What is the role of the hospice nurse?

The role of a hospice nurse is multifaceted, encompassing various aspects of patient care, support, and advocacy during the final stages of life. A hospice nurse is responsible for:

  1. Assessment and Care Planning:
    • Conducting thorough assessments to understand the patient’s physical, emotional, and spiritual needs.
    • Collaborating with the interdisciplinary team to develop a comprehensive care plan tailored to the individual’s preferences and goals.
  2. Symptom Management:
    • Providing expertise in managing pain and other symptoms associated with the terminal illness to enhance the patient’s comfort and quality of life.
  3. Patient and Family Education:
    • Offering guidance and education to patients and their families about the progression of the illness, treatment options, and the role of hospice care.
  4. Emotional Support:
    • Addressing the emotional and psychosocial needs of patients and their families through active listening, counseling, and facilitating access to additional support services.
  5. Coordination of Care:
    • Serving as a liaison between the patient, family, and the interdisciplinary hospice team to ensure seamless communication and coordination of care.
  6. Advocacy:
    • Advocating for the patient’s wishes and ensuring their voice is heard in the decision-making process, respecting their autonomy and preferences.
  7. End-of-Life Planning:
    • Assisting with advance care planning, including discussions about goals of care, resuscitation preferences, and ensuring that the patient’s wishes are documented and respected.
  8. Comfort Care:
    • Implementing comfort care measures that align with the patient’s values, promoting a peaceful and dignified end-of-life experience.
  9. Bereavement Support:
    • Providing support to family members and caregivers during the grieving process, offering resources and counseling to help them cope with the loss.
  10. Continuous Assessment:
    • Conducting ongoing assessments to adapt the care plan based on changes in the patient’s condition, ensuring responsive and personalized care until the end of life.

In essence, the hospice nurse serves as a compassionate guide and advocate, working collaboratively with the patient, their family, and the hospice team to ensure that the individual’s final days are characterized by comfort, dignity, and a sense of peace.

Why is Hospice important?

In the vast landscape of healthcare, hospice care stands out as a compassionate and invaluable component, providing support to individuals and their families during the challenging journey of terminal illness. This blog post explores the importance of hospice care in the medical field, shedding light on the unique benefits it offers and the significant role it plays in enhancing end-of-life care.

I. Comprehensive Patient-Centered Care:

  1. Focus on Comfort and Quality of Life:
    • Hospice care prioritizes the comfort and quality of life for individuals facing terminal illnesses. By shifting the emphasis from curative treatments to symptom management and emotional support, hospice ensures that patients experience their final months with dignity and minimal distress.
  2. Holistic Approach:
    • Hospice care takes a holistic approach, addressing not only the physical symptoms of the illness but also the emotional, social, and spiritual needs of the patient. This comprehensive care model recognizes the interconnectedness of these elements in providing true comfort and support.

II. Emotional and Spiritual Support:

  1. Counseling and Bereavement Services:
    • Hospice care teams include skilled professionals such as social workers and counselors who offer emotional support to both patients and their families. This support extends beyond the patient’s passing, with bereavement services designed to help loved ones cope with loss.
  2. Spiritual Care:
    • Recognizing the importance of spiritual well-being, hospice care often includes spiritual support, respecting the diverse beliefs and values of individuals. This holistic approach contributes to a more profound sense of peace and comfort.

III. Patient Empowerment and Decision-Making:

  1. Respecting Individual Wishes:
    • Hospice empowers individuals to make decisions about their end-of-life care, ensuring that their preferences are honored. This patient-centric approach fosters a sense of control and autonomy during a time that can otherwise be overwhelming.
  2. Advance Care Planning:
    • Hospice encourages and facilitates advance care planning, allowing patients to express their wishes regarding medical interventions, resuscitation, and other crucial aspects of their care. This proactive approach helps align medical interventions with the patient’s values and goals.

IV. Relieving Caregiver Burden:

  1. Support for Caregivers:
    • Hospice care extends its support beyond the patient to include family members and caregivers. By providing education, respite care, and emotional assistance, hospice helps alleviate the physical and emotional burdens placed on those caring for a loved one with a terminal illness.
  2. Enhancing Communication:
    • Hospice teams facilitate open and honest communication between healthcare providers, patients, and their families. This transparent communication ensures that everyone involved is well-informed and aligned with the care plan.

