Frequently Asked Questions
When is it time for hospice?
When the burden of treatment outweighs the benefits and/or the patient has experienced notable decline and multiple hospitalizations over the last several months, he or she might be ready for hospice. Other indications include:
Repeat trips to the emergency room (ER)
Sudden or progressive decline in physical functioning and eating
Weight loss/difficulty swallowing
Shortness of breath/oxygen dependence
What are the qualifications for hospice care?
A patient is eligible to receive hospice services when their illness is terminal, and a physician determines the patient’s life expectancy is six months or less if the disease runs its normal course. The patient must meet Medicare’s disease-specific criteria.
Is hospice only for people who are dying?
Hospice is for people who have a limited life expectancy and for patients whose condition is such that a doctor would not be surprised if the patient died within the next six months. This doesn't mean the patient is going to die in the next six months, it simply means that he or she
has a condition that makes dying a realistic possibility.
Does choosing hospice care mean giving up?
When treatment options for a disease have been exhausted or are no longer working, hospice provides a way for people to live in comfort, peace, and dignity without curative care. Hospice isn’t about giving up, but about improving the quality of a patient’s life by being free of pain, surrounded by family and in the comfort of their home.
What is the first step to begin hospice care?
Anyone can request a hospice evaluation at no cost. A physician may make the referral or provide several options and let the patient/family make the decision. The physician must certify to the hospice provider that the patient is eligible has a prognosis of six months or less.
When a referral is made, the hospice provider makes an appointment (the same day or on a date convenient for the family) to meet with the patient and family. The admissions nurse evaluates the patient, answers the family’s questions, and creates a plan of care that reflects the patient/family wishes. If the discussion goes well and the family is ready, they sign admission paperwork and the hospice team begins to visit.
How often does the hospice staff visit?
The hospice nurse creates a plan of care with the patient’s and family’s input that is designed to meet the patient’s needs. This determines the frequency of visits by the hospice staff. A hospice nurse is available to make additional visits if needed, 24 hours a day, seven days a week.
Once a patient begins hospice care, can they leave the program?
A person may withdraw from the hospice program for a variety of reasons, such as resuming aggressive, curative treatment or pursuing experimental measures. Also, patients often improve with hospice services because the focus of their care shifts to comfort, pain relief, symptom management, and quality of life. They still have a terminal illness, but their symptoms are so improved that they no longer qualify for hospice services. A hospice must discharge a patient whose underlying disease or condition is no longer considered terminal. Patients can revoke hospice care for any reason at any time and return at any time, as long as their doctor recertifies their eligibility.
Does hospice require a DNR?
While requiring a Do Not Resuscitate (DNR) order before admittance is required by some hospices, Medicare-certified hospices do not require a DNR order since it is understood by the patient and family that the patient will not be receiving curative care.
What is an Advance Directive?
The term advance directive describes two types of legal documents that enable an individual to plan for and communicate their end-of-life wishes if they are no longer able to express informed consent. These two documents are a living will and a medical power of attorney.
Living Will: Allows an individual to document their wishes concerning medical treatments at the end of life.
Medical Power of Attorney: Allows an individual to appoint a person they trust as their healthcare agent (or surrogate decision-maker), who is authorized to make medical decisions on their behalf.
Can a hospice patient go to the hospital?
While hospice strives to manage pain and other symptoms outside of the hospital setting, a hospice patient always has the choice of going to the hospital. The Medicare hospice benefit covers short-term general inpatient care in the hospital when a patient's symptoms can no longer be managed in another care setting. A written agreement between the hospital and hospice provider is required, and the patient and/or family should always contact the hospice nurse before going to the hospital.
Can a hospice patient go to the doctor?
A hospice patient may continue to see their PCP. In addition, hospice physicians and team members work with the patient’s PCP to ensure their clinical and emotional needs are being met and that their care is being carried out appropriately. Their PCP chooses his or her level of participation in their care. A patient must get permission from their hospice provider to see any other physicians/ specialists outside of their PCP for their terminal condition.
Is a hospice patient required to be homebound?
Unlike home health, there is no homebound rule for hospice patients. They are encouraged to travel outside of the home, if they are able, to encourage quality of life.
If a patient has home health, why would they need hospice?
Home health care patients require skilled care and must show improvement from this care. When these goals are no longer realistic, the patient can be transferred to hospice care. Home health and hospice can provide services together if the home health diagnosis is unrelated to the hospice diagnosis.
If a patient is in a nursing home, why would they need hospice?
Nursing homes focus on routine daily care and rehabilitation. Nursing home patients who receive hospice services get additional, customized support determined by their plan of care, which focuses on the physical, emotional, and spiritual end-of-life needs of patients and their families.