House Call: Hospice: Comforting Care When the End Is Near

From OncoLog, June 2009, Vol. 54, No. 6

House Call: Hospice: Comforting Care When the End Is Near

When seriously ill patients run out of treatment options, many choose to enter a final phase of care designed to make them as comfortable as possible—hospice care.

In hospice care, treatments aimed at fighting the disease are stopped. Instead, hospice patients receive palliative treatments—those aimed at relieving symptoms—along with social, emotional, and spiritual support.

The basics

Most hospice programs provide care in the patient’s home, but hospice care is also available in some facilities, such as assisted-living residences, nursing homes, hospitals, and private hospices. When hospice care is given at home, family members usually serve as the main caregivers, with support from doctors, nurses, home health aides, social workers, therapists, and trained volunteers. At-home hospice patients still may be admitted for short in-patient hospital stays so that troublesome symptoms can be managed. In facility-based hospice programs, health professionals provide the care, but family members can usually be by the patient’s side all the time.

A variety of hospice services are available, depending on the program and the patient’s needs. Services may include:

Care provided by a hospice doctor or the patient’s primary care physician
For at-home hospice patients, regular home visits by hospice nurses and 24-hour on-call nursing support
Help with bathing, cooking, cleaning, or other daily needs
Counseling for the patient and family members
Social services
Respite care (provided for at-home hospice patients so that their caregivers can get a break)
Medications and medical equipment, such as a hospital bed, oxygen, and a wheelchair
Bereavement support for the family following the death
Visits from a chaplain or other spiritual counselors, if requested
Arrangements for specialized services such as physical, occupational, and speech therapy and nutritional counseling

Many people receiving hospice care have cancer, but others have heart disease, dementia, obstructive pulmonary disease, or any number of life-ending conditions.

For hospice care to be covered by insurance, a doctor usually must certify that the patient is expected to live no more than 6 months. That is the guideline used by Medicare, which pays for most hospice care costs. Many private insurers have adopted the same policy.

Choosing a program

How do you decide which hospice program is the best choice? To start, find out whether the program is accredited by a nationally recognized group, such as the Joint Commission, and if it is certified by Medicare. Ask the agency that provides the program for a brochure or other written information about available services, eligibility rules, costs, and payment procedures.

Doctors, nurses, and social workers are also good sources of information about specific programs, as are area agencies on aging and elderly services organizations. The Eldercare Locator (1-800-667-1116 or www.eldercare.gov) can connect you with the right agency. Other helpful resources are the National Hospice Foundation (www.hospiceinfo.org); the Hospice Foundation of America (www.hospicefoundation.org); and Hospice Net (www.hospicenet.org).

Often, hospice care is not started until the patient is very near death, but entering a program earlier might be beneficial, according to hospice experts. The longer a patient receives hospice care, the better the chances are that the patient will have a peaceful and high-quality experience. For that reason, it’s important to explore options for end-of-life care sooner rather than later.

For more information, talk to your physician, visit www.mdanderson.org, or call askMDAnderson at 1-877-632-6789.

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