Hospice care is typically given in the patient's home but also may be given in inpatient hospice units. Hospice care does not provide 24 hour around the clock nursing care, so many patients are either cared for by family members, hired caregivers, or nursing home staff.
History of Hospice Care
The concept of hospice as an holistic, interdisciplinary approach to end-of-life care began in Great Britain during the 1960s. The Medicare Hospice Benefit was passed in the United States in 1982, and has served as the basis of the hospice model of care in the U.S. and as a model for Medicaid (Medi-cal) and private insurance provision and reimbursement.
Hospice Care and Palliative Care
Hospice care is one form of palliative care with the goal to alleviate symptoms and improve quality of life. In contrast to traditional palliative care, hospice care is appropriate when there is a life expectancy of six months or less. When curative treatments are no longer working and/or a patient no longer desires to continue them, hospice becomes the care of choice. Traditional palliative care, on the other hand, can be given at any time during the course of an illness and in conjunction with curative and aggressive treatments.
The mission of hospice is to affirm life and view death as a natural process. Hospice is not designed to hasten death or “help” someone die, but rather to help patients live the remainder of their lives as fully as possible. Most people, if asked, will say they dream of a peaceful, comfortable death surrounded by their loved ones. An interdisciplinary team of trained professionals work together to deliver hospice services that can make that dream a reality.
Services provided by hospice have been defined by the Medicare Hospice Benefit and are the same whether hospice care is covered by Medicare, Medicaid (or Medi-cal in California), private insurance, or charity. They include:
- Nursing services - A patient is assigned a case manager nurse who typically visits 1 to 3 days a week. Patients and their caregivers also have access to 24-hour on-call nurses.
- Physician participation - Patients are often cared for by their regular physician in cooperation with a hospice medical director.
- Medical social services - Patients are assigned a social worker to assist them with emotional and social needs.
- Counseling Services - may include pastoral or spiritual support, bereavement counseling for family and caregivers up to one year after patient's death, and dietary services as appropriate.
- Home health aide (HHA) services - HHA help patients with their personal care and typically visit 2 to 3 times per week.
- Medications - Hospice typically covers all medications that are related to the hospice diagnosis and those that are intended to alleviate symptoms.
- Medical equipment - Equipment that is necessary for providing safe, comfortable care in the patients home environment is supplied by hospice. This may include a hospital bed, wheelchair, and oxygen.
- Other medical supplies that are needed to provide care is provided by hospice. Supplies may include adult diapers, bandages, and latex gloves.
- Laboratory and other diagnostic studies that are related to the terminal illness
- Therapists as appropriate, which may include
Additional services may be available through individual hospice agencies through their volunteer and charity programs.
How to Know if Hospice Is Right for You or Your Loved One
Hospice care is appropriate when a patient has a terminal illness with a life-expectancy of six months or less. It is important to note that a life expectancy is never “by the book.” Some patients with a life expectancy of six months will live much longer and some will die much sooner than expected. It is generally accepted that the sooner a patient can access hospice services, the more they will benefit from the care received.
A patient is ready for hospice when they have decided to pursue treatments meant only to promote comfort, not cure the illness. Those treatments may include medications to relieve pain, nausea, shortness of breath, loss of appetite, muscle cramps, itching, hiccups, and many more. Other more aggressive treatments, such as blood transfusions, chemotherapy, and radiation, may be appropriate under hospice care when the goal is to alleviate pain and discomfort, not cure the disease.