Hospice care plays a pivotal role in the medical field by offering a compassionate and patient-centered approach to end-of-life care. Its emphasis on comfort, holistic support, and patient empowerment contributes to a dignified and meaningful transition for individuals facing terminal illnesses. In recognizing the importance of hospice, the medical field acknowledges the value of providing not just medical interventions but also the empathy, understanding, and support necessary to enhance the quality of life in the final stages of a person’s journey.

What makes someone eligible for hospice? Part 2

Facing a terminal illness is an emotionally challenging experience, and decisions about end-of-life care require careful consideration. Hospice care is often recommended when individuals are dealing with life-limiting illnesses, aiming to enhance the quality of life during their final months. In this blog post, we will explore when hospice is recommended and the reasons behind this crucial decision.

I. When is Hospice Recommended?

Hospice care is typically recommended when an individual has been diagnosed with a terminal illness and their life expectancy is six months or less, as determined by the treating physician and the hospice medical director. Some common scenarios in which hospice may be recommended include:

  1. Advanced Stage of Illness:
    • When a medical condition has progressed to an advanced stage, and curative treatment options are no longer viable or beneficial, hospice becomes a valuable option. This may include diseases such as cancer, advanced heart failure, or late-stage neurological disorders.
  2. Decline Despite Treatment:
    • If the patient’s health continues to decline despite undergoing aggressive medical treatments, the focus may shift from curative care to providing comfort, pain management, and emotional support.
  3. Frequent Hospitalizations:
    • Individuals experiencing frequent hospitalizations due to complications related to their terminal illness may find relief and enhanced comfort in hospice care. Hospice aims to minimize hospital visits and provide care in a familiar and supportive environment.
  4. Choosing Quality of Life:
    • When the emphasis shifts from prolonging life to improving its quality, hospice becomes a recommended option. Hospice care focuses on managing symptoms, alleviating pain, and enhancing the patient’s overall well-being.
  5. Exhaustion of Treatment Options:
    • When available treatment options have been exhausted, and further interventions are unlikely to provide significant benefits, hospice care offers a compassionate and holistic approach to end-of-life care.

II. Reasons Why Hospice is Recommended:

  1. Pain and Symptom Management:
    • Hospice care prioritizes effective pain management and symptom control, aiming to provide comfort and alleviate distressing symptoms associated with the terminal illness.
  2. Emotional and Spiritual Support:
    • Hospice care teams include professionals such as social workers and spiritual counselors who offer emotional and spiritual support to both the patient and their family, helping them navigate the emotional challenges of the end-of-life journey.
  3. Choice of Location:
    • Hospice care allows individuals to receive care in the comfort of their own home or in a hospice facility, providing a familiar and supportive environment during their final months.
  4. Holistic Approach:
    • Hospice embraces a holistic approach, addressing not only the physical aspects of care but also the emotional, social, and spiritual needs of the patient and their loved ones.
  5. Respect for Individual Wishes:
    • Hospice encourages individuals to express their preferences and make decisions about their end-of-life care, respecting their autonomy and dignity.

Choosing hospice care is a deeply personal decision that involves considering the individual’s medical condition, prognosis, and personal preferences. By understanding when hospice is recommended and the reasons behind it, individuals and their families can make informed choices that prioritize comfort, support, and dignity during a challenging time. Hospice care serves as a compassionate and comprehensive approach to end-of-life care, focusing on the quality of life in the face of a terminal illness.

What makes someone eligible for Hospice? Part 1

Hospice care is a crucial aspect of healthcare designed to provide comfort, support, and dignity to individuals facing terminal illnesses. For those eligible for Medicare, understanding the coverage and services offered under Medicare Hospice benefits is essential. In this blog post, we will delve into the specifics of what Medicare pays for in hospice care, helping individuals and their families navigate this challenging but crucial aspect of end-of-life care.

I. Eligibility Criteria for Medicare Hospice Benefits:

Before exploring the services covered by Medicare Hospice benefits, it’s important to understand who qualifies for this support. Generally, individuals must meet the following criteria:

  1. Medicare Enrollment:
    • The patient should be eligible for Medicare Part A.
    • The patient should be receiving care from a Medicare-approved hospice provider.
  2. Terminal Illness Diagnosis:
    • A doctor and the hospice medical director must certify that the patient has a life expectancy of six months or less if the illness runs its normal course.

