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Hospice: What Physicians Should Know
Determining when your loved one is ready to transition into hospice care is challenging. Family members often turn to their physicians to help them work through this decision and determine the next steps in the care plan. Visiting Nurse Association of Ohio sat down with MD News’ Jan Raabe to discuss the important information about choosing hospice care.
Q: Who is eligible for hospice benefits?
A: Hospice care is for patients who have a chronic or terminal illness with a prognosis of months vs. years. Confirmation of terminal status is received from patients’ primary physicians and the hospice medical director. Hospice provides care to patients with terminal illnesses who wish to have symptom management (palliative care) rather than curative treatment.
The majority – 38 percent – of patients referred to VNA of Ohio have cancer. Other terminal illnesses covered by the hospice benefit under Medicare include Alzheimer’s disease or dementia, chronic lung disease or emphysema, heart disease or heart failure, chronic kidney disease, stroke, HIV/AIDS, and end stage neurological illnesses such as Parkinson’s, ALS and MS.
Q: Does Medicare cover all of the costs?
A: Medicare covers the costs of hospice services 100 percent. Medicaid and private insurance companies – if they have a specific plan with a “hospice benefit” – will also cover hospice expenses.
Q: What specifically does the hospice benefit include?
A: The goal of hospice care is to improve the quality of a terminally ill patient’s life by offering comfort and dignity with a special emphasis on controlling pain and other symptoms. Hospice desires to make every day count for the patient and family. To accomplish this, hospice provides a holistic patient-centered approach to care. This includes the physical, emotional, social and spiritual needs of patients and their family.
These needs are different for each patient and family, so an individualized plan of care is developed for each … and updated routinely as the patient’s condition changes. This is completed by a team of professionals consisting of hospice-certified nurses, physicians, therapists, social workers, counselors, hospice care aide and specially trained volunteers who work together with patients, caregivers, families and personal physicians.
The care plan included ongoing medical care oversight and coordination with the patient’s primary care physician, pain and symptom management, 24-hour on-call crisis support services, patient and caregiver education, and payment for hospice-approved medications, treatments and medical equipment. Depending on the patient’s and caregiver’s needs, the plan may also include art and massage therapy, social work services and referral to community resources, hospice-approved transportation, and specialty hospice services for patients with Alzheimer’s/dementia. All hospice patients’ loved ones are offered bereavement services for 15 months following the patient’s death.
Q: Logically, the ideal setting in which a patient would receive hospice care is his/her own home. I understand, however, that patients in skilled nursing facilities can and do receive hospice benefits. What can hospice offer that the nursing home can’t?
A: Hospice care is of substantial benefit in the nursing home, as well as in the patient’s private home. Hospice offers a team of specialists, all of whom have received special education related to the principles of death and dying and the hospice philosophy. Having an extra set of eyes and ears for the hospice patient in the nursing home adds the extra layer of attention to detail and improves patient outcomes.
The same applies to acute care settings. When patients are in crisis and symptoms are too difficult to manage in the patient’s home, then hospice can be provided in the acute care setting until symptoms are managed. Hospice care can be beneficial regardless of what setting the patient calls “home.”
For patients who are actively dying, in any setting, we can also provide extended care if the family wishes. This entails specially trained vigil volunteers, nurses and/or aides – depending on the healthcare needs of the patient – who sit with patients around the clock so they don’t die alone.
Q: Why aren’t more physicians recommending hospice services sooner?
A: There are so many myths about hospice care. I’ve heard so many times, “Hospice takes a patient off all of their meds and just gives them medicine to die.” This is not true. Patients will continue to take medications that improve their quality of life. All medications have side effects, so some medications might be changed or discontinued if no longer needed. For example, a medication to reduce cholesterol might be discontinued when the patient is eating only about 25 percent of their meals. This is one of the reasons we have educational outreach programs – not only for medical professionals, but for community members at large – to dispel those myths and provide facts and valid information.
Q: There are terminally ill patients who won’t consider hospice because they don’t want to stop treatment. What do you say to these patients and their physicians?
A: The patient’s wishes always come first. With this in mind, VNA of Ohio offers a pre-Hospice Special Care program for patients with life-threating illnesses who choose to continue to receive treatment. Our Special Care team works with patients and their physicians to identify goals of care with an emphasis on pain and symptom management. In many cases, patients continue to receive treatment for their illness. In other cases, they may choose a smooth transition in hospice care.
Call VNA of Ohio Today
Learn more about VNA of Ohio hospice services, or call us today at 1-877-698-6264.
*content was repurposed directly from MD News, NE Ohio/W Pennsylvania edition, December 2013/January 2014 issue.