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What to Know About Hospice Care

What to Know About Hospice Care

Hospice is a type of health care provided to terminally ill patients with a medical prognosis of fewer than six months to live.

In order to lessen suffering and maximize a patient’s quality of life, hospice may include palliative care treatments, which are specialized medical treatments for people with serious illnesses that focus on improving a person’s quality of life. 

Hospice care is all-inclusive and can be given in a facility (like a hospital, nursing home, or hospice center) or at the patient’s home, providing care and comfort.

What makes hospice care different from other medical care is that attempts to cure the person’s disease are abandoned. Instead, hospice care focuses on providing compassionate care, comfort, and support for the patient toward the end of life. Hospice care also aims to assist the terminally ill patient’s family by allowing them to spend quality time with the patient and providing grief support.

What Does It Mean When Someone Goes on Hospice?

Hospice care is offered to terminally ill patients whose doctors have given them a prognosis of six months or fewer to live due to the natural course of their illness.

Therefore, a terminally ill individual must discuss hospice care with their doctor. In cases where the patient can no longer make their own healthcare decisions, a family member or a caregiver may need to decide whether or not hospice care is appropriate.

When all medical therapy options for curing or slowing the progression of the disease have been exhausted, patients may transition to hospice care. Hospice care is compassionate end-of-life care that follows the patient’s choices. As such, it is an alternative when a terminally ill person refuses to undergo specific treatments and medical procedures.

How Long Do Hospice Patients Live?

Hospice care is about short-term, end-of-life care. Therefore, only terminally ill patients with a six-month life expectancy or less are eligible for hospice care. In order to begin hospice care, a person needs a physician’s referral.

So, the typical life expectancy for hospice patients is six months or less. However, the life expectancy of these patients depends on many factors, such as:

  • Age – patients older than 65 are more likely to die within six months.
  • Diagnosis – people with cancer are more likely to die in the next six months than people with other diseases. 
  • Gender – men have a higher risk of passing away during the six-month timeframe than women.

Can You Survive Hospice?

While most people in hospice care die within six months or less, some patients can get better. Suppose you live longer than six months. You can still receive hospice care as long as your doctor verifies your eligibility.

In addition, if your condition improves while you are on hospice care, you can leave hospice and explore alternative medical choices at any time. However, if your condition worsens, they may continue hospice care at a later date.

Do They Feed You in Hospice?

Yes. No patient receiving hospice care is denied food or liquids. But, on the other hand, a dying person needs far less food and water than an active, healthy individual. 

A decreased need for food and drink is a natural aspect of the dying process since the digestive system is one of the first organ systems to fail as death approaches. In addition, as their metabolism slows, hospice patients have a reduced need for energy and can reduce their calorie intake.

Do You Have to Pay to Stay in a Hospice?

Medicare and Medicaid fully cover hospice care. In addition, other private insurance plans and health plans, such as health maintenance organizations (HMOs), may reimburse for hospice care.

Medicare covers the services provided by the interdisciplinary team, medications and equipment related to the terminal illness, grief counselors, and spiritual care providers.

What Happens if You Live Longer than 6 Months on Hospice?

It is often challenging for medical specialists to estimate how long a patient with a terminal illness will live.

If the hospice deems that the patient is no longer terminally ill with a six-month or shorter prognosis, they will discharge the patient from their care. 

Who Decides When Hospice is Needed?

A decision about whether hospice is needed is a healthcare decision. For that reason, healthcare providers determine whether the patient is eligible for hospice care in consultation with patients and their families.

When Someone Dies in Hospice, what Happens?

A hospice staff member may be absent when someone dies at home in hospice care. So, the hospice on-call-nurse who will come to the house must officially pronounce the death. After the death is confirmed, the nurse will notify the medical director of the hospice and fill out the necessary legal paperwork.

It is natural and expected for families of the deceased to want to spend some time saying goodbye to their loved one and arranging for any religious or cultural rituals, so hospice accommodates this request.

Can Hospice Tell When Death is Near?

Although every person is different, there are some common warning signals that death is on the way. Some signs of approaching death may include the following:

  • A person’s condition worsens, and pain increases.
  • Energy and strength decrease and most people spend their last days in bed.
  • A person may be in and out of consciousness, sometimes in a coma.
  • There may be a gradual decrease in interest in food and water.
  • Breathing may become irregular.
  • A person may seem agitated, confused, and delusional. They may see or hear things that other people don’t.
  • A person’s skin may turn cold, purple, and blotchy.
  • Hearing and vision may decrease.
  • A person’s interest in their surroundings may fade.
  • Heart rate, blood pressure, and breathing slowly decrease.
  • There may be changes in bladder and bowel function (constipation, loss of bladder control, etc.).
  • A person may sleep longer and find it more difficult to wake up.

When Someone Dies in Their Sleep, Who Do You Call?

Call an on-call hospice nurse or a hospice facility if a person receiving hospice care at home dies in their sleep and no medical professional is present. 

Every person in hospice gets a number that should be called in this case. They will come and confirm the death. You should also contact your local funeral home to make arrangements to have the body moved to their facility.