II. Covered Services under Medicare Hospice Benefits:

Medicare Hospice benefits provide a comprehensive range of services to address the physical, emotional, and spiritual needs of patients during their end-of-life journey. Some of the key services covered include:

  1. Medical Care:
    • All necessary medical services related to the terminal illness are covered, including doctor visits, nursing care, and medical equipment.
  2. Prescription Drugs:
    • Medications directly related to the terminal illness and symptom management are covered. This includes pain relief, symptom control, and other necessary drugs.
  3. Hospice Aide and Homemaker Services:
    • Trained hospice aides assist with personal care, bathing, and other daily activities. Homemaker services may include light housekeeping.
  4. Counseling Services:
    • Medicare covers counseling services, including emotional and spiritual support for both the patient and their family members.
  5. Respite Care:
    • In situations where caregivers need a break, Medicare provides short-term respite care in a Medicare-approved facility.
  6. Medical Social Services:
    • Social workers can provide counseling and help navigate the emotional and practical challenges associated with end-of-life care.
  7. Grief and Loss Counseling:
    • After the patient’s passing, Medicare continues to offer bereavement counseling and support for the family.

III. What Medicare Hospice Does Not Cover:

While Medicare Hospice benefits cover a wide array of services, it’s important to note that certain services are not included. These may include:

  1. Treatment for the Terminal Illness:
    • Hospice focuses on comfort care rather than curative treatment. Therefore, Medicare does not cover treatments intended to cure the terminal illness.
  2. Room and Board:
    • If a patient resides in a nursing home or hospice facility, Medicare does not cover the costs of room and board.
  3. Emergency Room Visits and Hospital Stays:
    • Unless pre-approved by the hospice team, Medicare does not cover emergency room visits or hospital stays unrelated to the terminal illness.

Navigating the complexities of end-of-life care can be challenging, but understanding the comprehensive support offered by Medicare Hospice benefits can provide much-needed clarity and assistance during a difficult time. By ensuring eligibility and being aware of the covered services, individuals and their families can make informed decisions that prioritize comfort, dignity, and support for their loved ones in their final months.

Palliative vs. Hospice…how do I choose?

At Elite, we are often asked about the difference between palliative and hospice. The biggest misconception is that palliative is “hospice light”, and this just isn’t true. Palliative is designed to help you live your best life while you are still pursuing curative treatments. That means, our goal is to help you live the life and participate in the activities by minimizing symptoms and side effects of the medical interventions you need. 

Palliative Care

Definition:
  • Palliative care is a holistic approach aimed at improving the quality of life for patients facing serious illnesses.
  • It is not limited to end-of-life situations and can be provided at any stage of an illness.
Goals of Palliative Care:
  • The primary goal is to manage symptoms and improve overall well-being.
  • A multidisciplinary team collaborates to address physical, emotional, and spiritual needs. At Elite, our team is led by a nurse practitioner, a medical assistant, a social worker, a chaplain, and a nurse. We meet together regularly to support your individual situation.
Applicability:
  • Palliative care is suitable for patients at any age and any stage of a serious illness, including those undergoing curative treatment.

Hospice Care

Definition:
  • Hospice care is a specialized form of care focused on providing comfort and support for those nearing the end of life.
  • Hospice care is typically considered when curative treatments are no longer effective or desired.
Goals of Hospice Care:
  • The primary goal of hospice is to enhance the quality of life in the final months, weeks, or days.
  • Hospice professionals are focusing on pain management, emotional support, and facilitating a peaceful and dignified death.
Applicability:
  • Hospice care is generally for patients with a life expectancy of six months or less.
  • While many believe that hospice means giving up on treatment, the goal of the program is actually a shift in focus towards comfort and quality of life.

Key Differences

Timing:
  • Palliative care can be integrated at any stage
  • Hospice care is typically considered towards the end of life.
Goals and Focus:
  • Palliative care is focused on improving overall quality of life
  • Hospice care is focused on end-of-life comfort.
Treatment Intent:
  • Palliative care is designed to be provided alongside curative treatments
  • Hospice care is more about comfort measures and discontinuing aggressive treatments.

