Choosing to seek hospice care for someone you love is never easy. The transition to end-of-life care is highly emotional, especially when questions come up about whether it’s the right time or whether the decision is permanent. This guide covers key information about hospice criteria, can a hospice patient change their mind after choosing hospice, and how to know when it truly is the right time to begin hospice care.
What is Hospice Care?
Hospice care is a type of palliative care for terminally ill patients who are expected to live 6 months or less. The focus of hospice care is on comfort, quality of life, and relieving pain and symptoms. Hospice care aims to allow patients to live their remaining days in dignity and peace, surrounded by loved ones.
Unlike curative treatments, the goal of hospice care is not to cure the underlying terminal illness. Rather, hospice prioritizes comfort care and pain management. Hospice teams work to ensure patients are free of pain, can breathe comfortably, and have their emotional and spiritual needs met.
Most often, hospice care is administered in the patient’s home, which allows patients to remain in a familiar setting, surrounded by family members and loved ones. Hospice care can also be provided in standalone hospice facilities, hospitals, nursing homes, or other long-term care centers if needed.
A specially trained team provides medical, emotional, and spiritual support to hospice patients. The hospice team typically includes doctors, nurses, social workers, spiritual counselors, home health aides, therapists, and trained volunteers. This team works together to provide comprehensive around-the-clock care tailored to the patient’s unique needs and wishes.
Hospice Eligibility Criteria
Patients must meet specific criteria, as assessed by a physician, to qualify for hospice care. The main requirements are:
- Prognosis of 6 months or less: A patient must be certified by both their own doctor and the hospice’s medical director as having a life expectancy of six months or less, based on the natural progression of their illness, to be eligible for hospice care. Prognosis can be difficult to determine exactly, so hospices focus on whether the patient is declining and if the disease will eventually be fatal.
- Choosing comfort care over curative treatment: The patient must agree to palliative care, or comfort care, instead of treatment to cure the disease. The goal of hospice is to improve quality of life and relieve pain and symptoms, not prolong life. The patient stops curative treatments and only receives medicine for comfort.
- Certification process: The patient’s doctor, called the attending physician, must sign a statement confirming the prognosis. The hospice medical director also reviews and certifies the prognosis. The initial certification lasts for 90 days. After that, the attending physician and hospice medical director must recertify every 60-90 days that the patient still has 6 months or less to live if the disease runs its normal course.
Hospices review each case carefully to determine eligibility. The focus is on providing comfort care and support when patients near the end of life.
Can a Hospice Patient Change Their Mind?
Yes, a hospice patient can change their mind and leave hospice care to return to curative treatment if their health situation improves. Hospice is not a permanent, irrevocable decision.
If the patient’s condition stabilizes or they decide they want to pursue life-prolonging treatment, they have the right to be discharged from hospice care. To leave hospice, they simply need to notify the hospice team that they wish to revoke their hospice benefit. They will then initiate the discharge process.
Before discharging from hospice, the patient should consider these implications:
- They may lose Medicare coverage for hospice services. To get hospice benefits again, their doctor will have to recertify that you qualify.
- If the patient used any hospice prescription medications, their insurance may not cover the costs once discharged.
- Leaving hospice means discontinuing visits from hospice staff, like nurses, social workers and chaplains. The patient will return to getting care from your regular doctors.
- The patient’s hospice team may require an in-person physician evaluation before discharging them. This ensures they fully understand the choice.
- Once discharged from hospice, the patient cannot return to the same hospice provider for a specified period, often 30-60 days.
Overall, the patient maintains the right to change their mind about hospice care. But, like with any medical decision, it will be important to weigh the implications first and communicate clearly with the hospice team throughout the process. With proper planning, they can transition off hospice smoothly.
Ready for a conversation about comfort and care? Request your Pike Peak Hospice consultation today.
Knowing When It’s Time for Hospice
Deciding when it’s the right time to begin hospice care is a very personal choice that depends on several factors. Key considerations include:
- Declining Health Indicators: There are certain declining health indicators that often signal it may be time for hospice, such as worsening symptoms, repeated trips to the hospital or ER, weight loss, infections that keep returning, incontinence, falling, and general fatigue, weakness or frailty. If your loved one is experiencing health declines that are impacting their quality of life, it may be a sign that hospice could help provide comfort.
- Quality of Life Considerations: Focusing on quality of life vs quantity of life is a major factor. If your loved one is no longer able to enjoy activities they used to participate in, or if they are losing their independence, need more assistance with daily activities, and are withdrawn or less social, hospice may help provide quality care focused on comfort vs aggressive treatments.
- Doctor Recommendation on Prognosis: Your loved one’s doctor can provide input on their prognosis and whether they may have 6 months or less to live if their disease runs its normal course. If the doctor estimates your loved one’s life expectancy is 6 months or less, they will meet the hospice eligibility requirements. Your doctor can help determine if it may be time to focus on comfort over continued curative treatments.
Paying attention to your loved one’s condition, abilities, quality of life preferences and doctor’s input on prognosis can all help signal when hospice may be appropriate. The hospice team can provide guidance and support when making this decision.
Hospice Benefits
Because hospice care focuses on comfort and enhancing the quality of life for those with terminal illnesses, it offers comprehensive benefits designed to ease symptoms and foster better well-being. The core elements of hospice care include:
- Comfort Care: The hospice team works to ensure patients are as comfortable and pain-free as possible. They can provide beds, equipment and other supplies to maximize comfort.
- Pain Management: Controlling pain is a major priority. Medications, therapies and other techniques are used to effectively manage pain and other distressing symptoms.
- Emotional and Spiritual Support: Counseling, therapy, social activities and spiritual care are available to help address emotional, psychological and spiritual needs.
- Covered by Medicare/Medicaid: The Medicare and Medicaid programs cover the costs of hospice care for eligible patients. This includes the medications, medical equipment, therapies and services needed for hospice care.
Hospice Care Settings
Hospice care can be and is provided in different settings depending on the patient’s needs and preferences.
Home Care
Most hospice care takes place at home. A hospice team, including nurses, social workers, spiritual counselors, and others, visits the home regularly to provide medical, emotional, and spiritual support. Families and caregivers are trained to provide care and use equipment, allowing patients to remain comfortably at home for as long as possible.
Inpatient Facility
For patients with more intensive care needs that cannot be managed at home, inpatient hospice facilities, like the Pikes Peak Hospice Inpatient Unit, provide round-the-clock medical care. Patients stay for short periods when they need extra care such as pain management. The goal is still focused on comfort and quality of life.
Long-Term Care Facility
Hospice services are also available in long-term care facilities such as nursing homes and assisted living centers. Here, the hospice team works with the facility’s staff to develop a care plan that respects the patient’s preferences, ensuring the seamless provision of hospice care even if the patient transitions into such a facility.
Discover Comfort and Dignity with Pikes Peak Hospice
Deciding on hospice care is a significant step towards ensuring comfort and dignity at life’s end. Remember that a patient can change their mind and stop hospice care if their condition improves. Pikes Peak Hospice provides personalized support, focusing on quality of life. If you’re contemplating this compassionate choice or seeking more information, we’re here to guide you.
Request a consultation with us today and discover how we can honor your loved one’s journey with care and respect. With the right information and support, both patients and families can make the hospice decision that is best for their individual situation.