HOSPICE: Making Intelligent End of Life Decisions
The Hospice Process
One of the most widely misunderstood "End of Life" concepts that the elderly, especially those approaching imminent death face, is "hospice." Because of this lack of understanding, they leave responsibility for their care in the final days of life with their families rather than trust the experience and compassion that hospice can bring. It is a moral responsibility for all of us to not only understand the hospice principal, but to embrace it so that our loved ones can be spared the agony of making that decision.
A decision to place a parent or spouse under the care of hospice is a difficult one. It is the choice to be considered before a person departs this earth. Many of us are badly misinformed about the true meaning of hospice. We assume that it is a choice reserved for those without family to care for them. Others refuse to face up to the reality of imminent death. As a consequence, families do not make the right decisions which leads to unfortunate conclusions, unnecessary expenses and a painful death. These are reasons we should assume responsibility for our final days and make those intentions clear in our final directives.
By doing so, we take control of our lives and spare our close family the grief. Most of them are not prepared nor equipped to make such decisions. Why add unnecessary discomfort and pain and mental anguish to the process.
I have experienced hospice for my mother and mother in law over the past several years. I can’t imagine how our family could have made it through without the kindness and support the hospice program gave us all. Mom asked for that in her final days. She had researched the subject and knew many who had chosen that alternative. Her intent was to make life easy for her family by taking responsibility for that decision. Like many people, we had a misconception of what hospice entailed. Many of us thought that hospice was simply a place to send your loved one to when she was near death. What we discovered about hospice was quite a different story
Hospice, as explained to us and as we experienced is more of a concept and a methodology than a physical place we send people to die. As explained, it is an approach recommended for patients who are deemed to be in the final 6 months of life. It employs a trained team of individuals - nurses, doctors and health aides who work in tandem to comfort not only the patient, but their family. These trained and caring people are on call whenever they were needed and made death bearable for all concerned,.
In our case, my mother who was in the final stages of her life due to advanced bowel cancer was placed in hospice care after spending 2 painful weeks in the hospital. Because we had no one who was capable to care for mother at her home, we were advised that the hospital itself would administer the hospice program. They promised a high level of maintenance care, pain management and counseling as needed. All of children were in agreement with the decision and with the program itself.
Per her request, no extraneous procedures were to be administered. Her basic hydration and nourishment was provided intravenously and pain medication was given on a constant and as needed basis. She was closely monitored by the family and hospice staff. Mother saw her priest daily. After 6 days of hospice care, she died peacefully. The family was advised when her death became imminent, and many of us were able to be with her during her last breaths.
Similarly, a few years later, my mother in law began care in a home hospice program set up for her at her daughter’s house the last month or so of her life. She met with the administrators and health care employees of the hospice program before it was put in place. She approved of the conditions and voluntarily agreed how the program was to proceed. About this time in her life, she saw herself weaken and begin to fail. Hospice was set up at home within a day or so of the meeting. At that point, she had around the clock supervision from hospice nurses and family for two weeks before it became evident that her days would soon end. Hospice aides were there giving comfort, administering pain medication, helping her bathe and groom and to feed her. They did an excellent job preparing her and all of us for the final moments.
Finally on the final day of hospice, the family, sensing that it could be her last, all gathered around mother. We arranged ourselves in a circle around her bed, held hands, bade her goodbye and she peacefully passed away. It was a beautiful moment.
Shortly after that, the hospice nurse appeared and respectfully washed and prepared mom’s body to be picked up by the funeral director. We all agreed how wonderful our hospice experience was. We strongly recommend hospice for anyone should the occasion arise.
Both parents were qualified to receive payment for hospice services through the medicare plan. To be declared eligible, the patient's doctor must certify that your loved one has less than six month to live. Should your parent live longer, as is often the case, she can be re certified for further hospice every 3 months for an unlimited number of 90 day periods. Once enrolled in a Hospice program, a person gives up her rights to medicare part A payments for the illness that caused their condition but can still be eligible for other medicare payments during the remaining months.
If your parent is not medicare eligible and you are considering hospice, it is much less expensive to have it administered at home than at a hospital or separate hospice facility.