What you need to know about hospice
The Catholic Doctor is In: By Dr. David Kaminskas
Between 40 percent and 50 percent of dying Americans are cared for by hospice during their last days on earth. Over the years I have referred many of my patients to hospice care and almost uniformly the family and patient experience has been very favorable. The timing of the referral and how one first introduces the patient and loved ones to the concept is of utmost importance. There needs to be an honest but loving conversation with the patient and family about their progressive illness, as we guide them to embrace a strategy of acceptance and preparation for death.
Progressive cancer that is no longer responding to treatment is the reason most people would think of hospice but there is a multitude of appropriate reasons for referral. For example, end stage heart disease is a common reason for my referrals but other reasons include end stage lung or liver disease or advanced dementia to name a few.
Before a referral to Hospice Care is made your doctor needs to be of the opinion that you have a terminal illness and have six months or less to live. The goal of treatment is no longer to cure the disease but to control symptoms and provide comfort to patient and loved ones. A hospice doctor is usually in charge but if you have a close relationship with your doctor he can agree to participate in your care. Specially trained nurses will visit you at home and make sure if you have pain that it is adequately controlled. Nurse assistants and home health care aides can help you with your personal care and activities of daily living. Hospice provides some of the needed help but they do not provide daily care and family and friends remain primarily responsible for your day-to-day care. Social workers can help you and your family take advantage of community resources and also provide emotional support. Bereavement counselors can help the family better deal with their loss and the family continues to have their support for one year after the loss of their loved one. The hospice team includes a chaplain and spiritual counselors if needed.
A common misconception is that once you accept hospice treatment you can’t return to the hospital. This is not true. If your symptoms are not adequately controlled, you and your hospice team can decide to go back to the hospital for a few days.
If your loved ones can no longer care for you at home, many hospice programs have an inpatient facility where you can be admitted and receive 24-hour care until the Lord takes you. You also can receive hospice care in a nursing home setting. A hospice service I recently learned about is Respite care. If, for example, the spouse is providing most of the care and needs a break, inpatient care at a Medicare-approved facility for up to five days to obtain needed and deserved rest can be arranged.
Medicare, Medicaid and most insurance companies cover hospice. Studies have proven that hospice care saves health insurance companies money. A huge portion of our health-care dollars is spent in the last six months of life. Some patients never become accepting of their fate and continue the process of frequent emergency room visits and admissions to the hospital, which not only drive up costs but cause emotional stress for the patient and their loved ones.
Deciding to go with hospice care does not mean you are giving up hope. Your goals can still include having good days and maybe even checking something off your bucket list. It can provide the time needed to heal some relationships with family and friends. Most importantly it can help provide a loving environment to receive the sacraments such as the Anointing of the Sick, Confession and Holy Communion as we prepare for death.
There are many appropriate scriptures that come to mind but one that always has provided comfort is John 14:1-4: “Do not let your hearts be troubled. Have faith in God and faith in Me. In my Father’s house there are many dwelling places; otherwise, how could I have told you that I was going to prepare a place for you? I am indeed going to prepare a place for you, and then I shall come back to take you with me, that where I am you also may be. You know the way that leads where I go.”