Why you shouldn’t wait to be imminent for hospice…

One of the common misconceptions for hospice is that people wait to go on hospice until they are “actively dying.” This is wrong!

Hospice is not designed and really is unable to provide the full service when the patient is actively dying. In the actively dying phase, hospice has already supported the patient and family with resources and care training. In an ideal scenario, families and loved ones are able to have extra support from their care teams, and the care teams can set-up what the patient has deemed is their ideal death, usually meant for the family members that are present. When hospice is thrown into an “actively dying” situation, the nurse is often administering medications, and that might be all. There is minimal support, because the rest of the team has not been involved to provide those services.

In a fast hospice situation, patients and families do not have a chance to prepare for death itself, the after-death choices, options, and expenses. There is often confusion about who is responsible for what, because there is no time for preparation. Medicare (and Medicaid) have intentionally created a program to support people during the last 6 months of life. This 6-month program is to allow for preparation, planning, education, and support. Often times, your chaplain and your social workers are critical team members that help families make decisions and plans, so the patient is able to have an ideal death.

Death is not like what you see on television, and giving someone a “good death,” involves preparation, planning and training. This is where your hospice team is crucial. Too often, patients are referred to hospice, and they do not get the benefit that they have paid for their whole lives.
Hospice is not designed for the imminent patient.
Hospice is designed as the last service the medical community provides for its patients.

Not what you thought? 

Not surprising!

Most people are uncomfortable with death and push it off. Unfortunately, pushing off hospice often results in a less than ideal death experience for the patient and their family. It can feel awkward and troublesome to talk about death and the dying process. Hospice professionals understand this, and they are trained and intentional in supporting your individual learning journey.

For more information, you can email our team at info@EliteHHH.com

I also recommend doing your own research on the hospice process. A great resource is Hospice Nurse Julie at www.youtube.com/@hospicenursejulie

How are Hospice and Palliative Care provided?

All hospice is palliative, but not all palliative is hospice.

Both programs are designed to provide you comfort and target quality of life.

The programs do this task in different ways, because of when and how the programs are accessed.

Hospice is a Medicare-designed program that is implemented when an individual is no longer pursuing curative treatments and has a prognosis of less than 6 months of life if the disease process were to run its course. Hospice provides equipment, medications, and a team of support – nursing, chaplain, social worker, and an aide. Additional services can be added such as massage therapy, physical therapy, occupational therapy, and speech therapy.

Palliative is not defined by Medicare and will vary based on the provider. Most palliative programs support interventions to aid in quality of life while pursuing curative treatments. The goal for palliative is to focus on the patient and their health goals during treatment. The patient is financially responsible for all care and equipment needs. The palliative team is comprised of a practitioner (for Elite, this is a nurse practitioner), a nurse, a medical assistant, a chaplain, and a social worker.

Elite provides both hospice and palliative care services to the communities of the Lewis-Clark valley, Moscow area, and Orofino area. We may request to schedule a meeting with you, called a Goals of Care, to support your goals and needs. This conversation also helps to identify the right program for you based on what you are currently pursuing with your doctor.

If you would like additional information, please email us at info@EliteHHH.com. We would be happy to address any questions you may have about our programs, these services, and your healthcare goals.

What are the quality ratings for hospice?

Medicare is intentional to provide open and transparent information about agencies that serve hospice as part of the Medicare benefit.

Agencies must convey the typical conditions they treat and therefore can claim expertise in providing services for end-of-life. Diagnoses that are typically identified for hospice services under Medicare include:

  1. Cancer
  2. Renal Failure
  3. Dementia
  4. Cardiac Disease
  5. HIV/AIDS
  6. Liver Disease
  7. Pulmonary Disease
  8. Neurologic Disease
  9. Stroke or Coma

Medicare requires agencies display where they provide services. This information is different from where they are eligible to provide services. Typical location include: home, assisted living facility, skilled nursing facility, inpatient hospital facility, inpatient hospice facility, or other locations.

