least a year following the death of a loved one. Halifax Health – Hospice also sponsors bereavement groups and support for anyone in the community who has experienced the death of a family member, a friend, or a similar loss.
When is the right time to ask about hospice?
Now is the best time to learn more about hospice and ask questions about what to expect from hospice services. Although end-of-life care may be difficult to discuss, it is best for family members to share their wishes long before it becomes a concern. This can greatly reduce stress when hospice is needed. By having these discussions in advance, patients are not forced into uncomfortable situations. Instead, patients can make educated decisions that include the advice and input of family members and loved ones.
How does hospice care begin?
Typically, hospice care starts as soon as a formal request or a ‘referral’ is made by the patient’s doctor. A hospice program representative will visit the patient within 24 hours of that referral, providing the visit meets the needs and schedule of the patient and family/primary caregiver. Our care is ready to begin as soon as possible.
Will I be the only hospice patient that the hospice staff serves?
All of our patients have access to a hospice volunteer, registered nurse, social worker, hospice aide and chaplain. For each patient and family, the team writes a care plan with the patient/family that is used to make sure the patient and family receive the care they need from the team. Typically, full time registered nurses provide care to about a dozen different families. Social workers usually work with about twice the number of patients/families as nurses. If needed, hospice aides, who provide personal care to the patient, will visit most frequently.
All visits, however are based on the patient and family needs as described in the care plan and the condition of the patient during the course of illness. The frequency of volunteers and spiritual care is often dependent upon the family request and the availability of these services. Travel requirements and other factors may cause some variation in how many patients each hospice staff serves.
Is hospice available after hours?
We are available 24 hours a day 7 days a week ‘on-call’ after the administrative offices have closed. We have nurses, chaplains and social workers on call.
How do we work to keep the patient comfortable?
Our staff receives special training to care for all types of physical and emotional symptoms that cause pain, discomfort and distress. Because keeping the patient comfortable and pain-free is an important part of our care, we have developed ways to measure how comfortable the patient is during the course of care. Our staff works with the patient’s physician to make sure the medication, therapies and procedures are designed to achieve the goals outlined in the patient’s care plan.
What role does the hospice volunteer serve?
Our volunteers are generally available to provide different types of support to patients and their loved ones including running errands, preparing light meals, staying with a patient to give family members a break and lending emotional support and companionship to patients and family members.
Because our volunteers spend time in patients’ and families’ homes, we have a specific application and interview process to assure the person is right for this type of volunteer work. In addition, our program has an organized training program for its patient care volunteers. Areas covered by these training programs often include understanding hospice, confidentiality, working with families, listening skills, signs and symptoms of approaching death, loss, grief and bereavement support.
Can I be cared for by Halifax Health – Hospice if I reside in a nursing facility or other type of long-term care facility?
Yes, our services can be provided to a terminally ill person wherever they live. This means a patient living in a nursing facility or long-term care facility can receive specialized visits from hospice nurses, hospice aides, chaplains, social workers and volunteers in addition to the other care and services provided by the nursing facility.
What happens if I cannot stay at home due to my increasing care needs and require a different place to stay during my final phase of life?
We have three care centers that cater to the mind, body and spirit of patients and families. These care centers are for patients who need extra care, that cannot be provided in their current residence.
Do state and federal reviewers inspect and evaluate hospices?
Yes, there are state licensure requirements that must be met by hospice programs in order for them to deliver care. In addition, we must comply with federal regulations to be approved for reimbursement under Medicare. To assure that we are meeting the required regulatory standards, we undergo periodic inspections by representatives of state and local agencies.