Vetting Hospice Care Before The Crisis

Vetting Hospice Care Before The Crisis

12 Questions to Ask When Choosing Hospice Care for a Loved One

Rosie’s story broke my heart. When a medical crisis landed her in the hospital yet again after a courageous and lengthy battle with breast cancer, Rosie accepted her need for hospice. Before moving to a hospice center, she enjoyed a day of shopping for a nightgown, manicures, pedicures, and watching funny movies with her niece, Jane.

Upon entering hospice, the provider immediately withheld all fluids. The prescribed morphine shots did not sufficiently address her pain.  On her third day in hospice, Rosie stopped talking and groaned loudly for hours for the next week. She died after ten days in hospice. Jane was distraught and questioned whether Rosie had received the right care.

That is not how hospice should be.

Not all providers offer the level of care that is the hallmark of true hospice. Once you understand the many reasons to embrace hospice and learn what hospice should be, you and your loved ones can prepare to choose hospice wisely, should the need ever arise.


Hospice Care

Photo credit: Depositphotos / alexraths

Hospice offers a range of services.

Well-managed hospice provides an array of services delivered by a team of interdisciplinary caregivers. Together, the team addresses the needs of the entire family.

  • Physicians order medications, treatments, medical equipment and supplies to control pain and symptoms, and to manage the overall care of the patient.
  • Nurses assess the patient frequently and make adjustments to achieve the greatest possible comfort care. Nurses also recognize how the stress of caregiving might be impacting the health of a family member.
  • Nursing assistants and home health aides attend to personal care, such as bathing and other activities of daily living, offer support to the family and companionship.
  • Social workers coordinate care, particularly for non-medical needs, for the patient and the family. Social workers can be instrumental in shepherding the patient and family through the emotional and relational dimensions of the journey.
  • Chaplains or spiritual advisors explore the spiritual questions and concerns patients and families face through the end-of-life journey.
  • Bereavement specialists help patients and families cope with loss. In fact, bereavement services are typically offered to family members for at least a year after a patient’s passing.
  • Volunteers offer support, respite for family caregivers, light housekeeping, companionship and may run errands.
  • Hospice staff are available by phone 24/7 to address patient and family concerns, and to quickly respond to medical needs. Additionally, hospice staff manage the notification of death to the county and coordinate the removal of the body according to the patient’s and family’s wishes.
  • Family members are considered part of the hospice team, especially when hospice care is delivered in the patient’s home.

Hospice team members come and go, coordinating care, offering services, comfort and support. Hospice does not swoop in to replace the family. Loved ones often continue as the primary caregiver(s) for patients who remain at home. Some families therefore choose services offered at a hospice center, feeling overwhelmed, exhausted and unable to continue caring for a loved one at home.

Vetting hospice before a crisis is a prudent step for those with a loved one who is nearing the end of life.

Choose wisely.

When selecting a hospice provider, patients and families must choose wisely. Due diligence is advised. In fact, researching hospice options prior to a crisis affords the opportunity to ask difficult questions more objectively. The following 12 questions will get you started. By all means, add you own. As you interview hospice providers, explore:

  1. How long has the hospice provider been in business?
  2. What is the staffing model and how is care coordinated across caregivers and team members?
  3. Is there continuity in the staff assigned to care for a patient?
  4. How frequently do physicians and nurses visit?
  5. What other professional services are part of a hospice team and how frequently do they visit? For example, are social workers, chaplain, massage therapy, or music therapy available?
  6. What is the provider’s approach to giving comfort care? For example, what options are offered regarding artificial food and hydration? Self-managed pain medication?
  7. Are financial limits set on approved palliative treatments based on cost? For example, if Medicare will not reimburse a given treatment, will it be unavailable even if requested or necessary?
  8. How are patients transitioned out of hospice if health status improves? Can they transition easily back into hospice?
  9. How are patients re-qualified to continue hospice care beyond the six-month Medicare approved timeline?
  10. Is a hospice center available if managing hospice for a loved one at home is no longer feasible for an overwhelmed family?
  11. Is short term care available at a hospice center if family members need respite?
  12. What is the cost of hospice care delivered by the given provider?

Dying is more personal than medical.

In his best selling book, Being Mortal, author and surgeon Atul Gawande reflects how our healthcare system typically applies science and technology—often to extremes—to solve the problem of dying. Family members’ denial of impending death coupled with a physician’s training and genuine desire to heal fuels the chase to find one more treatment, one more medication. The fog of the crisis veils the reality that dying is not a fixable problem.

Hospice care defies the “medicalization” of dying.  In his remarkable work Dying Well, Dr. Ira Byock, Professor of Medicine and Community & Family Medicine at the Geisel School of Medicine at Dartmouth, writes that dying is a far more personal process than medical. Hospice care reclaims the very personal nature of dying for patients and families.

Request hospice in your directive.

By including instructions to pursue hospice for end-of-life care in your healthcare directive, you can spare family members the difficulty of wondering whether or not to suggest hospice. When symptoms and pain are effectively managed, and emotional and spiritual needs are attended to, patients in a hospice setting can pass peacefully, with dignity, surrounded by loved ones.

QUESTION: If you or a loved one have been blessed to receive hospice care, would you please share your story and inspire others via social media? Please share this post with your comment.



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