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Shh, Let's Not Use The "H" Word!


I want to discuss a program that is part of the long-term care industry and that seems to not get the recognition for how beautiful it is; that program is called Hospice. I have seen families wait too long to get their loved one on hospice, for various of reasons, so I hope this blog will help educate you somewhat of what hospice is and when to begin discussing.

When we hear the word Hospice we automatically think of death, or end of life. In our culture the dying process still has the stigma of being morbid, dark and uncomfortable to discuss. However, there are cultures that celebrate the end of life process as a time to reflect on the person’s life, to make sure that person is comfortable and pain free until the final day they close their eyes. Hospice is actually a beautiful program that gives quality of life to the patient and family (known as unit of care), and provides comfort and methods to alleviate pain by techniques/medication as well as spiritual counseling.

When I was an active administrator my director of nursing and I used to promote hospice and were typically the first point of contact with the patient and/or family about the services hospice can provide that would give more quality of life to the patient. This past year I became a hospice volunteer; I primarily provide companionship to patients. I used to be uncomfortable with the dying process, but hospice has opened my eyes and understanding of how much hospice can do.

Hospice provides many benefits. To name a few I am familiar with…

  • Medication to alleviate pain, full medication review to make sure current meds are not interacting and causing further problems
  • Comfort techniques by licensed professionals
  • Aromatherapy, Massage Therapy, Music Therapy, Pet Therapy, Acupuncture,
  • Spiritual Counseling / Chaplain Service
  • The patient can be religious, spiritual, or have no belief system. Hospice does not discriminate
  • Volunteers
  • Companionship, crafts, music, reading, composing letters, light housekeeping, minor errands
  • Interdisciplinary Team (Physician, RN, Social Worker, Chaplain, Volunteer Coordinator, Aides) that encompasses a dedicated team that oversees the patient’s well-being and care
  • Equipment and products that will help the patient with transfers, mobility, incontinence, breathing
  • Social Worker that can meet with the patient and/or family to discuss end of life planning, advance directives, family dynamics, communication
  • Bereavement Coordinator that can assist with the grieving and loss process, especially after the patient passes
  • Supplemental care added to the staff that is already in the long-term care community (if the patient is residing in a community)
  • Providing a bath aide to help patients bathe especially ones that are bed bound

The most important benefit that has always stood out to me is that the hospice team LISTENS, UNDERSTANDS, and has EMPATHY. Their priority is to make sure the patient is comfortable, feels heard and understood, and still has autonomy, if applicable.

The next big question is when to discuss Hospice. If the patient is residing in a long-term care community, you can always meet with the Social Worker or the Director of Nursing. If the patient is at home or at an independent living community, you can call a hospice company and a representative will meet with you to discuss if the patient qualifies (medically). Anyone can be on Hospice as far as payment; hospice accepts almost all forms of payment sources (private pay, Medicaid, private insurances).

Here are a few qualifying factors, and signs of when to initiate the hospice conversation…

  • If a physician has deemed a person of having less than 6 months to live. Sometimes a patient does not need the “less than 6 months” physician order, but majority of the time the patient will need that specific order. A patient cannot be on hospice without a physician’s order.
  • Common diseases of hospice patients: Cancer, Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), End-stage Renal (Kidneys) Disease, HIV/AIDS, Alzheimer’s Disease
  • A patient can have one or more of the above to be on service
  • Signs of when to discuss hospice- several falls, incontinence of bowel and bladder, unable to do ADL’s (walking, bathing, eating, toileting), infections/sores, sleeping a lot, losing interest in eating and fluids, breathing changes, or any significant changes that show the patient is gradually declining

The more educated you are about Hospice and signs to look for in a loved one, the quicker you will be to initiate the conversation to begin services for that person, which will give that person a more quality of life and comfort measures as they gradually decline.

Part of my services is guiding individuals or families to understand this process, and to recommend top hospice companies to utilize in the area. The hospice companies I partner with are an extension of my services, so I only recommend the best.

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