Hospice Care
THE HOSPICE PHILOSOPHY
Hospice is a special kind of care designed to provide treatment and support for those with a terminal illness and a prognosis of six months or less if the illness takes its expected course. Hospice care seeks to enable patients to live a symptom and pain free life so that their remaining time may be spent with dignity and quality at home or in a home-like setting.
The focus of hospice care is palliative treatment or comfort. Palliative medicine involves the management of symptoms in an effort to provide maximum comfort to the patient. Hospice clinical staff members understand the symptoms of advanced illness and know how to alleviate those symptoms.
Together with the patient's attending physician, the patient and the hospice care team establishes and monitors a plan of care that incorporates reasonable and necessary medical and support services for the management of the terminal illness. Part of this plan is to avoid unnecessary hospital stays and emergency room visits.
Hospice neither hastens nor postpones the patient's death. Pain management and symptom relief are primary hospice care goals. Likewise, alleviating emotional and spiritual pain are considered as important as relieving physical pain. Addressing all three requires the skills of a hospice care team, and coming under their care before symptoms escalate can benefit both the patient and the family.
WHO BENEFITS FROM HOSPICE CARE?
Hospice serves patients who have a progressive, life limiting illness for which aggressive or curative therapy is no longer an appropriate option. The patient, the family, and caregivers are the unit of care. Diagnoses may include chronic diseases that are approaching end-stage, such as:
- lung disease
- AIDS/HIV
- cancer
- cardiovascular disease/heart disease/stroke
- Parkinson's disease
- dementia/Alzheimer's disease
and other life limiting illnesses. Support, education, intervention, and grief and loss services for the family and caregivers contribute significantly to the well being of survivors.
Health care providers have long held the belief that patients can live longer under hospice care. A recent study published in the March 2007 issue of the Journal of Pain and Symptom Management supports this belief. Researchers from the National Hospice and Palliative Care Organization (NHPCO), in collaboration with Milliman, Inc., a highly regarded consulting and actuarial firm, conducted the study. They selected 4,493 patients diagnosed with either congestive heart failure or cancer of the breast, colon, lung, pancreas, or prostate, and analyzed the difference in survival periods between those who received hospice care and those who did not.
Among the groups studied, patients who chose hospice care lived an average of 29 days longer than similar patients who did not choose hospice care. And, according to the study, these patients had improved quality of life. Even more important than living longer, hospice patients tend to live better. This is good news not only for patients, but for their families as well.
WHAT ARE THE LEVELS OF CARE?
Routine Home Care accounts for the majority of hospice days of care. A patient's home may be a primary residence, a nursing facility, an adult care home, an assisted living community, or a hospice residential facility. The hospice staff visits on an intermittent basis at a frequency designed to meet the care, teaching, and support needs of the patient and family.
Continuous Care may be used for the hospice patient experiencing more intense care needs. Medicare defines this level of care as appropriate for a period of crisis and states that it may be used only as necessary to maintain the patient at home. Care must be provided for a minimum of eight hours in a 24-hour period (defined as midnight to midnight). The majority of care must be provided by an RN or LPN and supplemented by a certified nursing assistant. The eight hours does not have to be in one block but may be provided intermittently throughout the 24-hour period.
Short-term General Inpatient Care is available for the patient requiring pain control or acute and chronic symptom management. It may be provided in a hospital, nursing facility, or hospice inpatient unit.
Inpatient Respite Care is designed to relieve the caregivers of patients being cared for at home. It may be provided occasionally for up to five days at a time. Care may be provided in a nursing home, acute care facility, or hospice inpatient unit.
OUR SPECIALIZED CARE PROGRAMS
Hospice & Palliative Care Charlotte Region is proud to offer specialized care programs for diseases that affect a significant proportion of our patients. The first program that we are introducing specifically targets the treatment of dementia, a disease that afflicts almost 15% of our patients. Click on the link to learn more about inventive new practices Hospice & Palliative Care Charlotte Region is using to help our patients with dementia.
HOW DOES HOSPICE DIFFER FROM OTHER TYPES OF HEALTHCARE?
Hospice offers aggressive comfort care, rather than curative treatment. Under the direction of a physician, hospice nurses use appropriate methods of pain and symptom management that enable the patient to live as fully and comfortably as possible.
Hospice treats the person, not the disease. The hospice care team is comprised of professionals who can address the physical, psychosocial, and spiritual needs of the patients and their loved ones.
Hospice emphasizes quality, rather than length, of life. Hospice affirms life and regards dying as a normal process. The hospice movement stresses human values that go beyond the physical needs of the patient.
Hospice considers the entire family a "unit of care", not just the patient. Patients and their families are included in the decision-making process, and grief counseling is provided for up to 13 months after the death of their loved one.
Hospice offers help and support to the patient and family on a 24-hour-a-day, seven-day-a-week basis. For hospice patients and their loved ones, help is just a phone call away. Patients routinely receive in-home services of a physician, nurse, medical social worker, nursing assistant, chaplain, volunteer, and other members of the hospice care team.
WHAT CAN HOSPICE PROVIDE?
- Skilled nursing visits
- 24 hour on-call staff for emergencies
- Management of pain and other symptoms to ensure the patient's comfort
- Assistance with bathing and other personal care needs
- Medical social work visits for counseling, support and advocacy
- Chaplain services for spiritual care
- Bereavement support for family and loved ones experiencing grief and loss, a service also extended to the community at large
- Trained volunteer support for respite, companionship, and other needs
- Comprehensive individualized care and coordination of core medical services with the patient's physician and the hospice physician
- Liaison with appropriate community resources for other necessary services
- Coordination of care plan, if hospitalization becomes necessary
- Assistance with advance care planning
WHO DOES HOSPICE SERVE?
- Those residing in our service area, including eight counties in North Carolina
- Individuals referred and followed by their physician, and who have a life expectancy of six months or less
- Individuals whose attending physician is willing to provide on-call coverage, provide orders, and work with the hospice care team
- Individuals desiring care focused on symptom management and pain control rather than on cure
- Those who live alone and have a caregiving plan upon admission
HOW IS HOSPICE FUNDED?
Some hospice services are covered by reimbursement from Medicare, Medicaid, and private insurance. Those on Medicare or Medicaid may be eligible for a special hospice benefit.
Payment for services not covered by insurance is based on the patient's ability to pay. Those eligible for care are not denied hospice services because of an inability to pay.
The Hospice Payment System Fact Sheet, which offers providers information about the Medicare hospice benefit, is now available from the Centers for Medicare & Medicaid Services Medicare Learning Network in downloadable format at http://www.cms.hhs.gov/MLNProducts/downloads/hospice_pay_sys_fs.pdf.
Hospice seeks contributions from individuals, foundations, corporations, communities of faith, and civic organizations to help pay for services not covered by reimbursement. Memorials, bequests, planned gifts, and other contributions are gratefully received and are important sources of funding. To make a gift to Hospice & Palliative Care Charlotte Region, click here.
IS HOSPICE CARE COST EFFECTIVE?
During the last months of life, cost savings of over 30% have been realized using hospice service for the care of cancer patients. ("An Analysis of the Cost Savings of the Medicare Hospice Benefit" conducted by Lewin-VHI.)