Saturday, July 27, 2013

Hospice, How to Know When It's Time To Call

HOSPICE Women's Dark T-Shirt

As a former hospice nurse, it was common for patients and their families to wait too long before using hospice services because they simply didn't know when to contact hospice.

If you or your loved one wishes to have palliative or comfort care only and no longer wish to have extensive tests, hospital stays or have CPR performed if the heart stops and there is a marked decline in overall health, it may be time to contact hospice.  Anyone can ask for a referral to a hospice service.  Your doctor or the hospital can make a referral for you if hospice is what you desire to assist with comfort care during the end stages of life.

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I have encountered instances where a patients own physician has refused to allow their patient to go onto hospice services for various reasons.  Some physician's simply do not believe in hospice and still have the mindset of "we can fix this" or "it's not time yet", when the patient and family know their loved one has little chance of recovery or improvement.  In this case, a patient and or family can by-pass their own physician and contact any hospice on their own and request and evaluation to see if they meet the criteria for hospice services.  After the evaluation, the hospice nurse will contact your own physician for an order of referral.  If the physician denies the request, you have the option to utilize the hospice medical director as your physician, he or she can accept you onto the hospice service.  The main criteria is having 6 months or less to live, providing the disease follows the natural course. 

Who pays for hospice services?  Medicare pays 100% of hospice if you are over 65 as well as many private insurance carriers.  If you are not on Medicare and do not have private health insurance the hospice you choose will assist you in obtaining Medicaid or help to ensure you receive hospice care.

Patients sometimes improve or stabilize while on hospice care and stop showing signs of decline, in this case, your doctor or the hospice physician will discharge you from hospice care.  If your condition declines or worsens again at a later date, you will again be reevaluated for hospice services if you so desire.

Hospice does not provide 24 hour care in the home.  A nurse will visit at least once a week or as often as necessary if needed.  A nurse is always on-call and can generally be at your home quickly should you need assistance.  Nursing assistants are usually assigned to assist with bathing, dressing and feeding based on your needs.  In addition, a hospice chaplain and social worker as well as volunteer services will be assigned and readily available to you or your family.
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Some hospice services have their own in-patient facilities, some do not.  If you or your loved one can not be cared for at home, hospice DOES NOT COVER long term care room and board if you are on Medicare, but Medicaid does.   Or perhaps you have private insurance for nursing home/long term care coverage.   This is something you need to consider.  Caring for a loved one at home is rewarding but also can be tiring and wearing on just one caregiver.  Many families try to line up several family members to assist in the care to give the primary caregiver a much needed break, even  if it's just for a few hours to go to church, an appointment or grocery store.  If you ever find yourself as a caregiver in a situation where something comes up such as an appointment for yourself, you can ask hospice if someone is available to come sit with your loved one for a few hours, most are happy to accommodate you.

Again, if you unsure if you are ready for hospice because of your current illness or eligibility for hospice services, give any hospice a call, they will be more than happy to answer your questions.  After all, it's what they are there for. 

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