Hospice can be a bit of a mystery to most people. It’s often the case that only people who have managed care for a dying loved one understand it. However, hospice can be vitally important to quality of care for people with advanced disease. It’s highly valuable to learn a little about hospice, so patients and family caregivers can ask questions of their doctors and participate knowledgeably in care planning. Here we provide concise answers to the top five questions about hospice.
1. What is Hospice?
Hospice can be delivered in multiple settings, but the majority of people receive hospice at home. For the most part, hospice is both a type of home care agency and a home care program paid by Medicare, Medicaid, and insurance. Hospice sends nurses and aides to a person’s home to help with symptom control, physical support, and emotional support. The hospice program often picks up the cost of professional services at home, home equipment related to the hospice diagnosis, medications, and supplies. Traditional Medicare pays 100%. Depending on a person’s needs and requests, hospice may also send volunteers, physical therapists, occupational therapists, and a chaplain. More info.
2. Is My Doctor Giving Up? Does Hospice Mean We are Giving Up Hope?
No. Both of these concepts are myths. Choosing hospice means a patient is embracing hope for a better quality of life. The last months of life are a very important time of life. Some people are fortunate enough to have a choice regarding how those days will be spent. Will they be spent in hospitals, with surgeries, uncomfortable treatments, visiting hours, and aggressive therapies? Or will a person’s last days be spent with maximum symptom control, in the comfort of home, surrounded by loved ones?
Part of the “giving up” myth stems from the fact that Medicare will not pay for hospice and curative therapies at the same time. Hospice is mainly intended for people when there is not a path to a likely cure. Doctors who inform patients about hospice or who recommend hospice in a timely way are providing the best possible medical care for their patients.
3. Will My Doctor Tell Me When It’s Time for Hospice?
No. Most doctors report that they do not regularly tell patients about life expectancy. This leads to fewer people using hospice in a timely way.
The converse is also true. A minority of doctors will start teaching patients about hospice months before they might need it. Their goal is to empower patients to make their own decisions in the future.
4. When Is the Right Time for Hospice?
Everyone has their own individual goals for the medical care they are receiving. Hospice is often appropriate when a person’s goals have shifted. Goals may shift away from using drugs, chemicals, and surgeries to alter the progression of a disease. A person’s goals may instead begin to focus on symptom control, comfort, quality of life, and emotional and spiritual preparation.
Expert consensus holds that people should receive hospice for three to six months. Surveys of families support the three to six-month recommendation. Families who say hospice started at the right time received hospice for an average of 98 days. Families who say it started too late had hospice for an average of 47 days.
5. Wouldn’t Hospice Shorten a Person’s Life?
No. This is a false assumption. In fact, hospice tends to lengthen life – not only for the patient but also for the family. Hospice is for people who already have a medical life expectancy of six months or less. Among this group of people, it turns out that rest, comfort, and gathering your strength is good medicine. Compared to patients who pursue other medical care, patients who choose hospice tend to live longer by days to weeks, and in some cases months.
Interestingly, hospice also protects the family. The death of a spouse or loved one can be hard for a family. So much so, that research has found a higher death rate for recently widowed spouses. Hospice improves the emotional status of family after a loved one dies. Research has even found that widows live longer when their husbands received hospice. This is likely a result of the enhanced support provided by hospice which includes preparation and bereavement support.
In conclusion, hospice is a type of health care agency and a medical program that provides palliative care for people with advanced diseases. Patients and families may need to be the ones to start a hospice conversation with the doctor. The right time for hospice is when a patient’s goals shift toward comfort and quality of life. Patients and families should learn about hospice, because it’s an important part of medical care. Learn more about hospice.