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When is hospice care appropriate?
Hospice care is appropriate when an individual with a life-limiting illness desires comfort care. Hospice emphasizes quality of life rather than length of life. Hospice is typically offered when the prognosis could be six months or less if the disease follows its usual course. Although many hospice patients have a diagnosis of cancer, patients with any end-stage condition may receive hospice care. Individuals with advanced illnesses such as heart disease, lung disease, Alzheimer's disease or dementia, stroke, or kidney failure may qualify for hospice services.
How do you access hospice care?
Anyone may call St. Vincent Hospice for information. Calls are answered 24 hours a day, seven days a week. The phone number is (317) 338-4060 or toll-fee (888) 780-7284. The hospice staff can contact your physician and/or your insurance provider to assist you in accessing hospice care.
Does insurance/Medicare pay for hospice?
Medicare, Medicaid and most private insurances cover hospice care. If a patient has no coverage for hospice services, St.Vincent Hospital can provide financial counseling. The St.Vincent Hospice policy ensures that no one is denied services based upon ability to pay.
Although Medicare pays for hospice care, Medicare does not cover room and board (known as custodial care) in an extended care facility. The patient pays room and board fees. If a patient has both Medicare and Medicaid coverage, Medicare pays for hospice care and Medicaid pays for room and board at the extended care facility. When a qualifying individual elects to have Medicare pay for "skilled" care (complex medical care or rehabilitation) at the extended care facility, he or she is not eligible for hospice services through Medicare at the same time. The hospice staff can help to determine Medicare and/or Medicaid eligibility and coverage. www.medicare.com
Where is hospice care provided?
Hospice is a concept of care, not a place of care. Patients can receive care in several settings. Many patients prefer to receive hospice care in their own homes. In those cases, home care team members visit on a scheduled basis and are also on-call for urgent needs.
Individuals residing in nursing homes, or extended care facilities, are also eligible for hospice home care. Hospice staff coordinates care with the facility staff, and provides pain and symptom management services as well as emotional and spiritual support.
The St.Vincent Hospice inpatient unit is available for intensive symptom management or short-term crisis care. Inpatient care might be necessary for physical symptoms, such as pain, nausea, vomiting, agitation or respiratory distress, which have not responded to treatment at home.
The patient can also use inpatient care when family or caregivers are unable to care for the patient at home due to physical or emotional limitations or exhaustion. Stays in the inpatient unit are generally brief. The patient usually returns to the home setting when the symptoms or situation are under control. If the patient is unable to return home, the hospice assists with alternative placement.
Respite care in the St.Vincent Hospice inpatient unit is available for short-term stays (usually five days or fewer) to give the caregivers a break from 24-hour responsibilities. This allows family members or caregivers an opportunity to rest or participate in planned activities or family responsibilities.
The St.Vincent Hospice inpatient unit provides residential care on a limited basis subject to availability. Patients who do not meet criteria for inpatient care, yet desire care in the inpatient setting, can use residential care.
Who are the hospice caregivers?
An interdisciplinary team cares for hospice patients. The team members work with the patient and family to develop and implement a plan of care. Team members include:
- Attending Physician: The attending physician is usually the patient's own primary doctor who works directly with the hospice team in the day-to-day management of the patient's care.
- Hospice Physician: The hospice medical director and team physicians direct the hospice team's patient care. The medical director or team physician also acts as a resource for other physicians and can assume the role of attending physician if requested.
- Registered Nurse: The hospice nurse acts as a case manager and coordinates the team's patient care. Hospice assigns each patient a primary nurse who assesses the patient's physical and emotional needs, including vital signs, level of pain, medication and equipment requirements, nutritional status, and mobility. The hospice nurse is specially trained to manage pain and other symptoms, and answers questions and educates the patient and family about care.
- Social worker: The social worker assesses the patient and family's emotional, cultural, psychological and social needs, including coping skills, financial counseling and assistance, and support systems. The social worker provides emotional support and makes referrals to other services or community agencies.
- Chaplain: The chaplain assesses the patient and family's spiritual needs and religious preferences. The chaplain works closely with the patient's own clergy and can provide additional spiritual resources or support. Chaplains can also assist with funeral planning and bereavement services.
- Home Health Aide: The home health aide provides direct personal care, including bathing, mouth care, skin care and socialization. The home health aide also assists with walking and range-of-motion. Aides work under the supervision of the nurse case manager and report any changes in the patient's condition.
- Dietician: A registered dietician is available for consultations about nutrition.
- Therapists: Therapists are available to provide physical, occupational and speech therapy.
- Volunteer: Volunteers receive special training and provide socialization, visitation and active listening for patients and families. They can be friendly visitors for those with limited support from family or friends. Volunteers also assist with emotional support for the family both before and after the death of the patient.
What equipment/supplies are provided?
The hospice team assesses the need for medical equipment and provides any necessary equipment such as hospital beds, oxygen, walkers and wheelchairs, shower chairs, and bedside commodes, as needed. Hospice contracts with a medical equipment company to deliver and set up the items required.
Hospice delivers patient care supplies to the patient's location. Supplies may include incontinence pads and briefs, dressings and bandages, bedpans, urinals, and catheters. The patient/family is responsible for non-medical supplies, including toiletries, linens and gowns.
How are medications administered?
Hospice covers medications related to the hospice diagnosis. Hospice also provides medications, including narcotics, as needed for comfort and symptom management. Hospice does not cover medications not related to the patient's diagnosis, and the patient must purchase most non-prescription medications.
