Hospice – or “comfort” – care helps patients and their families navigate the complex issues associated with a prolonged illness, including medical care, financial concerns and living arrangements.
Hospice can be offered in a patient’s home or a care facility. It is designed to provide emotional support to patients and families, and to educate caregivers so that they are able to provide physical care to their loved one.
Hospice team members can include a registered nurse, a medical director, a home health aide, a social worker, a spiritual care coordinator, a volunteer and your attending physician, if he or she remains involved in your care. Other team members may include a music therapist, physical therapist, speech therapist or occupational therapist.
Transitioning to Hospice
Unlike other medical care, hospice focuses on treating symptoms, such as respiratory distress and pain, rather than trying to cure the illness itself.
For heart and stroke patients, a hospice referral will come from the cardiologist or neurologist.
A patient being moved into hospice care must meet several requirements, including:
- Having a life-limiting illness
- Progressive decline in status
- Continued weight loss
- Weakness and fatigue
- Other uncontrolled symptoms
For heart patients, additional symptoms may include recurrent congestive heart failure, an inability for the heart to adequately move blood out of its chambers, chest pain at rest, history of cardiac arrest and/or resuscitation, history of unexplained fainting due to loss of blood to the brain (syncope), and irregular heart rhythms that are resistant to therapy (arrhythmias). Stroke patients referred to hospice may have severe lack of consciousness or coma greater than three days duration, difficulty chewing or swallowing (dysphagia) leaving patient unable to eat enough to sustain life and post-stroke dementia.
Levels of Care
There are four levels of care in hospice.
- Routine: Patient is cared for at home or a care facility. Reimbursement to hospice is at a daily rate and all of the members of the team are available to the patient and family as needed.
- Respite: Patient goes to a facility for short-term care to provide relief to the caregiver. Patient is seen by hospice team members just as they were at their home.
- Continuous care: Used when the patient is in crisis, with pain or other symptom(s) out of control, and needs to be monitored closely by a nurse. The hours of the nurse and home health aide are counted toward the continuous care hours for reimbursement.
- Inpatient contract: Patient is placed into in a hospice-contracted facility that has a registered nurse on site for 24 hours a day. For this level of care, patient must be in crisis, with pain or other symptoms out of control, and unable to remain at home.
Hospice is covered by Medicare, Medicaid and most insurance companies, and will cover medications related to the primary hospice diagnosis, and all equipment and supplies needed to care for the patient related to the disease. Medicare Part A and Medicaid cover 100 percent of hospice care; however, payment levels vary for private insurance companies.
References: National Hospice and Palliative Organization