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What
is hospice?
Hospice is a concept of care which provides for the medical, emotional,
psychological and spiritual needs of persons facing incurable, life-limiting
(usually six months or less) illness. The goal of hospice is to maximize
the quality of life through relief of pain and other distressing symptoms
enabling persons to live life fully.
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When
should a decision about entering hospice care be made and who should make
it?
During any stage of a life limiting illness it is appropriate to discuss
all care options with your doctor. By law, care and treatment decisions
belong to the patient. Many patients enroll in hospice when aggressive
treatment of incurable disease is no longer desired or helpful. As a rule,
the earlier the admission to hospice the more effectively hospice's full
range of services can be experienced enabling patients to live with dignity
and quality in the manner they choose.
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What
if our physician doesn't know about hospice?
Your physician may be aware of hospice but desires further information
which can be provided by Community Hospice & Palliative Care, 1-734-522-4244;
the Academy of Hospice Physicians; the American Medical Association; the
National Hospice Help line, 1-800-658-8898, or the National Hospice web
site at www.nhpco.org.
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Who
can refer a patient to hospice?
Anyone can make a referral to hospice. Your local hospice can assist you
with determining whether the patient is appropriate for hospice care and
answer any questions you may have. The National Hospice Help Line, 1-800-658-8898,
will also provide answers or assist in locating a hospice near you.
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What
does the hospice admission process involve?
Hospice will contact the physician to ensure hospice care is appropriate
for the patient. At the time of enrollment the patient and caregiver will
be fully informed about hospice care and asked to sign consent and insurance
forms.
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Can
a hospice patient who shows signs of recovery be returned to regular treatment?
Certainly. If the patient's condition improves, the illness goes into
remission or new curative options become available, patients can be discharged
from hospice. Should a patient later need to return to hospice care, Medicare
and most insurances will cover re-enrollment.
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Are
there special equipment or changes needed in my home before hospice care
begins?
Not necessarily. Because hospice affirms the patient/caregiver right to
choice, the hospice nurse will assess your needs and make recommendations
for safe and convenient care. The nurse will arrange for delivery of supplies
and equipment that the patient and caregiver determine will be helpful.
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How
many family members/friends does it take to care for a patient at home?
There is no set number. On admission to hospice, the hospice team will
develop an individualized plan of care that will address the amount of
caregiving needed. As the illness progresses and care needs change, the
team will provide ongoing education and care support. Home health aides
are available to offer personal care providing relief for caregivers.
Trained hospice volunteers can also provide intermittent respite care,
run errands, and perform many other services. Hospice nurses are available
24 hours a day to answer questions, provide reassurance and visit if needed.
Hospices with inpatient units can provide periodic overnight respite stays
of up to five days.
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Must
someone be with the patient at all times?
This may not be required during the early weeks of care. However, one
of the most common fears of patients is the fear of dying alone. Hospice
generally recommends someone be with the patient continuously as the illness
progresses.
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How
difficult is caring for a dying loved one at home?
The level of difficulty varies with the experience and concerns of each
caregiver. Because hospice treats the patient AND caregiver as the unit
of care, the hospice team of doctors, nurses, social workers, and clergy
provides counseling, education and support to the caregiver.
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Is
caring for the patient at home the only place hospice care can be delivered?
No. Although most patients receive hospice care in their own home, some
patients reside in nursing homes, adult foster care homes or hospice centers.
Hospice care is provided wherever the patient resides.
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How
does hospice manage pain?
Hospice doctors and nurses are trained in the latest techniques for all
types of pain management. Emotional and spiritual pain are just as real
and are also addressed.
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Will
medications prevent the patient from being able to talk or remain alert?
Usually not. The goal of hospice is to enable the patient to be pain free
and alert.
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What
is hospice's success rate in battling pain?
Very high. Hospice specializes in pain management and has developed successful
combinations of medications, counseling and therapies to address the unique
pain of each patient.
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Does
hospice do anything to make death come sooner?
Hospice neither hastens nor prolongs death. Hospice is palliative (comfort)
care which provides relief of pain and physical and emotional discomfort.
Hospice affirms life and regards dying as a normal process.
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Is
hospice affiliated with any religious organization?
Hospice is not an offshoot of any religion. Some churches and religions
have started hospice care programs but provide care without requiring
patients to adhere to any particular belief or religion. Hospice does
offer clergy and spiritual support to those who desire it, however.
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Is
hospice covered by insurance?
Medicare and CHAMPUS provide hospice coverage nationwide while Medicaid
coverage is available in most states. Most private health insurance provides
hospice care. Check with your employer or insurance provider for the terms
of coverage.
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Are
there any additional out of pocket expenses for Medicare eligible patients?
Medicare covers all services and supplies for the hospice patient. Some
hospices require a 5% or $5 co-payment on medication and respite care.
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What
if the patient has no insurance?
Hospice will assist the patient/family in finding out whether the patient
is eligible for coverage they may not be aware of. Many hospices utilize
a sliding fee scale or care for patients without reimbursement using funds
received from donations, memorials or foundation gifts.
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Does
hospice provide any help to the family after the patient dies?
Hospice maintains continuing contact and support for family and friends
for at least a year following the death of their loved one. Many hospices
sponsor bereavement groups that are also open to the community.
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SUGGESTIONS
FOR CONVERSATION WITH YOUR DOCTOR
All patients have a right
to make informed decisions concerning their health care and treatment
options. The following questions are provided by Community Hospice
& Palliative Care to assist you in gaining information about
your care and treatment prior to choosing hospice.
What is the chance my
disease/condition will get better?
What treatment is available
to me for my disease/condition?
What will the side effects
of the treatment be?
What is the chance of
success from the treatment?
What is the chance of
the treatment not working? Could the treatment hasten my death?
Will my life be lengthened
as a result of treatment?
What impact will treatment
have on my quality of life?
What can I expect if
I do nothing?
What symptoms will I
experience and what will be my life expectancy?
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GUIDELINES
FOR SELECTING A HOSPICE
While all Medicare certified
hospices provide core services as required by federal guidelines, hospices
have flexibility in the implementation of their services. To ensure that
the hospice you select will be able to meet your needs, the following
is a suggested list of questions to ask when comparing hospice programs:
1. Is your program Medicare
certified and Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) accredited?
2. Do your nurses have the
Certified Hospice Palliative Nurse (CHPN) certification?
3. How many of your staff have
degrees or credentialing in hospice care?
4. What is the ratio of nurses
to patients? Home Health Aides to patients?
5. What is the role of the
nurse?
6. What are the maximum numbers
of hours per week of Home Health Aide assistance you provide?
7. How many hours per week
is volunteer assistance available in my area? What services do volunteers
provide?
8. Must I have a family or
friend caregiver to enroll in your program?
9. What hospitals and nursing
homes do you contract with for inpatient and respite care?
10. Do you charge co-pays for
drugs, biologicals, ambulance transport and respite care?
11. Do you provide care if
I run out of insurance, have no insurance or cannot pay for care?
12. Do you provide antibiotics,
pain control pumps, IV's, and tube feedings?
13. What medications will I
be able to continue if I enroll in your program? (Some hospice programs
consider certain medications to be life prolonging).
14. If I desire resuscitation
may I enroll in your program or must I agree to a Do Not Resuscitate status?
15. After office business hours
are nurses available for home visits for emergencies and other problems
or do they provide telephone assistance only?
16. At the time of death what
support does your hospice provide?
17. What types of bereavement
support do you provide?
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For further
information call 734-522-4244.
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