The hospice nurse reviews the medications the patient is taking, makes recommendations, and contacts the physician to obtain orders for any new medications. The hospice nurse teaches the patient and family about medication and discusses actions, side effects and administration.
St.Vincent Hospice has an on-site pharmacy for inpatients and home care patients. The hospice nurse can usually deliver medications at a scheduled visit if the patient knows when he or she will need refills and notifies the nurse in advance. Patients and families may pick up medication at the hospice pharmacy if required. Hospice can also work with a local pharmacy or delivery pharmacy for urgencies or after-hours crises.
How often will team members visit?
Upon admission to the hospice home care program, the nurse case manager works with the patient and family to develop a plan of care specific to the patient's needs. This plan details which team members will visit and how often. Visit frequency may change as the illness progresses. Although regulations require that the nurse visit at least every two weeks, the patient and family may decline visits from other team members if they wish.
Hospice encourages patients or caregivers to call if the patient's condition changes or questions arise. Pain, changing symptoms, caregiver questions or equipment problems can require a visit.
What if the family cannot care for the patient at home?
Family members are usually able to safely care for a hospice patient at home with the help of the hospice team. If the patient wishes to remain at home and the family desires more care than the visiting hospice staff can provide, we can offer a list of agencies providing private duty or companion care at home. Hospice does not cover these services.
The St.Vincent Hospice inpatient unit can provide care for a short-term crisis or symptom management. If the patient is not able to return home, the hospice staff can provide a list of extended care facilities in the area.
What if the patient lives alone?
In the early weeks of care, it may not be necessary for someone to be with the patient all of the time. Many patients are physically and mentally capable of living alone and can manage with intermittent visits by the hospice team. As the illness progresses, the patient may require more assistance. The hospice staff assesses the patient's needs on an ongoing basis and makes appropriate recommendations.
Should the patient have an advance directive?
Advance directives are documents that state an individual's preference about medical treatment decisions or designate another person to make decisions on the individual's behalf. They are called "advance" directives because they are signed in advance to inform doctors and other health care providers of a patient's wishes. Through advance directives, a patient can make legally binding decisions about future medical care. These directives take effect when a patient is no longer able to make his or her own health care decisions.
Although hospice does not require a patient to have an advance directive, families often find it very helpful and comforting to know their loved ones wishes. Hospice social workers are available to discuss and assist in preparing advance directives.
Other terms you should be familiar with include:
A living will is a document that informs doctors and other health care providers of the patient's wishes concerning life-prolonging treatments or procedures when a terminal condition exists.
A health care representative document allows the patient to appoint another person to make medical decisions if he or she is no longer able to do so. This document also makes it possible for a patient to state specific wishes regarding life-prolonging treatments or procedures.
A power of attorney is a legal document that enables an individual to appoint another person to make decisions about financial affairs, in addition to health care decisions, should he or she become unable to make those decisions.
Upon admission to the program, hospice asks the patient to state his or her preference regarding life-prolonging procedures such as artificial respiration or cardiopulmonary resuscitation. If a patient does not desire attempts at resuscitation in the event of cardiac or pulmonary arrest, hospice informs the attending physician. Hospice obtains a DNR (Do Not Resuscitate) order from the physician. This DNR enables hospice staff to allow the patient to die peacefully and naturally.
What happens if we need help at night or on the weekends?
Hospice provides assistance 24 hours a day, seven days a week. The on-call hospice nurse is available for urgent problems and after-hour visits. Patients and families need to call the hospice office. Do not call 911 unless you want life-prolonging, aggressive interventions.
A chaplain and social worker are also on-call for spiritual or emotional needs. A home health aide is on-call on Saturday and Sunday from 8:00 a.m. - 4:30 p.m. A member of the administrative team and a hospice physician are also available.
Can a patient cancel hospice services?
A patient can cancel or revoke hospice care at any time for any reason. Hospice asks the patient or responsible party to sign a Revocation of Hospice Benefits form. The patient is then no longer covered under the hospice Medicare benefit and regular Medicare coverage resumes. Non-Medicare patients may also revoke hospice.
A patient may elect to resume hospice services at any time if medically eligible. The hospice representative discusses the patient's eligibility to re-enter hospice at the time of discharge. Hospice may not discharge any patient because he or she is unable to pay for hospice services, the illness is too expensive to manage, or the condition requires hospitalization for symptom control.
What if the patient dies at home?
Most hospice patients choose to die at home. The hospice team educates the patient and caregivers and prepares them for what to expect during the dying process. A family may elect to have private time with their loved one during this time or may request the hospice staff to be present. At the patient or family's request, hospice will arrange a transfer to the inpatient unit when death appears imminent.
In hospice care, death is usually anticipated and is quite peaceful. When a hospice patient dies at home, the family needs to call hospice; do not call 911. A hospice nurse confirms the patient's death and provides emotional support. The nurse also notifies the physician. A chaplain or social worker also may visit at the time of death to provide additional emotional and spiritual support.
The hospice nurse prepares the body and calls the funeral home if desired. The nurse also notifies other team members and disposes of all unused medications. Hospice cannot accept unused medical supplies. However, many families donate them to charity. (The hospice staff can provide a list of charities; most will pick up the supplies at the patient's home.)
What support is provided after death occurs?
Hospice offers bereavement care to the patient's family members or significant others for a period of at least thirteen months from the date of death. The bereavement assessment process begins at admission to the hospice program. Staff contacts the bereaved within six weeks from the date of death to initiate the formal bereavement process. The hospice bereavement program can provide encouragement through phone calls, newsletters and grief support groups. Hospice also offers memorial services and educational programs periodically.
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