The goal of home health and hospice care is the same-providing the best comprehensive care for the needs of the patient. The difference between home health care and hospice care is the focus of that care.
Home health care is focused on curing the patient’s condition. All treatments are oriented toward healing the patient. Treatments include medication therapy, radiation, surgery, experimental care and treatment outside accepted medical practice. Once it becomes clear that cure-oriented treatment will no longer benefit the patient, transition to hospice care will address the patient’s and family’s needs more appropriately. If the disease runs its normal course, life expectancy is six months or less. Hospice care is focused on helping patients comfortably transition through their end-of-life experience.
The Hospice Medical Director and the interdisciplinary team use the latest methods in pain and uncomfortable symptom control to allow a patient to live life as fully as possible. A comprehensive assessment is completed to develop the hospice interdisciplinary care plan. The care addresses medical, emotional, psychological and spiritual needs.
Hospice is a caring, sensitive approach to meeting the needs of the patients. Under the Hospice philosophy, the last days are spent with dignity at home, if possible, or in a setting where care is provided appropriately. The patient retains control over their lives with the support of Hospice. The patient and the Hospice team address problems together and the Hospice team supports the patients in their choices. Care and support is also provided to the loved ones of the dying patient. This care and support is provided after the death of the patient, assisting caregivers and families in the grief process.
Hospice affirms life and regards dying as a normal process. Hospice neither hastens nor postpones death. Each death is an individual experience and the Hospice Team is there to provide needed support.
Four Levels of Hospice Care
Hospice care is provided in the home or a home-like setting. The goal is to allow the patient and loved ones as much independence as possible and provide the patient with the support needed to allow their last days of life to be lived with dignity, free of pain and other uncomfortable symptoms. The four levels of care provided under Medicaid and Medicare coverage are:
- Routine Home Care: Care is provided in the home or if the patient is in the hospital for a condition unrelated to the terminal illness. The care is intermittent as the hospice team visits the patient periodically to provide care.
- Continuous Home Care: Continuous care is provided only during a period of crisis as necessary to maintain the terminally ill patient at home. A sudden increase in pain which is not controlled, a change in level of consciousness or family members that are in crisis as death grows closer.
- Respite Care: Provide care to patients in an inpatient setting whose caregivers need respite. The patient is placed in a contracted facility that provides daily care. A patient may be placed for up to 5 days at a time for inpatient respite. The hospice team continues to visit the patient daily to monitor and facilitate care.
- Inpatient Level of Care: Patient requires care that cannot feasibly be provided in the home or the home support has broken down. The care is provided in a contracted facility with an RN on site 24/7. The hospice team continues to visit the patient daily to monitor and facilitate care.
Commercial insurance hospice care is provided on a case by case basis. The Case Manager from the insurance company must be involved in developing the hospice plan of care and level of care provided.
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How Hospice Supports the Family and Caregivers
It is never easy and sometimes very hard to care for a dying loved one. At the end of a very long progressive illness, the days and nights can be very long and lonely. Families/caregivers can become overwhelmed, frightened and unsure of the future. Hospice not only cares for the patients, but the family/caregivers as well. Hospice staff and volunteers provide support in many ways.
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- Addressing the physical needs of the patient, such as hospital bed, bedside commode or walker
- Attempting to fulfill the heartfelt needs of the patient, as much as possible
- Serving as a go-between for the patient and their doctor
- Teaching the family/caregiver how to administer pain medications
- Instructing the family/caregiver on how to make caring for the patient a team effort
- Encouraging the family/caregiver to surround themselves with a network of support from friends or church members
- Challenging the families to reminisce and take time out for lighthearted moments with the patient
- Urging family members/caregivers to express their true feelings about what is happening
- Preparing the family/caregiver for when the patient passes away, adjusting expectations, who to call first, when the time comes. This training is often a comfort to the family/caregiver.
- Give the family/caregiver breaks and running errands.
- Offering companionship to the patient.
- Assisting with funeral plans as needed, sending cards and letters and offering continuing psychological and spiritual support to the family/caregiver as long as needed.
Medicare/Medicaid Hospice Benefits
Hospice is primarily a home care service which provides reasonable and necessary medical and support services for the management of symptoms and pain associated with a terminal illness.
Covered Services include:
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- Physician services from the attending physician, and other consulting physicians as deemed necessary for control of pain and other symptoms.
- Nursing Care provided by registered nurses who visit patients/families as needed to perform nursing techniques, instruct and support the patient, family and caregivers.
- Medical/Social Services provided by certified social workers, and dieticians to assist patients and families in coping with special concerns.
- Personal Care Services provided by experienced home health aides who give bed baths, skin care, shampoos, change bed linens, and clean patient’s bedroom and bath.
- Therapy Services are provided by physical therapists. The need for therapy services is determined by the Hospice Team.
- Volunteer Services provided by trained men and women who visit patient/families to share friendship, assist with errands, and relieve the caregiver for short periods of time.
- Spiritual Services available from the Hospice spiritual care coordinator for patients/families who need or request this service.
- Medical Supplies and Equipment covered when needed for care related to the patient’s Hospice diagnosis.
- Drugs and Biologicals for pain and symptom management when related to the Hospice diagnosis.
- Inpatient Care during a medical crisis provided in contract hospitals and skilled care facilities. These admissions must be approved by the Hospice Team when it is related to the patient’s Hospice diagnosis.
The Five Stages of Dying
When a patient is diagnosed with a terminal illness, they will often experience the five stages of dying as defined by Elizabeth Kübler-Ross.
- Denial: “I am not ready to die. There must be some mistake.”
- Anger: Suddenly you are no longer in control of your life, you are helpless and it makes you angry.
- Bargaining: You try to make a deal with God, you are willing to promise anything if it gives you more time.
- Depression: This is a normal part of the dying process. You are aware of the pain your death is causing your loved ones.
- Acceptance: You become less emotional, calmness settles in and you realize that it is alright for you to die.
Patients will usually elect hospice in this final stage of acceptance. Acceptance is not doing nothing, defeat, resignation or submission. Acceptance is coming to terms with reality. It is accepting that the world will go on without you. Death is as much a part of life as living.
The patient or designee signs an election form that documents their decision to receive hospice care for their terminal illness and to no longer seek curative measures. The election of hospice does not affect the care a patient receives for other medical conditions. A patient is not required to be a DNR. This is their choice and not a requirement of hospice.
When the patient elects hospice, the coverage is reviewed with the patient and their loved ones so they have a complete understanding of the program.
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