First and foremost, hospice is a philosophy of care. It emphasizes palliative or comfort care for those with a life-limiting illness who are either choosing not to pursue aggressive treatment or no longer have aggressive treatment options available to them. Hospice focuses on the patient and the family as a unit, providing not just physical support but emotional and spiritual support as well, so the patient can make the best of every day.

Hospice services are for the patient and family, coordinated with your physician. We provide a medical director, case manager, home health aide, social workers and spiritual coordinators. We have volunteers who provide services such as pet therapy and massage therapy, and we offer bereavement services.
After the second sentence add this sentence: We provide medications, equipment and supplies related to the hospice diagnosis.

Your physician, the patient and the family are all part of our hospice team. The entire team works together so that we can develop an individualized plan of care to meet each patient’s specific needs. Our hospice nurses are required to call the physician for any changes in orders that would affect the plan of care.

We have found that the best way is to simply ask your family member. Ask what their goals are. If they say things like “I don’t want to go the hospital anymore,” “I just want to go home,” or “I’m tired of being in pain,” it’s probably time to have a hospice discussion. If they say they want to continue aggressive treatments or they want to do everything possible, then maybe it’s not quite time to have that discussion.

Hospice is not just for people who have cancer. Hospice is available to any patient with an end-stage condition. Actually, less than 50 percent of our patients have cancer. Other leading diagnoses for hospice are heart disease; debility; dementia, including Alzheimer’s disease; lung disease; and stroke.

You can have hospice at home, but you also can have hospice in a personal care home, assisted-living facility, a skilled nursing facility, independent living, and also, if appropriate, you can have hospice services in a hospital. We go wherever you are.

Hospice is about comfort. We will make every effort to keep a patient comfortable whereever they call home. Sometimes a symptom arises in the course of the patient’s care that is not able to be controlled despite home hospice interventions. In these cases, patients can be admitted to the hospital short-term to get that symptom managed under the hospice general inpatient benefit. The goal is to get the patient comfortable as soon as possible so that they can return home.

Hospice is covered by Medicare, Medicaid and most private insurances. The services covered include medication, equipment and supplies related to the hospice diagnosis, as well as the patient care team that is assigned. In addition, if you have a condition that is unrelated to the hospice diagnosis, your insurance continues in the same manner as it did prior to the hospice start date. Most hospice patients experience no out-of-pocket expenses, with zero copay or deductible. Your insurance will be reviewed upon referral.

Talk about how hospice services can help patients achieve their goals. Explain that the nurse coming to their home will help them remain pain-free, that the nurse’s aide can help them with their activities of daily living, that the social worker can help them resolve any issues that they have. Explain to them that hospice will help them have the end-of-life experience that they desire.

We provide a respite level of care for families who may need a break from taking care of their loved one. To accomplish this, we pay the patient’s room and board for up to five days at a skilled nursing facility, and we cover all the medications, equipment and supplies related to the terminal diagnosis. For the patient’s safety, we also provide transportation to and from the facility.

Hospice focuses on much more than just the patient’s physical pain. The hospice nurse does a full physical assessment during each visit and reports back to the physician. With that information, the physician can make recommendations for pain and symptom control, which the nurse can then implement. Medications will be delivered right to the patient’s door. In addition, hospice provides emotional and spiritual support for the family and the patient. Bereavement services are initiated once the patient passes away.

Hospice is about making patients as comfortable as possible. We encourage patients to continue to engage in all their activities as they can tolerate them. You do not have to be home-bound to be on hospice. With adequate pain and symptom control, you can focus on living.

The facility is still considered the primary care giver. We don’t replace them. We come there and give them the additional support they need. We create a bridge between the family and the facility so that all parties understand the patient’s objectives and work together to achieve them.

Almost all our patients are aware they are nearing the end of their lives. For them, hope means having the end of life experience that they desire – to be in the location of their choice, surrounded by family and friends, pain free, symptoms under control, and enjoying the most of every day.

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• Creatinine clearance < 10cc/min (15cc/min in diabetics)
  • Supporting indicators:
  • Signs of uremia
  • Intractable fluid overload
  • Oliguria <400cc/24 hours