Hospice includes 4 levels of care. Those are:

a) Routine home care which is the most common and is provided with the patient is generally stable and symptoms are adequately controlled.

b) General inpatient care is a crisis-like level of care that is implemented for the short-term to support controlling pain and other symptoms. It is usually provided in the hospital or skilled nursing facility.

c) Continuous home care is a crisis-like level of care that is implemented for the short-term to support out of control pain and symptoms in the home setting.

d) Respite care is a temporary care level in a nursing home, hospice facility, or hospital to allow a family member or caregiver some time off. This level of care is not tied to the patient’s symptoms.

Hospice agencies must report what levels of care they engage in to support their patients.

Another rating is the family and caregiver experience. This rating involves the family review of communication, timeliness of services, respect for the patient, providing emotional and spiritual support, help with pain and symptoms, the training provided for the care of the patient, an overall rating, and the willingness to recommend the agency.

Medicare reviews all agency documentation and identifies the completeness of the initial nursing assessment and the visit frequencies from a nurse or social worker in the last 3 days of life. Medicare will also identify if the agency is accepting Medicare, Medicaid, and/or Medicare Advantage patients, as well as report on average how long people access hospice services through the particular agency.

For example, Elite serves both Medicare and Medicaid patients, as well as Medicare Advantage Plan recipients. Patient with Elite’s hospice services are typically receiving hospice for 56 days. The information is updated with Medicare review and state surveys. If you would like to review agencies that you are considering for hospice services, please go to medicare.gov/care-compare/

How do I choose a Hospice Agency? Part 2

The Centers for Medicare & Medicaid Services (CMS) has created the hospice coverage program to support patients who have a terminal illness and their families through the dying process and 13 months afterwards. The guarantee supports patients receiving care from a certified hospice agency, collaboration from two providers to certify the patient’s prognosis, and the patient election of services. While the hope is for all patients to experience the comfort and care that is provided through hospice, patients and families always have a choice.

A common misconception is that hospice is only for palliative services, i.e., pain management via morphine. This is an oversimplification of the skilled services the hospice team provides and limits the level of intervention that is actually provided. Services that can support quality of life include the medical oversight from the agency provider, the skilled nursing care, the medical equipment and supplies provided, the medications that address pain and other symptoms, the care services of the certified aide, the counseling services of the social worker, the spiritual guidance of the chaplain, and the consultative training and support of physical, occupational, speech, and dietary therapies. Finally, the ongoing service provision after the patient has died cannot be discounted.

Facilities and providers that claim “hospice-like” services will often charge for the medical consultation, charge for the medications provided, and often do not address the psycho-social-emotional-spiritual aspects of the dying process. Patients on hospice are supported with a comprehensive plan that addresses how they would like to pass away, their funeral arrangements, their household arrangements, and the collaboration with their family members for key decisions beyond their healthcare. This is included in the hospice benefit. The Medicare benefit covers all of these services.

Patients are entitled to hospice. They have paid their whole life for the service, and they deserve the full benefit.

Questions you may want to explore with a potential hospice company are:

1)How will the hospice team manage my pain or other symptoms that arise? Your nurse and medical provider will review your symptoms and implement different interventions, including medications, therapies (e.g., massage), or strategies.

2) Can I take my current medications? Some patients choose to continue existing medications. All medications are discussed with your hospice team to identify side effects and symptoms that may alleviate or contribute to your comfort.

3) What if my symptoms become uncontrollable at home? Can I go to the hospital? Hospice involves different levels of care. While our goal is to manage all of your symptoms in the comfort of your home, if we are unable to do this, we will increase your care potentially involving an inpatient stay.

4)How will the hospice team keep me and my family informed about my condition? You will have ongoing communication with your hospice team, primarily through your nurse case manager.

5) Will my family and I be involved in making care decisions? Yours and your family’s concerns for care are integral in the team dynamic. Your concerns and questions are critical to developing a care decision that meets the need.

6)How do I communicate any questions or concerns I have about my care? You have access to all of your care team members. These individuals are available to you to support issues or concerns that arise.

7)Can I still see my regular doctor if I am on hospice? If you choose the agency’s medical director, your care will be deferred to the new provider in collaboration with you and the care team. You may elect to use your primary care provider to oversee your hospice benefit if you prefer to retain your provider.

8)How will the hospice team prepare me and my family for what to expect? Your team involves trained professionals who recognize signs and phases of the dying process. Part of hospice is to provide education and support as things change. This is why you will have regular visits with the nurse who will assess and provide education and training. This visit with your nurse may introduce, or exit, members of your care team based on your individual needs.

