Facts About Hospice Care

Each community is different, and there may be a variety of resources for locating hospice care in your area. Some of these may include:

• The physician handling the case: Chances are, his or her staff has helped refer patients to these services and can help refer you to a hospice provider they've worked with in the past.
• Hospital Social Services: Many hospitals have social workers on staff who can help direct patients and their families to various services and resources outside of the hospital.
• Nursing Facilities and Homes: These facilities should be familiar with local hospice care providers and can often provide you with contact information.
• Insurance Companies: Check with the patient's insurance plan to see if hospice care is covered and whether they have an approved list of providers.

In recent years, hospice care has been an important end-of-life addition to the care cycle. In many cases, patients who are in the final stages of a disease can stay at home in familiar surroundings, with loved ones nearby to comfort them. In other cases, Hospice care will be provided at a hospice center, a skilled nursing facility or even a hospital. The individual circumstances of the patient as well as the family will help determine where care is to be given.

Hospice workers visit on a planned schedule to check the patient's basic status, administer certain medications (including IV drugs) and in cases where care is given at home, to make certain more acute care in a facility is not needed. This care is generally called palliative care, or comfort care.

The goal of hospice is to offer a humane and comfortable environment for the patient, and to offer medical, spiritual and psychological help and support to the patient and his or her family at this difficult time. The center of focus is the patient, with a priority on peace, dignity, freedom from pain, comfort and the ability to stay alert and in personal control for as long as possible.

Generally, a patient may enter into hospice care when their life expectancy is six months or less. Often, the physician following the case will introduce the idea of hospice as he or she becomes aware that time is approaching.

Other factors can be considered, such as the desires of the patient to remain at home as long as possible, the ability of the family to be part of the care team if the patient is kept at home and the level of care the patient might need. Patients whose conditions are somewhat stable but declining (meaning there are few, if any, instances requiring immediate medical attention) might be better candidates for hospice in a home environment.

The decision of when and whether to use hospice services for end-of-life care should be made by the patient (if possible), the family and the medical team. The U.S. National Library of Medicine offers information on Hospice Care through its MedlinePlus service.

Hospice care can be provided through a number of resources. Since it is often less expensive than hospitalization, many insurance companies provide a degree of coverage for this type of care. Here are places to contact to help find payment options that might apply in your situation:

• Medicare or other government plans for Seniors: Check the government-provided plan in your country to see what hospice care is included in the coverage.
• Medicaid: In the U.S., Medicaid can often provide hospice care. Other countries with health coverage based on income or disability may also have this type of coverage.
• Health Insurance: Many health plans cover hospice care. Be sure to have the full information of the insurance plan when you contact the insurance company. Not all plans within a company offer the same coverage. They will need the policy number and the name and identification number (in the U.S. this is probably the Social Security Number) of the patient. Explain the situation and ask what coverage, if any, is included in the policy.
• Veterans Administration: If your loved one served in the Armed Forces, hospice care might be available through these services. You will need the patient's military discharge records (in the U.S., the form is called a DD-214) to help determine if the length of service and the circumstances of the discharge allow for coverage.
• Other Resources: If you are not able to find adequate coverage for hospice care through the above resources, check with state agencies, local social services offices and your place of worship to see if they offer support.

There are many things to take into account when your family faces an end-of-life situation with a loved one. Here's a brief checklist of some of the things you may want to consider:

• A living will: Does your family member have personal preferences about the steps they want to be taken in emergencies?
• DNR: Do you need have forms such as Do Not Resuscitate legally signed and placed in medical records?
• DNR during Transport: A special form may be required to decline resuscitation during transport (such as in an emergency vehicle). Regular DNR instructions may not apply if the patient is en route to another location.
• Power of Attorney: If the patient is at risk of declining to the point of not being able to sign the above documents under his or her own power, you should get a Power of Attorney signed. This allows another person (generally a close family member) to make difficult choices regarding life support and other issues you might encounter.
• A Last Will and Testament: If the patient does not have a signed will, do not delay in getting a valid document prepared and signed. The complications that can arise from lacking a will are expensive, heartbreaking, exhausting and time consuming.

Important tip: Be sure to review all documents to make certain they're being signed and/or witnessed by the proper person. Many documents cannot be witnessed by immediate family members, and many documents require notarized signatures. If you're in a hospital when these documents are being signed and reviewed, there is probably a notary on the staff to help in such situations. Many social service agencies have notaries on hand, and you might also find one through an attorney in your network of friends or at church.

You are probably wondering what to expect when you arrange for hospice care. Hospice workers are there to help you in a number of ways. In addition to providing medical help, they are skilled in understanding the many emotions the patient and family members are experiencing at this time.

Don't hesitate to ask your hospice worker(s) about how to best support your loved one, what you should and shouldn't do, and where you can turn for additional help. They have been through this time with others, and they have valuable information and experience to share.

You can expect a myriad of feelings through this time. Sadness, grief, fatigue, fear, anger, resentment that this is happening and other very normal feelings. Hospice workers can help address these feelings, and help you feel a sense of peace that you are doing all you can to give your family member love, support and dignity during this transition of life.