In the last month, as part of Hospice and Palliative Care Month, On Your Health has been focusing on issues surrounding the final stages of life, including how to become a caregiver for your loved one, what to expect at the end of a life-limiting illness, and the differences between palliative care and hospice care. Our last article in the series answers questions you may have about hospice. Whether your loved one needs in-home care or prefers to be in a hospice facility, INTEGRIS Hospice Services can meet your hospice and palliative care needs. We also offer support to the family of our patients through respite care, as well as bereavement and grief recovery support groups.

When should the decision about entering hospice be made, and who makes it?

Patient care options, including the decision about whether to enter into hospice care, may be addressed at any time during a life-limiting illness. However, it can be common for some people to feel uncomfortable with changing goals from fighting or beating the disease to comfort or palliative measures. Hospice staff members are sensitive to these concerns and are available to discuss them with the patient and family.

Is it appropriate for me to inquire about hospice to my physician before he or she does?

Patients and family should always feel free to discuss hospice care at any time with their physicians, health care providers, clergy or friends.

Can hospice patients who show signs of recovery be returned to regular medical treatment?

If a patient's condition improves, or if the patient and physician desire aggressive treatment, the patient may be discharged from hospice at any time. The patient may return later for hospice care when appropriate. Medicare and most private insurance allow additional coverage for this purpose.

What can a patient and family expect during the hospice admission process?

Hospice will first contact the patient's physician to ensure he or she agrees hospice care is appropriate. Some hospices have medical staff available to help patients who have no physician. The patient will sign consent and insurance forms similar to what is signed for admittance to a hospital. The hospice election form says that the patient understands the care is palliative (aimed at pain relief and symptom control) rather than curative. It also outlines available services. Medicare forms the patient signs explain how electing the Medicare benefit for hospice affects other Medicare coverage for the patient.

Is the home the only place hospice care can be offered?

No. Although most hospice services are delivered in a personal residence, some patients live in nursing homes, assisted living centers, or in a hospital or hospice house on a short-term basis.

Are there special pieces of equipment or changes I should make to my home before hospice care begins?

Your hospice provider will assess your needs, recommend necessary equipment, and help make arrangements to obtain it. The need for equipment is often minimal at first and increases as the disease progresses. Hospice will assist in any way to make home care as convenient, clean and safe as possible.

How many family members are needed to care for a patient at home?

One of the first things a hospice team will do is prepare a care plan that will, among other things, address the amount of care needed for the patient. Hospice staffers visit regularly and are always accessible to answer questions and provide support.

Must someone be with the patient at all times?

It depends on individual patient needs. Some feel safe and comfortable alone, while others require 24 hour care. Families, friends or private caregivers may combine to provide care in the home. If this is not possible, a patient may need to be cared for in a nursing home.

How difficult is caring for a dying loved one at home?

It's never easy for caregivers emotionally or physically. The hospice team focuses on educating caregivers on how to cope and make the patient more comfortable.

What specific assistance does hospice provide to the home-based patient?

A team of physicians, nurses, social workers, chaplains, hospice aides, therapists and volunteers care for hospice patients. Hospice will provide medications, equipment, visiting staff and a nurse on-call 24 hours a day. Hospice does not replace the family and caregivers providing 24 hour care in the home, but adds an extra layer of care and service to the existing support in place.

Does hospice do anything to make death occur sooner?

Hospices do nothing to speed up or slow down the normal dying process. Just as physicians and midwives lend support during the birthing process, hospice provides its presence and specialized knowledge during the dying process.

How does hospice manage pain?

Hospice staffers are knowledgeable about the latest medications and devices for pain and symptom relief. Hospices believe emotional and spiritual pain are just as real as physical pain and address these as well.

Will medication prevent the patient from being able to talk or know what is happening?

The goal of hospice is to help patients be as comfortable and alert as they desire. This is achieved by hospice staffers who continuously consult with the patient and caregivers.

Is hospice covered by insurance?

Hospice coverage is widely available. It is provided by Medicare and most private insurance. In Oklahoma there is no Medicaid hospice coverage at this time for adults, although Medicaid will provide hospice services for children.

If the patient is not covered by Medicare or any other insurance, will hospice still provide care?

The first thing hospice does is assist families in finding out whether patients have any coverage they may not be aware of. Barring this, most hospices will provide care for those who cannot pay using money raised by donation.

If the patient is eligible for Medicare, will there be any additional expenses to be paid?

Medicare covers all services and supplies related to terminal illness for the hospice patient.