9)Can we speak with other caregivers to learn of their experience with hospice? We can connect you with individuals who have gone through the hospice process. Many times, these individuals are volunteers with our agency who want to give the support they received back to individuals who are now going through the process.

10) What support services are offered by the hospice? One of the levels of hospice involves respite care. There are also coordinated services for caregivers to provide regular opportunities to refresh. Your case manager will work with you and the social worker to identify and coordinate the appropriate supports.

11) What if we cannot take care of our loved one at home? Your social worker is a critical member at addressing your psycho-social-emotional needs. If you find that you are unable to care for your loved one at home, your social worker will work with you to identify options for placement, increased hired help, or other supports.

12) How will the hospice team support us emotionally through the grieving process? Bereavement is offered for up to 13 months. By design, your hospice benefit is meant to support your loved ones after you pass away through important dates, such as birthdays, anniversaries, and your death. These services are part of hospice and help family members after you have transitioned.

These questions are some of the more common questions we address regularly. You may have others, and those should be talked about before you start hospice. It is a big decision, and for many family members, a decision that helps shape how someone passes.

How do I choose a Hospice Agency? Part 1

Hospice is a Medicare program designed to provide comfort and support for individuals at the end of their life. Medicare evaluates agencies that provide services by addressing issues related to how quickly comfort is provided and the level of support the hospice team is giving to a patient and their family.

Questions you may want to consider in evaluating a hospice agency include:

  1. Are my hospice services covered by my insurance? While Medicare covers hospice at 100%, there are insurance companies that cover only a portion of the service or limit the services provided, including the number of days the patient may access the benefit. It is important to have an idea of out-of-pocket costs if you are not accessing hospice as a Medicare beneficiary.
  2. How long has this hospice agency been supporting patients in this community? Every community is different, and there may be cultural practices that agencies that have been serving an area for a long time may be aware of and are able to better support. The hospice benefit should incorporate your individual beliefs, spiritual needs and practices. Chaplains are provided as spiritual counselors. They are not proselytizing or promoting any particular religious belief system.
  3. Where does this agency provide hospice services? Agencies may choose to provide services in particular spaces, such as skilled nursing, assisted living, or in hospice houses. Elite provides services anywhere the patient calls home. It is important to check if your agency has restrictions on where they are able to provide services to support continued care even if you have to move locations.
  4. Does this hospice agency provide all of my medical equipment? Most hospice agencies will cover the cost of necessary medical equipment, such as a hospital bed, commode, and incontinence supplies. These needs are typically identified at admission and adjusted if needed during the course of hospice services.
  5. Will I have the same hospice nurse/team? While staffing may change to support on-call coverage, most hospice agencies are intentional in having the same hospice providers – nurse, chaplain, social worker, and aide – with you during the duration of your hospice service. We know that having familiar people in your home is part of providing comfort and care. Our on-call nurse is the exception to this, as we rotate our staff to support work-life balance. With that said, many of our nurses will request to be present when their patient passes and will often put the on-call nurse on alert if the call is about their particular patient.
  6. How many patients are assigned to each hospice nurse? These numbers vary by agency. At Elite, our patients serve both home health and hospice, so our numbers reflect that difference. We also support a large geographic space, so each nurse’s caseload is determined in part by the area being covered, the patient complexity, the mix of home health and hospice, the nurse’s employment status (part time or full time) and the nurse’s experience, anywhere from 8-20 patients is the average.
  7. Does the hospice agency have after hours, weekend, holidays and night support? Yes, hospice is a 24/7 service. We are available through our phone triage and in person. Simply call our main number 509-758-2568, and we will get you the right level of support.
  8. When I call with an urgent need, how long will it take someone to respond? We have a 20 minute turnaround on all phone calls. If the nurse identifies the need for a visit, there may be a delay depending on where the nurse is coming from. They will typically provide a time expectation based on the patient location and where they are coming from. If they are addressing another patient need, there may be a delay in an in-person visit. Know that we create redundancies to support if there are multiple needs at once, so a nurse can come to the home in a reasonable amount of time if needed.

We have lots more to cover. Stay tuned to next week for Part 2!