Why Do Hospitals Recommend Hospice?

In certain circumstances, curative medical treatment is no longer effective. This is when hospice becomes an option. A patient may also decide that they do not wish to pursue curative treatment. Also, some people nearing the end of life may receive unwanted treatments and care in hospitals. When a patient is in hospice, they can remain autonomous while still getting necessary care in a healthcare facility or their own home.

Hospitals may recommend hospice care to ensure the patient receives the best possible care and support.

Hospice tries to make patients as comfortable as possible and prevent unnecessary hospitalizations by caring for their pain and other physical needs related to terminal illness.

Hospice care is available in various settings, including hospitals, inpatient hospice centers, and extended care facilities; however, many terminally ill patients choose to receive hospice services in the comfort of their homes. 

Additionally, hospice care addresses patients, caregivers, and families’ psychological, social, and spiritual needs. It makes the end-of-life process easier for patients and their families and less stressful for caregivers, relieving some of the caregiver burden. 

What is the Biggest Challenge Facing Hospice?

Access to hospice care and other problems related to COVID have been the biggest challenges for hospice care over the past two years.

Apart from COVID, staff shortages are one of the major concerns in hospice care in both physician and non-physician disciplines.

How Quickly Can Hospice Be Set Up?

Most terminally ill people enter hospice care in their final weeks or days. However, some people start hospice during an earlier stage of the disease. How quickly a hospice will be set up depends on the person’s condition and the care needed at the end of life.

Most of the time, it doesn’t take more than a few days to set up a hospice. In some cases, though, it can be set up on the same day. To establish hospice care, patients must discontinue curative therapy for their condition. Typically, such a choice is made in consultation with the patient’s doctor.

The doctor must also fill out the paperwork confirming a six-month or shorter life expectancy.

The next step involves getting the appropriate paperwork, such as Medicare certification for hospice care, and calling the referral center (available 24/7) or contacting a local hospice organization to set up an assessment and determine the level of care the patient needs and prefers.

Who Puts a Patient in Hospice?

Cognitively competent individuals in critical condition can make their own choice about hospice. They commonly make this decision after consulting with their family and healthcare provider. 

If you are considering hospice care, your doctor can help you decide whether you are eligible for Medicare-funded hospice care at home or a facility.

What Medications are Allowed on Hospice?

Persistent pain is one of the most distressing aspects of a terminal illness. As a result, many drugs are administered in the context of hospice care to relieve pain or discomfort brought on by a terminal diagnosis. Furthermore, research shows that antidepressants are commonly prescribed for hospice patients with dementia, cancer, and lung disease. 

Additionally, hospice patients may need medicine to treat other symptoms of end-of-life illness, such as nausea, dyspnea, or delirium. So, hospice medication management commonly includes some of the following medications:

  • Acetaminophen/Tylenol (pain and fever)
  • Methadone (pain)
  • Morphine (pain)
  • Codeine (pain)
  • Diclofenac (pain)
  • Ibuprofen (pain)
  • Carbamazepine (neuropathic pain)
  • Dexamethasone (pain, nausea, vomiting)
  • Diazepam (anxiety)
  • Lorazepam (anxiety)
  • Citalopram (depression)
  • Trazodone (insomnia)
  • Zolpidem (insomnia)

How Long Does the Final Stage of End-of-Life Last?

When all of the body’s functions cease in preparation for death due to a terminal illness, this is known as the “end-of-life stage.” This time frame might range from a few days to a few weeks. Cardiovascular, respiratory, neurocognitive, and muscular systems gradually shut down as death approaches.

During this stage, a person may become unresponsive while their blood pressure, heart rate, and breathing slowly decrease.

What Happens a Few Minutes Before Death?

Everyone’s experience is different in the final moments of life. However, some changes happen minutes before a person dies. These may include the following:

  • Loss of consciousness
  • Changes in breathing (noisy, irregular, or shallow breathing)
  • Skin changes (cold hands and feet, mottled and bluish/purple skin)

How Do I Know If I’m Close to Death?

When you have a terminal illness, there are probably a lot of questions about what to expect or how to know that you are close to the end of life. 

It might be difficult to tell when we are approaching the end of life, though, because every person is different. Still, terminally ill people may feel increasingly tired and weak in the last few weeks or days. They may be less able to do things they did before, such as eating or taking care of their hygiene.

They might sleep more, feel confused, or be agitated. Also, a person approaching the end of life may fall in and out of consciousness, eat and drink less, or have bladder and bowel problems. In addition, some people may have cold hands and feet, feel cold or hot, experience increased pain, and talk and communicate less.

Because of their familiarity with hospice care and end-of-life issues, the members of your hospice team can provide comfort and help you understand what’s happening.

Can Hospice Patients Go Home?

Hospice care focuses on alleviating symptoms rather than curing terminally ill patients. Consequently, hospice patients can choose to receive treatment in the comfort of their own homes rather than at a medical institution.

When deciding on hospice care, a patient can choose a person to be their primary caregiver. This is typically a family member or close friend.