When Should Hospice Care Begin?

Opening the hospice discussion earlier rather than later can help ensure that the end of life is spent in a comfortable and compassionate environment __________________________

When asked what "hospice" means, many people would reply that it is a place or a facility, but it is more than that. "Hospice" is a philosophy of care.

The goal of hospice is to provide palliative care, aimed at treating pain and other symptoms, rather than on a "cure" or aggressively treating the patient's life-limiting condition.

The hospice philosophy supports the right of people who are at the end of life to experience as much peace, comfort and dignity as possible. This includes managing pain and other symptoms so a person can remain alert and comfortable. Hospice cares for the whole person—emotionally, physically and spiritually. Hospice also provides services to help and support a patient's family.

It is a common misperception that selecting hospice means the end of all medical treatment. But in reality, palliative care might include surgery to improve a painful condition, a course of antibiotics to reduce a high fever, wound care, or medication for pain and nausea. Comfort is the guiding light.

Choosing hospice care: when is the right time?

Many families report that they wish their loved one had chosen hospice treatment earlier. Studies have shown that choosing hospice earlier makes things easier on patients with a life-limiting condition, and on families as well. For example, the American Cancer Society believes that hospice services can be most effective and supportive if the patient and family have a minimum of 30 days of hospice care.

When considering whether it is time to choose hospice, it's important to know that the hospice emphasis doesn't mean abandoning hope. Rather, hospice means a positive choice for quality of life and living each day to the fullest during the final stages of life.

Selecting hospice care earlier also lessens the difficulty and stress of making an important decision at a time of crisis. It can make a critical difference in how a person comes to terms with dying, and can give patients and families the time they need to prepare themselves for the loss of a loved one. It also means there is time for important discussions about advance directives and other healthcare decisions, while the patient is still able to speak on his or her behalf and make his wishes known.

Hospice brings comprehensive services

Hospice care can occur in a hospital, hospice center, skilled nursing center or at home. Hospice services are very inclusive; the hospice team members include physicians, nurses, social workers, care aides, chaplains, volunteers and therapists. The hospice team works with patients to set up a plan of care that meets individual needs. Families receive support during the person's illness, as well as respite and bereavement services.

Hospice and financial considerations

When considering hospice care, it's important to know how the patient's insurance coverage applies, and the hospice benefit period of the policy.

Hospice care is covered under Medicare Part A (Hospital Insurance). Patients who are eligible for Medicare Part A can receive hospice care once the doctor or hospice medical director certify that the patient is terminally ill and probably has less than six months to live.

Patients must sign a statement choosing hospice care instead of standard Medicare. Medicare will still pay for covered benefits for any health problems that are not related to the terminal illness.

With Medicare, hospice care is given in two 90-day periods followed by an unlimited number of 60-day periods. The patient's doctor must recertify that the patient is terminally ill once the 90 or 60-day period is over, in order for care to continue.

Hospice care respects the individual

With hospice care, patients and their families can expect services that address their individual needs. Hospice care affirms life by providing the comfort that helps everyone involved experience death as a normal part of life.