How does Physical Therapy fit into Hospice?

When considering hospice care for yourself or a loved one, it’s essential to explore all aspects of the services offered, including physical therapy. While hospice primarily focuses on providing comfort and support to individuals with life-limiting illnesses, physical therapy can play a crucial role in maintaining or improving quality of life during this challenging time. In this guide, we’ll delve into how physical therapy fits into hospice care and explore the options available.

The Role of Physical Therapy in Hospice Care

Physical therapy aims to enhance mobility, alleviate pain, and improve overall physical function. In the context of hospice care, physical therapy focuses on addressing specific issues that impact the patient’s comfort and quality of life. This may include:

  1. Pain Management: Physical therapists can employ various techniques to help manage pain, such as gentle exercises, manual therapy, and positioning strategies, to alleviate discomfort and improve mobility.
  2. Maintaining Mobility: For individuals with mobility limitations due to illness or frailty, physical therapy can offer exercises and interventions to help maintain or improve mobility, allowing them to move with greater ease and independence.
  3. Fall Prevention: Falls can pose significant risks to individuals in hospice care. Physical therapists can assess the home environment, provide education on fall prevention strategies, and teach exercises to improve balance and stability, reducing the risk of falls and related injuries.
  4. Enhancing Comfort: Physical therapy interventions, such as massage, stretching, and positioning, can help relieve muscle tension, improve circulation, and enhance overall comfort for individuals receiving hospice care.

Elite Home Health & Hospice: Elite Home Health & Hospice is able to provide physical therapy services as part of comprehensive hospice care offerings. The interdisciplinary team works closely with patients and families to develop personalized care plans tailored to individual needs and goals. As the largest home health provider, our physical therapists are uniquely trained to support hospice patients.

When selecting a hospice provider, it is essential to consider factors such as the provider’s experience, the expertise of their physical therapy team, and their approach to personalized care. Discussing your specific needs and preferences with potential providers can help ensure that you choose the right fit for you or your loved one. Physical therapy looks very different depending on the reason for the intervention.

Incorporating physical therapy into hospice care can significantly enhance the comfort, mobility, and overall well-being of individuals with life-limiting illnesses. By exploring hospice options that offer physical therapy services, you can access comprehensive care that addresses both the physical and emotional needs of patients and their families during this challenging time.

Why do Hospice early?

When facing a terminal illness, the decision to transition to hospice care is a pivotal one, and timing plays a crucial role in ensuring the best possible quality of life during the final stages. In this blog post, we explore the compelling reasons why hospice is often considered better when embraced earlier rather than later in the end-of-life journey.

I. Focus on Comfort and Quality of Life:

  1. Early Symptom Management:
    • By opting for hospice care earlier in the course of a terminal illness, patients can benefit from proactive symptom management. This includes effective pain relief and interventions aimed at minimizing discomfort and enhancing overall well-being.
  2. Holistic Approach:
    • Early engagement with hospice allows for a more holistic approach to care, addressing not only the physical symptoms of the illness but also the emotional, social, and spiritual needs of the patient. This comprehensive care model fosters a more meaningful and dignified end-of-life experience.

II. Patient and Family Education:

  1. Informed Decision-Making:
    • Early introduction to hospice care provides the opportunity for patients and their families to become informed about the available options, make decisions aligned with their values, and actively participate in creating a care plan that reflects their preferences.
  2. Advance Care Planning:
    • Initiating hospice discussions earlier facilitates advance care planning, allowing individuals to express their wishes regarding treatment preferences, resuscitation, and other critical aspects of their end-of-life care.

III. Emotional and Spiritual Support:

  1. Building Relationships with Care Team:
    • Establishing a relationship with the hospice care team early on enables patients and families to build trust and rapport. This relationship becomes a source of ongoing emotional support and guidance throughout the end-of-life journey.
  2. Addressing Emotional Needs:
    • Early hospice care allows for the timely addressing of emotional and spiritual needs, providing counseling and support that can help individuals and their families navigate the emotional challenges associated with terminal illness.

IV. Caregiver Relief and Preparation:

  1. Reducing Caregiver Burnout:
    • Engaging with hospice services earlier can help alleviate caregiver burden by providing additional support, education, and respite care. This proactive approach reduces the risk of caregiver burnout during the demanding final stages of a loved one’s life.
  2. Educational Resources:
    • Hospice teams offer valuable educational resources that empower caregivers with the knowledge and skills needed to provide optimal care, enhancing the overall well-being of both the patient and their support network.

Choosing hospice care earlier in the journey of a terminal illness is a decision that prioritizes comfort, dignity, and quality of life. The benefits of early engagement with hospice services extend beyond symptom management to encompass emotional support, informed decision-making, and holistic care. By embracing hospice earlier rather than later, individuals and their families can navigate the end-of-life journey with greater understanding, support, and the assurance that their preferences and values are respected and prioritized. Early hospice care is not just about end-of-life support; it’s about living the final moments of life to the fullest, surrounded by compassionate care and the comfort of one’s choosing.

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/