Guidelines

Guidelines for Recommending Hospice Care and Treatment

As a medical professional, you dedicate your life to curing and healing. Yet there are times when you realize that it's no longer beneficial to your patient to pursue aggressive curative treatment. That can be a very difficult moment for you. Hospice at Home understands and is here to support you as well as your patient and your patient's family and friends.

We've written these guidelines to help you refer your patients to hospice. Please share this information with them so they have a better understanding of the benefits of hospice care and the financial responsibilities they may retain. While this is a thorough discussion, we realize it may not be all-inclusive. If you have additional concerns, please read about how to deliver difficult news, the responses to common hospice myths, or frequently asked questions. We also offer resources that can augment your professional knowledge about palliative care. If you have more questions, or if you would like to offer suggestions for how we can better support your efforts to give the best care to your patients, please call (269) 429-7189 or (800) 717-3811.

Hospice provides the best quality of life for your patients and their families

One of the biggest gratifications in your profession is being a beacon of hope for your patients. Often we hear medical professionals say they feel as if they are giving up hope when they refer their patients to hospice care. We want to assure you hospice is a hope-filled decision.

The hope that hospice offers to patients and their families is to give them the best quality of life possible. Our area of specialty is pain and symptom management. To the fullest extent possible, we help your patients be alert and active so they can more fully engage in life. As you know, not all pain or symptoms are physical when you are terminally ill. There are emotional, spiritual, and social pains to consider. Your patient's Hospice at Home team will help you provide holistic care that is inclusive of both emotional and physical needs.

What to talk about with your patients and their families before referring them to Hospice at Home:

1. Hospice is a choice

Electing hospice care is a personal decision that your patient or patient's caregiver makes. Explain to your patient that hospice care neither hastens, nor prolongs the natural dying process. Assure your patient and their family that they will have a say in the types of services provided. They can alter or cancel services as needed or stop having hospice care if they choose. Explain that Hospice at Home will work with you, taking into consideration the medical care plan you've been advising for your patient, so the best medical hospice care is provided.

2. Every care plan and Hospice team is customized to your patient's needs

Hospice is one of the most collaborative ways of caring for someone who is terminally ill. The care comes from an interdisciplinary team that not only works with you, the attending physician or medical professional, but also with your patient and your patient's family to provide a customized plan. As the attending physician you will work with the Hospice medical director to develop and medically supervise this plan.

3. What comprehensive hospice coverage includes

Hospice at Home is not part of a national organization. It is an independent, non-profit, community-owned organization. Many of our services are reimbursed by some kind of health insurance. Medicare, Medicaid and most major Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and other private health insurance, such as Blue Cross/Blue Shield include a hospice benefit in their plans. Treatments that are typically covered include:

• Medication related to the primary diagnosis
• Nursing care
• Home health aide/personal care
• Spiritual comfort
• Social work support
• Volunteer help
• Medical equipment and supplies required for the patient's comfort and safety
• Oxygen therapy
• IV therapy required for the patient's comfort
• Respite care (provides temporary care of the patient in a facility to give caregivers relief from caregiving)
• Inpatient general care (temporary care of the patient in a facility to better manage symptoms)
• Continuous nursing care (see item 6. When hospice care is available)
• Physical therapy
• Speech therapy
• Nutrition counseling

We provide many other services in our patient plans that are often above and beyond what Medicare, Medicaid, and other insurance companies cover. These are made possible through the generosity of our donors. They include:

• Complementary therapies (such as massage), when performed by Hospice personnel
• Grief counseling and bereavement support

4. What comprehensive hospice coverage does not include

Hospice care is primarily palliative in nature. Our purpose is to provide comfort for your patient. We generally do not render treatments with the primary purpose of curing the illness or treatments that extend the length of life for your patient, but compromise the quality of the time remaining. Each plan is evaluated on a case-by-case basis, and we appreciate your input.

5. No one is refused care due to an inability to pay.

Assure your patient that Hospice at Home is committed to care for his or her needs even when there is no coverage available from Medicare, Medicaid, or private insurance. Our Benevolent Care fund is available to ensure we can provide hospice services regardless of ability to pay for them.

6. When hospice care is available

Let your patient know that Hospice can be reached by phone 24 hours a day. In the evenings, the phone triage nurse (who is an expert in making evaluations and decisions over the phone), will determine if or when a nurse, or other team member, should be sent to the home. Our specially trained, on-call staff is ready to visit your patient any time of day or night, seven days a week, as needed or as desired.

There are occasions when patients or families require support from Hospice staff for many hours. We always make sure your patient gets all the time he or she needs with our experts. This continuous care is covered under the hospice benefit because it is occasionally crucial to symptom management.

Hospice care does not provide routine around-the-clock care. Advise your patient and caregivers that primary patient care is the responsibility of the family or friends. If family members and friends are unable to provide around-the-clock care they will need to employ private duty caregivers to fulfill the need.

7. When hospice care incorporates hydration and tube feedings

When your patient has dehydration symptoms and other means of relieving the discomfort, such as ice chips, fail, the Hospice medical team member will consider IV therapy for hydration. Hydration, however, is not always helpful during the last stages of life and may actually cause more discomfort than it relieves so these decisions will be carefully weighed.

If your patient is already receiving tube feedings upon admission to hospice, Hospice at Home will continue the treatment. Hospice will supply the nutritional products used for tube feedings.

If your patient loses the ability to take food and fluids by mouth while under hospice care, the Hospice care team will help the patient and family determine whether placement of a feeding tube will further the goals of comfort for the patient.

8. Hospital stays

Your patient will rarely if ever need to go to the hospital ER or admissions once hospice care begins. Occasionally symptoms may become too difficult to manage well in a home setting. Hospice at Home can then arrange for a General Inpatient Hospital admission. While at the hospital, hospice care will continue under the Medicare or other provider's hospice benefit.

Please assure your patient that he or she can stop using hospice care at any time. This allows your patient to revoke the hospice benefit to pursue hospitalization for aggressive life prolonging treatment. If your patient chooses to revoke the hospice benefit while hospitalized, Hospice at Home will review with your patient his or her health goals at discharge. At that time, your patient can decide whether or not to reassign the Medicare benefit to the Hospice at Home program.

9. Other complementary and alternative therapies that provide comfort

Hospice at Home provides many comfort and life-enhancing services above and beyond Medicare requirements. The hospice team will work closely with your patient to include in the plan complementary options that will relieve stress, manage symptoms and promote wellbeing. Some therapies that will be considered include a professional massage therapist, who can provide massages for patients and family members, or skilled staff and trained volunteers who offer gentle touch to the hands and feet for relaxation and comfort. Other alternative therapies include relaxation music, aroma comfort, friendly pet visits, or life reviews that allow your patient to record his or her story. If there is a therapy you believe will help your patient, please talk with the Hospice team.