Hospice care offers comfort and symptom management both for the patient and the family. The benefits of hospice care allow a person to die in the comfort of the home and offers support to the patient and the family.
As seen in the Community Newspaper Group August 1-7, 2014
My father stopped eating shortly after his 90th birthday. He said he was not hungry and did not want any food. My sister, brother and I took him to the doctor to see if he was ill or was suffering from some infection. The doctor explained that there was nothing physically wrong with him and wrote up the diagnosis as “Failure to Thrive”.
She told us we had two options. We could put him on a feeding tube. This would give him needed nutrition. She explained there was always a chance that Dad would decide to start eating again. The other option was to enroll him in hospice care. She assured us that hospice did not necessarily mean he was going to die, but it offered him a comfortable option until he decided to start eating again or passed on.
My siblings and I decided on hospice care. We had heard that a feeding tube is often painful for the patient and that it could cause infections. We also figured that a feeding tube was not going to reverse his condition. We agreed that if it was time for him to leave us, we wanted him go peacefully. If he regained his desire to eat, all the better.
Our doctor referred us to a local hospice program. We already had a live in home health aide who attended to him during the week, but the service appointed a male aide to visit my father twice a week to bathe him and make sure he was comfortable. When the aide arrived he would pick Dad up in his arms, cradling him gently and settle him into a bath. The hospice service even scheduled entertainment. Every week a pianist with a portable keyboard would visit and perform for him.
A hospice social worker visited my sister, brother and I to discuss our fears and concerns about the process and answer any questions. She explained that the hospice team would keep Dad comfortable at all times. She placed a package in the refrigerator that included a morphine patch that could be used at any time if Dad should show signs of distress or discomfort.
Then the social worker informed us about the process of dying, explaining the different stages. She offered us a pamphlet called Crossing the Creek by Michael Holmes, a registered hospice nurse who spells out the stages of dying. His pamphlet explained that dying is a natural process. It is a time when a person reviews his life and comes to terms with himself. To this day I often refer to this essay as a way to place life in prospective.
My father’s condition did not improve and after three weeks he passed away peacefully in his own bed with the three of us beside him. We never regretted our decision. My sister Naomi, summed up our thoughts; “It was one of the most comforting events we experienced together as a family. Our only regret is there was a death at the end.”
Many people cower from the thought of hospice because it implies “the end of life”. Often people think that if they sign up for hospice it is a death sentence and they are giving up. This is not always true. A person does not have to stay in hospice care. He can leave the program at any time.
Not everyone who enters into hospice care dies. Sometimes people get better and “graduate” from the program. Hospice nurses and physicians are specially trained in symptom management. When they become involved in a person’s care, the medical conditions are frequently stabilized and they actually feel better and can enjoy life again.
Some people remember the story of Arthur “Art” Buchwald, a prominent humorist and columnist for the Washington Post. In early 2006, Mr. Buchwald was diagnosed with kidney failure and required frequent dialysis treatments to survive. After some treatments, he decided to discontinue dialysis and checked into hospice care even though he was warned he would have only three weeks to live. Six months later he checked himself out of the program, spent a summer in Martha’s Vineyard, finished one of his books and continued to live through October 2006.
Hospice care is intended for people with 6 months or less to live. That does not mean you have to die in that time span. Nobody can say for sure how long a person has to live, but physicians can give an “educated guess” based on the person’s disease and the course the disease typical takes as it progresses.
Hospice has developed criteria for certification. The initial certification (when a person is admitted to hospice) is 90 days. The patient can be recertified to continue if the hospice medical director feels the patient still meets the criteria at the end of the 90 days. The first two benefit periods are 90 days in length. After that, the recertification periods are 60 days. A person can continue to be recertified as long as the criteria is met.
Hospice care offers several benefits. The main goal of hospice is comfort and symptom management. Each hospice has an interdisciplinary team that works together for the benefit of the patient. Social workers or counselors offer counseling to both the patient and the family. Many times when faced with the possibility of death, people admit that they have family issues or loose ends they want to “tidy up”.
Nurses will visit and consult with the patient’s physician and/or hospice medical director to help make sure the patient is comfortable and do everything they can to keep the patient pain free. Nurse aides are available to provide personal care such as bathing. Clergy visits are offered if needed. Volunteers typically provide companionship for short periods. There is also a bereavement team to help the family and patient get prepared for the end. The team stays in contact with the family for up to a year after the death to ensure emotional needs are met and the family has adjusted to life without their loved one.
Medicare pays for hospice, so there is no cost to most seniors. Many insurance plans have a hospice benefit as well. A 2000 CNN poll disclosed that 7 out of 10 Americans say they would prefer to die in their home. The biggest benefit to most people is that Hospice provides the support to allow a person to die at home.
Hospice does not usually provide 24 hour care, but will provide the needed support for the family or caregivers to manage the patient’s care in the home. (One of the requirements of hospice in the home is that there must be a caregiver available). There is always a Registered Nurse on-call who will answer questions over the phone and go to the patient’s home when needed in addition to the scheduled visits. Most of the time, a nurse will go to the home if the person is “actively dying”.
You can select from several hospice programs. The first step in finding the right program is to ask your doctor to suggest a service. You can also find hospice programs by looking in the yellow pages or searching the Internet. Before selecting a program, make sure that your insurance covers it. Review what services the agency provides. Make sure it includes a hospice doctor and nurse that are available 24 hours a day, social workers, and hospice aides. You should also ask if they have additional services like friendly visits and other activities.
You do not have to keep the same hospice service if you are not satisfied. There are many programs that are available, through hospitals, religious groups, medical facilities and not-for-profits organizations. Go over all the details and ask as many questions as possible.
Death is something we all must face. It is hard to lose our loved ones, but hospice can help make your loved one’s passing a peaceful experience. Many hospice staff and volunteers have had family members who were recipients of hospice services. They have been in your shoes. Once they experienced how much hospice helped them, they wanted to give that same care to others. You will find hospice a life changing experience.
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