Thursday, March 27, 2014

Using Hospice - Is it the right thing for you?

Hello on this blustery San Diego Day.  I always love it when the weatherman isn't bored and we have rain or clouds--a great change of pace.

Today's topic is about Hospice.  What does it mean to use hospice; what are the benefits; is it right for me and my family; how will I pay for it?

Hospice is a really wonderful program and, when dealing with end of life-type issues it is a godsend.  Let's start with the money question--how will I pay for it?  The good news is that Medicare will cover hospice costs. 

What does it mean to use hospice Hospice was designed to provide you the services and equipment needed for comfort care through end of like.  This includes visiting nurses, medical equipment, and comfort care medications such as pain meds and oxygen.  The interesting thing about hospice is that a person can go in and out of hospice depending upon their needs.  We had one client who had a severe medical incident, ended up in the hospital, and was transferred into a skilled nursing facility under hospice.  She was not expected to live more than a day or two.  Miraculously she survived but was in a severely compromised medical status for a couple of months.  Hospice supported her throughout this period and managed her pain, provided chaplain support to the client and family members, and coordinated all needs with the skilled nursing facility.  After two months the client had recovered enough and she wanted to receive physical therapy to regain her strength.  She signed herself off of hospice and recovered enough to move out of the SNF and into assisted living.  She has continued to get stronger and is now off her walker and using a cane.

There are other times that a doctor may recommend hospice to a patient even though they are not in imminent danger of passing on.  The reason they do this is that hospice will provide help in the home that is not otherwise covered by Medicare. Hospice will evaluate all of those things needed to keep the patient safe and comfortable and have them provided without the patient having to do anything. If a hospital bed is needed it will be brought in. If the O2 saturation level is low (this can cause agitation) oxygen will be delivered.  Medications will be managed to ensure the best possible level of comfort and pain control.  And, visiting nurses will monitor all care, coordinate with the doctor, and work with your own caregivers to ensure consistent care.

What are the benefits of hospice?  You may use hospice in a hospital, nursing home, your home, or a hospice hospital.  It is a very flexible program that operations 24/7, 365 days a year.  Yes, hospice works on holidays!  You can also sign in and out of hospice as your needs change.  A hospice order must come from a doctor but you use the program as you need it.

We had a client last year that came to us as a referral from a local hospital.  The client was discharged to family but the family was not told that she was dying.  We started working with this client 2 days before Thanksgiving.  The next day our caregiver called the office to express concerns about the client's status.  I went over to evaluate and then called in the family to let them know that if the client wanted to live she needed to be readmitted to the hospital.  She was taken by ambulance and admittance was refused by the hospital because they said there was nothing that could be done for her.  She was sent home again, but this time with an order for hospice.

Unfortunately the hospital coordinator did not think that hospice would respond on a holiday weekend and never forwarded the order.  The next day, Thanksgiving Day, the family called me to say that hospice never showed up.  I immediately called Elizabeth Hospice and gave them the details. They coordinated with the hospital to get a copy of the order and arranged a hospital bed, visiting nurse, and pain management to be in place that day. O2 levels dropped creating increased agitation and oxygen was added, which caused the client to relax and become very peaceful.  She passed away the next day in her own bedroom. Family and friends had time to come in, surround her with love, and say goodbye.

A few years ago my step-dad passed away in a hospice hospital.  He had fallen and incurred very severe injuries that could not be survived.  The hospice hospital provided wonderful support and ensured that he was kept comfortable through his last days.  The hospice social workers and chaplain coordinated with us daily to help us with the stress and grief of the loss.  This type of support is available to the family for a full year after the passing of the loved one and can be a great part of moving through the grief process.

So, what does hospice not provide?  While they do provide visiting nurses, the program does not pay for general caregiver support.  Caregivers can be a very important part of hospice support--especially in the last days when you want to make sure your loved one has all that is needed.  Some people think that they must do a 24-hour bedside vigil through those last days.  The problem is that this is exhausting and it is important to take care of yourself so that you may be there both physically and emotionally for your loved one and the rest of the family.  Caregivers will help you do that and will keep a close eye on status.  The hospice nurses will also keep you apprised of status.

Also, you cannot receive Medicare paid physical therapy if you are on hospice.  Physical therapy implies that you are getting better an gaining strength.  When you are strong enough to 

OK, now for my AltaGolden plug of the day.  AltaGolden has great experience in assisting clients with hospice support.  Planning ahead helps minimize stress when higher levels of support are needed.  You may not need help now but, if you'd like to sign up for our services, you may call us 24-hours a day when you do find you have a need.  Click HERE to visit us online.  You may also follow us on Facebook, Twitter and LinkedIn.