Today's Hospice: It's Not What You Think

Patients and their families are suffering needlessly. Over 1/2 the deaths in the United States in 2009 occured without the support of hospice. Be a patient advocate and learn how hospice can help patient's with life-limiting illness Nurses Announcements Archive Article

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Today's Hospice: It's Not What You Think

As patient advocates, we need to understand the appropriate use of hosppice. Families and patients are suffering needlessly without it. Recent research by the National Hospice and Palliative Care Organization shows over 1/2 the deaths in American in 2009 occurred without the support of hospice. It is my goal as a hospice nurse and patient advocate to better educate medical professionals to the appropriate use of this valuable medical service.

Five common myths surround the subject of hospice and inhibit its appropriate use.

Myth #1 Hospice is only for patients that are very near death.

The truth is patients can benefit from hospice as soon as the family and patient decide they no longer want aggressive treatment. Medicare requires two physicians determine the patient has 6 months or less to live. If the patient lives longer than 6 months after accepting hospice, they have a simple medical review by their hospice physician. If their health is still declining and they meet hospice criteria, they are given another 6 months of hospice. As long as the patient's health is declining and they meet hospice criteria, they can stay on hospice.

Myth #2 Qualifying for hospice care is complicated.

The truth is, obtaining the necessary assessment by two physicians is not difficult. The first physician is usually the patient's primary physician, who then refers the patient to a hospice physician. To accommodate the patient, the hospice physician or their representative will usually come to the patient for this second assessment. In this way, the patient has meet the two physician criteria

Myth #3 Hospice doesn't really do anything for patients.

This misunderstanding is based on confusion between palliative care and traditional medical care. Traditional medical interventions attempt to cure the patient's disease. Palliative hospice treatments are for comfort care only, but a patient with a life-limiting illness requires extensive comfort care. Any nurse or doctor can treat a patient's pain but hospice, like any other specialty field of medicine, has medical professionals with extensive experience and training in symptom management of terminal patients.

In fact, an entire team of medical professionals will assist the family caring for a hospice patient. Hospice patients receive visits to their home by a licensed nurse, social worker, physician, chaplain and home maker. All experienced in the delicate work of caring for the dying and their families.

Hospice also will deliver medical equipment and medicine to their home and hospice support is available around the clock by phone or home visits. Respite care to relieve care giver stress or a short term stay at a hospice facility is also offered with hospice.

Myth #4 Hospice is a service provided by churches or volunteers.

Hospice services are offered through either non-profit organizations or by for profit companies. Either way, there is little to no cost to the families for services provided by hospice. Never-the-less, families need to be aware of the profit driven aspect of this medical service. According to the Center for Medicare and Medicaid Services, over 50% of the hospice organizations in the United States in 2010 were operated by for-profit companies. Driven by profit instead of ethics, not all hospice agencies give the same quality of care.

Myth #5 All hospice companies offer the same services.

All hospice programs accepting Medicare must follow Medicare guidelines, but the delivery of this care can vary greatly from one hospice to another.

In order to have the time to find an acceptable hospice program, families need to begin their search well in advance. As soon as the patient's symptoms continue to become worse, despite repeated curative procedures, this is the time to bring up the possible need for hospice in the patient's near future. The nurse is in a unique position to bring up this subject because she/he is not directing the patient's medical treatment. That's the physician's job. Physicians may delay discussion of hospice because they do not want to appear to be giving up on the patient. The nurse can educate families regarding what hospice can provide. They need you to remind them that the physician has the medical training but only the family and patient have the right to determine how to judge the balance between patient quality of life and length of life.

Hospice and the subject of death and dying are not easy for families to think about. The analogy I often use is this, pre-planning the eventual use of hospice is similar to making pre-planned funeral arrangements. Both are uncomfortable facts of life but like many things, planning ahead for the inevitable will save unnecessary grief and expense for everyone.

katie'sangel

About katie'sangel, BSN, RN

Hospice RN, BSN, certified hospice nurse with 10yrs experience. Dedicated to the improvement of end-of-life care.

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I am currently a student at the University of South Florida. We are fortunate enough while in Psych clinicals to do rotations with the Palliative Care Team and on the Palliative Care Unit. While not exactly hospice, the comfort of the patient is the main concern. I likened it to this.... The patients have their cardiologist for their heart, the nephrologist, hematologist... etc. Those are all doctors that care for the person's disease. The Palliative Care and Hospice doctors care for the patient. They know about the person and what they want. I have been impressed with the knowledge that the Palliative Care doctors have about their patients lives. I see true value in getting Palliative Care and Hospice consults for patients that have come to the end of what we can do for them medically or those who decide to not aggressively treat a life limiting disease.

i work in achte care. i love when palliative care gets involved . those drs are so much better at approaching the family and the pt, ordering pain, anxiety, anti nausea meds etc ... usually make a big differnece

Specializes in LTC, Hospice, Case Management.

I voted I didn't learn anything from the article but I wanted the OP to know it's only because as a LTC nurse I am a huge advocate of hospice services and am usually on the front line educating the families on why they should consider a hospice evaluation or at least a meeting with our local hospice provider to understand their services better. The biggest hurdle I usually encounter is the misconception that I'm telling them that their love one is dying tomorrow.

Specializes in Medical Surgical.

Just wanted to add to the conversation that the pts doctor is not the only one that can refer to hospice. Anyone who knows of someone who meets the criteria can refer.

Specializes in Med/Surg., Geriatrics, Pediatrics..

My mother-in-law was on Hospice for almost 2 1/2 years. The nurses were wonderful. Oddly, though, she was never seen by a Hospice Physician. When you mentioned that patients are seen by Hospice Physicians, I wondered where was her's. Everything was done by nurses and nurses only. A Chaplin did stop by every now and then, he was comforting to the family. But I must say, when I saw those Hospice nurses at work, caring for my dying mother-in-law, I was proud to be a nurse. Hospice nursing, to me, is one of the hardest parts of the nursing profession. Not only does the nurse have to comfort the dying, they also comfort the whole entire family.

New regulations by Medicare require more frequent visit by the hospice doctor or a nurse practitioner. MD or NP has to see pt about once a month, depending on how long the pt has been on hospice

I agree and several nurses have posted the same. We nurses can make a difference because we are the only medically trained staff at the bedside that aren't hired to Cure the patient. Nascare nurse stated her/his? patients freak out with the mention of hospice from their nurse. If we nurses get that reaction, you know the MD ( in many cases ) will wait till the patient is literally on their death bed before suggesting hospice. My goal is to get these families and patients to hospice much earlier in their disease projector so we have the time to help them

Specializes in CCM, PHN.

Great article. My only issue is that the Medicare guidelines sometimes create "hospice hoppers," because the term is only 6 months. It's sometimes the case that because the palliative care provided during the term prevented decline so well, the patient is discharged as soon as 6 months is up. Then they have to appeal or find another hospice. It's kind of weird.

Specializes in Hospice, LTC, Rehab, Home Health.

The attending physician may elect to maintain full medical management and allow the Hospice MD only to weigh in on the recertification process so the family may not have any meaningful interaction with the hospice MD. Sometimes this works out well, but sometimes not. It depends on how well educated the PCP is on comfort care and how open he/she is to the suggestions offered by the hospice nurses.

huh

need more patience

Specializes in being a Credible Source.

I'm a huge fan of hospice though the quality of the care can be highly variable even within the same hospice agency.

A good hospice nurse might be one of the most important healthcare clinicians that some people ever have.

Dying can be handled so much better than it often is.... 'tis terribly sad to be to see EOL happening in the hospital.