Palliative care can be provided to a patient who is still receiving care aimed at curing or reversing the effects of a serious illness. Hospice care is generally provided for patients who are diagnosed with a terminal illness and are likely in the final six months of their lives. Hospice patients have elected to forgo or stop other treatments and focus on treatment of symptoms or "comfort care" in the last days, weeks, or months of life. Patients may transition from palliative care to hospice care if they and their doctor determine that hospice care is more appropriate.
In the United States, to be eligible for hospice care under Medicare, an individual must be entitled to Part A of Medicare and certified as being terminally ill by a physician and having a prognosis of 6 months or less if the disease runs its normal course. If the physician thinks it is too soon for Medicare to cover the services, an individual can investigate how to pay for the services that are needed. Diagnoses that often qualify can include Heart Disease, Pulmonary/Lung Disease, Kidney Disease, Liver Disease, Stroke/Coma, Dementia/Alzheimer’s, ALS, Cancer or HIV.
Hospice provides a number of services to benefit the patient and caregivers. These include 24/7 nursing care, nursing aide assistance for bathing and personal hygiene, social workers to assist with emotional and financial help, chaplains for spiritual support, bereavement counselors for family members of the deceased, and volunteers who visit patients, provide support and companionship and share interests, hobbies and light recreational activities. Hospice care may also include complementary therapies such as music, massage, aromatherapy, pet therapy, hypnotherapy and end of life doulas. Some hospices provide a program to honor veterans and acknowledge their unique experience at end of life.
Hospice provides four levels of care that include routine hospice care, general inpatient care, continuous home care and inpatient respite care. The following provides an overview of each of these levels of care:
Yes. The hospice must establish a contract with the facility to provide care to residents.
Unfortunately, while there is much interest in a hospice house, one does not currently exist in the Roanoke Valley.
For people in hospice care, pain management is important because it affects a person’s quality of life. Hospice offers medical, psychosocial, spiritual and holistic measures to address different kinds of pain needs - even those that go beyond the physical body. Hospice also offers helpful resources to address symptoms associated with chronic disease, cancer, etc.
Misconceptions surround the use of opioids in hospice. One concern is that a person might become addicted to opioids. Patients receiving hospice care usually have six month or less to live – experts believe that care for someone who is dying should focus on relieving pain without worrying about possible long-term problems of drug dependence or abuse.
Hospice patients may go to the emergency room to seek care for an injury or condition not related to their hospice diagnosis. For example, if a patient has a terminal diagnosis of cancer, but falls and breaks an arm, he may absolutely go to the ER for treatment of the broken arm. But if that same patient goes to the ER to seek treatment for the cancer, then, yes, he revokes hospice service.
Remember, hospice care steps in when a cure is no longer realistic and the patient has decided he no longer wishes to pursue curative measures.
No. Patients do not need to have a DNR order signed at the time of enrollment into hospice. Often, hospice staff will work with the family to determine the best time to have a DNR order signed.
An Advance Directive is a legal document that allows adults to make their health care choices clear and
name a surrogate to act for them should they become unable to speak for themselves. Advance directives address health concerns as well as decisions regarding visitation, disclosure of medical records and other instructions specific to each individual.
Advance directives have two forms: A living will and a durable medical power of attorney. Advance directives are completed in advance of a health care crisis, ideally. People who are not ill are encouraged to complete one, in the event there is a sudden accident.
To obtain an advance directive form contact your physician or visit www.vsb.org . Print and fill out the form that best fits your needs, and provide copies to your physician and to trusted family and friends.
A living will is a written, legal document that spells out medical treatments you would and would not want to be used to keep you alive, as well as your preferences for other medical decisions, such as pain management or organ donation.
A durable do not resuscitate order is an order that is issued by a physician at the time that an individual determines he/she does not want CPR at a time that heart and/or respirations stop. A durable DNR is maintained at the individual’s place of residence and acts as a protection from aggressive CPR in the event that the 911 system is activated.
Virginia Physician Orders for Scope of Treatment (POST)
POST (physician orders for scope of treatment) is an advance care planning process for people with advancing serious illness or medical frailty. After a discussion with your physician, a POST form can be completed. The POST form is much more detail oriented regarding treatment preferences than advance directives are.
A POST form is a medical order in which patients nearing the end of life may work with their provider to define and specific their treatment preferences. These treatments may include resuscitation preferences, comfort and airway support measures, artificially administered nutrition and other medical preferences. If you have completed a POST form, you keep it with you wherever you reside and take it with you if you go to a medical facility outside of your home (i.e. hospital, nursing home)
An individual can name someone as their durable medical power of attorney (agent) who can make decisions on his/her behalf when he/she is incapacitated and no longer able to make decision on his/her own. The agent is responsible for following the wishes closely and acting in the person’s best interest.
The person who creates and signs the durable medical power of attorney is called the principal, while the person who is given the power to act on the principal's behalf is generally called the health care agent or proxy.
A durable medical power of attorney gives the health care agent broad power and responsibility to make decisions regarding the principal’s medical treatment, including medication, tests, nourishment and hydration, as well as decisions regarding surgery, doctors, hospitals and rehabilitation facilities. However, the principal can limit the agent’s authority and responsibilities by including specific limitations in the document itself.