Idaho Hospice

Should I wait for a physician to raise the question of hospice?

Ideally, the physician would explain the stage of the illness, and present different treatment options, including comfort and palliative care well in advance of making any final decisions. He or she would engage the patient and family in the plan of care, and provide time to consider the various options. If there is disagreement, then the physician should encourage you to discuss these options with others.

If you do not feel a physician is addressing what you feel are the issues, then you should ask him or her directly:

It is advisable to learn what hospice care is available well in advance of when it might be needed. A frequent lament hospice workers hear from patients and caregivers is that 'we wished we would have known about hospice sooner'.

Do all physicians know about hospice?

Most physicians are aware of hospice and palliative care treatment, but some find it difficult to broach the subject since it often means that he or she must admit a patient is beyond curative care. You need to talk to them openly to determine the stage of the illness and whether you or your loved one is ready for hospice.

If you or your physician need more information, it is available from the Academy of Hospice and Palliative Medicine, the National Hospice and Palliative Care Helpline: 1-800-658-8898, and the American Cancer Society.

What does the hospice admission process involve?

Once a patient or a patient's family contacts the local hospice, the hospice will check with the physician to determine whether/when hospice care is appropriate. Just like entering a hospital, the patient (or a family member with power of attorney) will then be asked to sign consent and insurance forms.

The hospice consent form asks whether the patient understands that the care is palliative and aimed at pain management control rather curative care. The Medicare form shows how the Medicare hospice benefit affects other Medicare coverage.

What happens if a hospice patient shows signs of recovery?

If a patient improves and the disease appears to be in remission, he or she can be discharged from hospice and resume treatment or go about their daily lives. If they need at some point to return to hospice care, they need to check insurance or Medicare coverage, but most will cover the additional care.

Can any decisions and directives be made in advance?

It is important for all of us to think about what care and treatment we would like at the end of our lives. We need to share those thoughts with families and loved ones so that our wishes are known, and keep the dialogue ongoing in case our wishes change over time.

We should select someone to speak for us if we cannot speak for ourselves, and be sure we have discussed our views about end-of-life care with our doctor.

Advance directives allow you to give instructions about the medical care you wish to receive should you be unable to speak for yourself. The living will provides specific instructions about medical care while a medical power of attorney names a person you trust to make decisions on your behalf. In Idaho, there is also a "DNR" (do not resuscitate) directive that can be completed.

Ideally, we should complete these documents to ensure our wishes are carried out and be sure they are easily accessible.

(Under "Resources and Links" see "Partnership for Caring: America's Voices for the Dying" at www.partnershipforcaring.org where legal information by state is available. The two advance directives for Idaho can be downloaded directly from the site. )

How does hospice manage pain?

For the dying, pain is often on many levels. There is the physical pain, and hospice staffs are well briefed on the latest medications, therapies and devices to alleviate pain and disease symptoms. Their success rate in reducing pain is very high: nearly 95%.

It is important for patients to understand that these treatments do not turn them into 'drug addicts' or make them unconscious. The goal is to get the balance right between making a patient pain-free and comfortable, yet keeping them alert.

Hospice staffs are also conscious of the emotional, spiritual and social aspects of pain, and address those as well. Their goal is to make patients as mobile and self-sufficient as possible for as long as possible. When that is no longer feasible, then they strive to help the patient reach a level of personal peace and comfort.

Various other therapies may be offered, such as pet or music therapies, nutritional counseling, massage therapy, and learning to write in a journal.

Patients are cared for by a team of experts: doctors, nurses, social workers, counselors, home health aides, clergy, therapists and volunteers. Each has been trained to meet the highly specialized needs of the dying.

Must someone be with a patient all the time?

One of the first things the hospice team does is determine how much care is required. At the beginning, it is usually minimal, but as the disease progresses, hospice will generally recommend someone be present continuously. This coverage is not only to care for the physical needs of the patient, but also to help alleviate their fear of dying alone.

Caregivers are usually family members and friends, but hospices can provide trained volunteers to assist with errands, stay with a patient, and do whatever else might help to relieve primary caregivers.

How difficult is it to care for someone dying at home?

Caring for someone who is ill at home is not easy, and can sometimes be very difficult. Yet, when Americans have been surveyed, nearly all state that they wish to die at home.

To meet this desire, hospices offer guidance and help to prepare families and caregivers for the changing needs of the patient. Hospices often have staff who are available around-the-clock to help a family through times of crisis.

But this time can also be one of the most rewarding for the caregiver as the patient reaches the end stage of the illness. This experience is often one, which enriches people's lives and attracts volunteers.

Does hospice do anything to hasten death? In other words, is placing a person in hospice care a 'death sentence'?

Hospice is a form of care that specializes in helping people to die with dignity. It does nothing to speed up or slow down the dying process. Those trained in hospice care act more as facilitators, lending support and expertise to those dying in order that they may have a self-determined life closure through safe and comfortable dying.

Is hospice affiliated with any religious organization?

While hospices often address the spiritual needs of the dying, they are not religious organizations. In places where churches and religions have started hospices, they are often in conjunction with a hospital. Even these hospices serve the broad community. So, no, a patient does not have to adhere to any particular religion in order to receive hospice care.

Is hospice care covered by insurance?

Hospice care is often covered by private insurance, as well as by Medicare nationwide and Medicaid in 43 states, including Idaho. In some cases, a minimal co-payment may be required for medications and care. Families should check with the healthcare provider to be certain of the amount of coverage, and ask about the co-payment requirement.

Will hospice turn away someone who does not have insurance?

Hospice will first try and find out if a patient is eligible for any coverage, and seeks these resources. But no one will be turned away because of inability to pay. Many hospices have funding available to help cover these cases from community donations and memorial gifts.

Does hospice provide any help to the family after the patient dies?

Most hospices will provide continuing contact and support for family and friends for up to a year after the death of a loved one. Many offer individual counseling and bereavement and support groups for family, friends, and children, or for anyone in the community who has experienced the death of someone close to them. There are also special support groups to which individuals can turn, such as Compassionate Friends for parents who have lost children.

The above information is derived from information provided by the National Hospice Foundation and from "Finding Your Way: a Guide for End of Life Medical Decisions published by Sacramento HealthCare Decisions. For more questions and answers, click on www.hospiceinfo.org and refer to " Resources and Links' in this website