The total U.S. population that is age 65 and older has more than tripled over the last century. As a logical consequence, this demographic shift has made the process of aging and dying a greater concern for a larger portion of the population than in previous times.
Facts About Hospice Care
With a significant section of the population 65 years and older (14%), it begs the question: What do Americans know about end of life care? In particular, what do Americans know about hospice and palliative care? Evidence from surveys conducted about attitudes toward hospice and palliative care show that there are a lot of misconceptions among older Americans. These misconceptions could be attributed to the fact that America is an aging nation that appears not to like to discuss or even think about end of life care. According to survey conducted by Pew Research Center Survey, “a quarter of adults (27%) say that they have not given very much thought or have given no thought at all to how they would like doctors and other medical professionals to handle their medical treatment at the end of their lives, even those aged 75 or older (25%).”
In light of American’s somewhat lukewarm attitude toward end of life care, hospice and palliative care is often misunderstood, causing some patients to lose out on this valuable end of life care due to a lack of understanding. The following list represents questions related to misconceptions about hospice care.
Does Hospice Care Place a Time Limit on Patient Stays?
Many people mistakenly believe that to receive hospice care, the patient must be expected to live less than six months. In fact, there is technically not a limit on the amount of hospice care a person may receive.
The only limit on the length of hospice services is found in Medicare rules. Although requirements for private insurance providers may vary, Medicare guidelines state that a patient may receive hospice care if the hospice doctor or the patient’s regular doctor certifies that the patient is terminally ill and is expected to live less than six months. However, if the patient lives longer than six months, they will not be disqualified from receiving hospice care as the Medicare program grants an unlimited number of 60-day extensions. In many cases, due to the reduced amount of stress and increase in comfort for patients who receive hospice care, patients often exceed their diagnosed lifespan, making the extension beyond the six-month window relatively common.
Are Hospice Services Only Available at Home?
Hospice care can be provided in a number of settings. In most cases, care is provided in the patient’s home, but it may also be provided in a freestanding hospice center, hospitals, nursing homes, and other long-term care facilities. In fact, according to the National Hospice and Palliative Care Organization, the percentage of hospice care provided at home was 58.9% in 2014, with another 31.8% of hospice patients receiving care in an inpatient hospice facility.
Does Hospice Care Involve Pain or Symptom Management?
Hospice care technically should not involve care that is considered curative (care that is provided to cure the terminal diagnosis); however, patients will generally receive treatments to alleviate pain and the symptoms caused by the terminal illness. Palliative care, care crafted to relieve emotional and physical pain while managing symptoms, is provided as part of hospice care. As a general rule, palliative care in the form of pain-relieving treatment is viewed as a necessary component of hospice care’s goal of providing patients with the necessary support to die in comfort and with dignity.
Does Hospice Care Involve “Drugging Up” Patients So They Can Die in Peace and Without Pain?
Providing comfort to a patient is a foundation of hospice and palliative care’s treatment philosophy. A patient’s designated decision maker and their physician will determine the appropriate amount of medication for pain a patient may receive. Unless deemed medically necessary, a patient will not be “drugged” so as to allow them to fade away peacefully. However, there may be some circumstances in which symptom management and palliative care dictate that a patient receives an increased amount of pain medication, which is often narcotic-based, that could make a patient seem foggy or disconnected.
Does Hospice Care Involve Services Beyond Traditional Medical Care?
In addition to physical pain, patients in hospice care often experience emotional and psychological pain as well. In addition, the patient’s friends and family also experience emotional pain in many circumstances. In consideration of these situations, hospice care often involves grief and loss counseling for the patient and his or her family,
Is There an Age Requirement to Receive Hospice Services?
Hospice care is available to patients of all ages. Recent statistics show that a vast majority (84%) of hospice patients are 65 years of age or older, with 41.1% being 85 or older. Pediatric and young adult patients accounted for less than 1% of hospice admissions.
These statistics represent the fact that older Americans suffer in greater numbers from terminal illnesses that require hospice care. However, one should not mistake the distribution of terminal illness in the population for the fact that hospice care is not available to younger segments of the population. While uncommon, hospice care is available to younger patients as well.
Does Hospice Care Only Handle Certain Terminal Illnesses?
Under Medicare and most other insurance plans, a patient must be “terminally ill” to receive hospice care. Under Medicare guidelines, a patient is terminally ill “if the medical prognosis is that the individual’s life expectancy is six months or less if the illness runs its normal course.”
The disease that underlies the terminal illness does not define whether a patient is eligible for hospice care, rather it is the severity of the disease or illness that dictates eligibility for hospice in that the disease or illness carries with it a life expectancy under six months. According to data on the reasons for hospice admission, cancer diagnoses account for less than half of all hospice admissions (36.6%). The next four non-cancer, primary diagnoses for patients admitted to hospice in 2014 were dementia (14.8%), heart disease (14.7%), lung disease (9.3%), and stroke or coma (6.4%).
What Services Are Provided to Patients and Families?
Hospice care involves a range of services. Among its major responsibilities, the hospice interdisciplinary team will often provide the following services or benefits:
- Managing pain and symptoms
- Assisting the with the emotional, psychosocial, and spiritual aspects of dying
- Providing drugs, medical supplies, and equipment related to symptom and pain management
- Instructing the family on how to care for the patient
- Special services like speech and physical therapy when needed
- Making short-term inpatient care (respite care) available when pain or symptoms become too difficult to treat at home, or the caregiver needs respite
- Providing bereavement care and counseling to surviving family and friends
What Level of Care Do Most Hospice Patients Receive?
There are four general levels of hospice care.
1. Routine Home Care: The patient receives hospice care at the place he/she resides.
2. Continuous Home Care: The patient receives hospice care from a licensed nurse on a continuous basis at home for brief periods only as necessary to maintain the terminally ill patient at home.
3. General Inpatient Care: The patient receives general inpatient care in an inpatient facility for pain control or acute or complex symptom management.
4. Inpatient Respite Care: The patient receives care in an approved facility on a short-term basis to provide respite for the caregiver.
According to statistics on hospice care, routine home care comprised the vast majority of hospice patient care days. However, the level of care a patient receives is a product of the care plan produced by the hospice interdisciplinary team based on the patient’s goals.
Can a Patient Go Back to a Curative Approach While on Hospice?
People are often mistaken that once a patient is enrolled in in a hospice program, there is no way to return to curative treatment. Patients can stop hospice treatment at any time and return to curative care. In the unfortunate event that the curative care is not effective, and a patient wishes to return to hospice, Medicare and other insurance providers may pay for the extended coverage.
Beyond Misconceptions: Benefits of Hospice Care
Using hospice care can provide a person with a terminal illness the right to die pain-free and with dignity while providing families with the necessary support to allow their loved one to do so. When patients and families move beyond the misconceptions surrounding hospice and palliative care, they often realize that hospice care can provide a valuable service in the event a loved one is stricken with a terminal illness. By understanding what hospice and palliative care entail, these types of care can be used as a valuable part of end of life planning care, thereby relieving a great deal of stress and emotional strain in an already difficult time. Contact Harbor Light Hospice for more information.