When is it Time for Hospice?
When someone is nearing the end of life, families must begin making some very serious and difficult decisions. Perhaps your loved one has already thought things through thoroughly and created an advanced directive; maybe you have simply had a conversation about how and where they would like to be when they finally pass away.
Terminal illnesses or accidents can, unfortunately, speed up the decision-making process, and tough conversations must be had. If your loved one cannot speak for him- or herself, difficult decisions rest on the shoulders of the family.
Nursing Homes vs. Hospice Care
You are probably familiar with a nursing home, or, as they are known in many settings, skilled nursing facilities (SNFs). SNFs provide round-the-clock monitoring and medical care, often including rehabilitation treatment. Patients may stay for a short time in an SNF after surgery or hospital stay, with the goal of getting better and stronger, and returning to the patient’s previous living situation.
However, what happens if the patient’s prognosis is not so good? Perhaps their curative treatment is not yielding results, or the surgery was not successful. What if the unthinkable happens and a doctor sadly gives the diagnosis that only 6 months or less of life remains?
At this point, a patient is eligible for hospice. The main criteria for hospice care is 6 months or less to live, along with a decision to stop curative treatment. Hospice entails a focus on managing the symptoms related to the disease and to end of life. It brings together multiple service providers into a single cohesive plan to comfort the whole person, body and mind. Hospice is most often administered at home, and surveys show that most people do prefer to live out their final days at home if given the choice.
Specifically related to Alzheimer’s disease and dementia, hospice can be particularly helpful, as the burden on family and caregivers grows considerably with the patient increasingly unable to respond or communicate.
There are some questions and misconceptions that may prevent someone from considering entering into hospice care. For example:
Can a person return to curative treatment if they begin to improve? The answer is yes, a person can be discharged from hospice and return to curative treatment if their condition begins to improve. They can also return to curative treatment if they simply change their mind, even without significant improvement in condition.
Does hospice care cause a person to give up or cause death to come sooner? In many cases, discontinuing painful or uncomfortable curative treatment (when no improvement is being seen) can actually reduce the stress on a patient. Focusing on treating pain and symptoms of the disease, along with counseling options, can actually help improve a person’s quality of life overall and may even extend their longevity.
Can a person only use hospice services for six months? No. Even though a patient must be given the prognosis of six months or less to live for hospice care to be covered by most insurance companies or Medicare, a person can use hospice services for as long as they are needed.
Medicare, Medicaid, and most private insurance plans cover hospice services but it’s important to note that Medicare requires hospice care be provided at home, with only short stays in an inpatient facility. This means that a family caregiver may be expected to be more involved in the round-the-clock care, although the hospice team should be very present on a regular basis and many also have volunteers willing to help sit with a terminally ill patient (one of the biggest fears of death for many people is dying alone).
If your loved one is living in a nursing home, he or she may not be eligible to receive hospice care, unless the facility has a special agreement with the local hospice care provider. Some hospice agencies do have in-patient living that offer both 24-hour medical monitoring and the added layer of hospice specializations.
If your loved one is currently healthy, it’s actually a good time to discuss the future “what ifs” so that you can help honor their wishes to the best of your ability. By understanding the hospice is not scary or a sign of “giving up,” but a way to make the final transition as comfortable as possible, you can ensure that you fully understand all your options to make the most out of every day.