In a recent post, I wrote about the most common misperceptions people have about hospice care. I was glad to have an opportunity to clear up some of these misunderstandings and, in the process, educate readers on what hospice care is and how it helps terminal patients and their families.
Still, one question families often struggle with is knowing exactly when to involve hospice and how the process works. To be clear, it’s not an exact science. Generally, though, for a patient to be considered for hospice care, he or she must be diagnosed as terminal with a life expectancy of six months or less. Also, the patient has to agree not to receive any treatment intended to cure the underlying disease or condition. They can only receive care that improves quality of life and manages symptoms.
I often advise families that if their loved one has been diagnosed with COPD (chronic obstructive pulmonary disease), or suffers from an advanced case of dementia, it may be time to talk to a doctor about hospice care. Other signs might include repeated falls or unexplained weight loss.
That said, once these criteria have been met, the best time to get the patient into hospice is simple: get them in as early as possible. The professional caregivers at a hospice center are trained and experienced at providing end-of-life care, which means that the sooner you get the patient under their care, the faster they and their family members can benefit from all the services that are available.
Starting the process is also a little blurry. While a physician referral is required to admit a patient into hospice, the patient or a family member can be the one to request that referral. Even a friend or pastor can make this request. Sometimes, the patient’s family or friend initiates the process, and other times, a physician will make the initial recommendation.
Another concern many families have is the cost of hospice care. Generally, these costs are covered by most private health insurance plans, as well as Medicare and Medicaid. That said, many non-profit hospice care providers make their services available regardless of the family’s ability to pay for them. So, there’s no need to delay hospice care services to keep costs down.
Another important fact about hospice care is that it’s not only for the elderly, which is a common misunderstanding. A patient of any age can be eligible if they are diagnosed with a terminal illness and it’s been documented by a certified physician that their life expectancy is six months or less. Our patients tend to be older and often have what we call a “failure to thrive,” which may not be specific to a particular disease. However, if they’re being hospitalized repeatedly for infections, such as urinary tract infections, or they’ve lost their desire to eat, it may be time for hospice care.
The bottom line is that determining when to start hospice care is sometimes not a clear-cut decision, especially for the family. That said, I’ve found that patients and their families know intuitively when it’s time to focus on making their loved one’s quality of life as fulfilling as possible during the time they have left.