Hospice Care

Considering Hospice Care

You may want to consider hospice care if:

• You have a disease or illness that is expected to shorten your life.
• Treatment that tries to cure the disease or prolong your life has become more of a burden than a benefit to you.
• You would like to spend your remaining life as comfortably as possible in a setting that you choose, such as your own home.
• You want family and friends to participate in your care.
• You want your loved one who has a terminal illness to die comfortably at home.

Some people who might benefit from hospice care do not receive it for a variety of reasons. Many people, including some health professionals, simply don't know much about hospice care. It can be difficult for a doctor to acknowledge that a person is approaching the final stages of an illness and to introduce the concept of hospice services. It can also be difficult for you and your family to accept that the end of life is approaching. Some families choose to pursue aggressive medical care up to the end.

By choosing hospice, you decide to stop trying to cure your illness and to focus instead on comfort and quality of life. If you are at home, your hospice team will prepare your caregivers to cope with almost anything that could happen at home. But this does not mean that you cannot go to a hospital. When a hospice takes over your care, they will work with you to arrange for any medical care that you need. If something happens that causes a caregiver to call 911, you may be treated in a hospital and later return to hospice care.

The Medicare Hospice Benefit legislation, passed in 1982, pioneered the model for hospice programs in the United States. Eligibility for most hospice programs, as established by Medicaid, is based on two main criteria:

• Your condition is considered incurable. This is called a terminal illness.
• Your doctor has indicated that your life expectancy is 6 months or less if your illness runs its normal course. A form must usually be signed by your primary doctor as well as the medical director or physician member of a hospice team.¹

It can be hard for doctors to know how long a person will live. Some people live longer than expected. If you live longer than 6 months, you can continue on hospice. If your illness gets better, you can stop receiving hospice care.

Hospices usually take patients who are declining in their health and daily functioning. This means that the patient may need help with activities of daily living and isn't eating or moving around very well. The goal is to live out a natural life without artificial medical assistance. Medical care is provided to give comfort rather than to prolong life. For example, chemotherapy may no longer be used to cure your cancer, but it may be given to reduce pain. People who want to live as long as possible by any medical means are not a good match for for hospice care.

Many people who are living with a disease that has an unpredictable but still terminal course may also want and be able to receive hospice care. In some of these cases, Medicare might not cover hospice care costs. Medicare covers the cost of hospice in the last 6 months of life. There are guidelines for terminal diseases that have an unpredictable course. People who have AIDS, amyotrophic lateral sclerosis (ALS), emphysema, heart failure, kidney (renal) disease, or Alzheimer's disease are all eligible for hospice care when their disease has reached an advanced, terminal stage.

People of any age, including children, may receive hospice services. In some areas, there are special hospice programs for children who have cancer or other terminal diseases and for people who have AIDS.

Hospice care programs do not discriminate. Care is provided regardless of age, sex, religion, diagnosis or type of health problem, ethnic or cultural background, sexual orientation, or ability to pay.

Many complex challenges face a dying person. Treating physical symptoms alone does not take care of emotional suffering or family upheaval. A recent study asked people what aspects of their end-of-life care they considered most important. Overall, the important factors included:²

• Pain and symptom control and assurance that future pain and symptoms would be managed.
• Clear and participatory decision making.
• Preparation for death, with full knowledge of the changes that could occur.
• Completion, including spiritual peace, life review, resolving conflicts, spending time with family and friends, and saying good-bye.
• Contributing to the well-being of others.
• Affirmation of the individual as a unique and whole person.

Hospice care helps you address these challenges and approach death as comfortably and with as much dignity as possible.

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Author:	Jeannette Curtis	Last Updated: December 27, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Shelly R. Garone, MD - Palliative Care
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