A medical recommendation for hospice care always follows a regular course of medical care. That being said, once the medical diagnosis is made recommending hospice care, medical care will continue, but under the auspices of the hospice care program rather than the hospital’s regular medical team. Hospice care teams include a variety of medical professionals (doctors, registered nurses, dietitians, physical therapists and others). The patient’s regular physician may also continue providing care, even under hospice.
Understanding Hospice Care
Hospice care is only recommended when traditional medical approaches have failed to halt the progress of disease and there is no longer hope for a reversal or a cure. In fact, the basic tenets of hospice itself dictate that hospice begins only when all traditional medical measures have failed. For this reason, hospice care is different than traditional medical care. Hospice care is comfort-based and palliative rather than curative. The goal is provide the absolute best quality of life to the patient for any time still remaining.
Administration of Dialysis Under Hospice Care
Hospice care is generally not prescribed until the patient has decided to cease dialysis for treatment of ESRD (end stage renal disease). It is for this reason that Medicare does not cover dialysis. Even for ESRD patients that decline hospice, many (up to half of all patients) choose to stop dialysis before death. This is because dialysis itself is often difficult and painful.
For patients continuing dialysis, they are often still able to receive palliative care in lieu of or in addition to hospice care. For patients who are undecided about whether to continue or cease dialysis, it can be helpful to discuss options with the treating physician.
Administration of Chemotherapy Under Hospice Care
Hospice care is generally not prescribed until a patient has declined further due to chemotherapy or other forms of active cancer treatments. At such time as patients and the treating physician(s) determine further cancer treatment is not likely to achieve remission or a cure, hospice is often prescribed. This does not mean that medical care ceases as well, but the goal changes from remission or cure to comfort and quality of life for the time remaining. So if any treatment is predicted to cause discomfort or stress to the patient, that treatment would be contraindicated under hospice care.
Patients with a terminal cancer diagnosis who are still receiving chemotherapy or other active cancer treatments can often still qualify for palliative care if they are not eligible for or desirous of hospice.
Use of Feeding Tubes and IV Fluids
Hospice care can include the administration of intravenous (IV) fluids and nutrients via feeding tubes. Hospice care does not require the removal of IVs or feeding tubes. It is best to discuss this with the patient (if possible) and the treating physician before making a determination.