When Hospice Care Is the Right Choice

This piece is the second in a three-part series profiling United Hospice of Rockland. Read the first here.

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Families often have many questions and misconceptions about hospice care.

Those can delay them from getting a loved one into hospice care as early as possible—and can impact the patient's quality of life in those last days, weeks and months, said Amy Stern, executive director of United Hospice of Rockland.

That additional time in hospice care can benefit the patient because it allows more time for the hospice-patient relationship to develop, which is a critical part of the care, she said. It also allows the hospice staff more time to prevent painful symptoms that may develop and improve the patient's quality of life for their remaining days, she added.

Here are some common questions about hospice care to help one decide if it's the right step for their family to take to help a dying loved one:

Question: Why should I use hospice services?

Answer: Hospice offers care for people facing serious illness. It will offer you choices about your care and help you to maintain control over decisions that affect you. The staff will make every effort to keep you comfortable in surroundings that can best meet your needs. They also will provide the emotional and practical support you and your family need during this time.

Q: When is the right time to call?

A: The sooner hospice becomes involved, the sooner it can help. Hospice will contact your doctor and meet with you to help determine the right time for services to begin.

Q:  Should I wait for our physician to raise the possibility of hospice, or should I raise it first?

A: The patient and family should feel free to discuss hospice care at any time with their physician, other health care professionals, clergy or friends.

Q: What if our physician doesn't know about hospice?

A: Most physicians know about hospice. If your physician wants more information about hospice, it is available from the Academy of Hospice Physicians, medical societies, state hospice organizations, or United Hospice of Rockland at (845) 634-4974.

Q: Who can receive services?

A: If you live in Rockland County or lower Orange County, have a serious illness and are in agreement with the goal of comfort care, hospice will help you no matter what your age.

Q: Where can I receive services?

A: Care is provided primarily in the patients' home. Hospice also is able to provide assistance in most local hospitals, skilled nursing facilities, assisted living facilities, group homes and other residential settings. 

Q: What specific services does hospice provide home-based patients?

A: Hospice patients are cared for by a team of doctors, nurses, social workers, counselors, home health aides, clergy, therapists and volunteers -- each provides assistance based on his or her area of expertise.  In addition, hospice provides medications, supplies, equipment, and hospital services if and when needed.

Q: Who pays for the services?

A: Most insurance carriers, including Medicare and Medicaid, cover hospice care. The staff will work with your insurer to arrange coverage. If you do not have health insurance, you may qualify for reduced fees or other special considerations. No one is ever turned away because they cannot pay for care.

Q: What does the hospice admission process involve?

A: One of the first things hospice will do is contact the patient's physician to make sure he or she agrees that hospice care is appropriate for this patient at this time. United Hospice of Rockland has a medical director available to help patients who have no physician. The patient also will be asked to sign a consent form. It is similar to the form a patient signs when they enter a hospital. The consent form says that the patient understands the care is palliative (aimed at pain relief and symptom control) rather than curative. It also outlines the services available. The form also explains how electing the Medicare hospice benefit affects other Medicare coverage for a serious illness.

Q: Can a hospice patient who shows signs of recovery be returned to regular treatment?

A: Certainly. If the patient's condition improves and the disease seems to be in remission, patients can be discharged from hospice and return to aggressive therapy or go on about their daily life. If a discharged patient should later need to return to hospice care, Medicare and most private insurance will allow additional coverage for this purpose.

Q: Is there any special equipment or changes I have to make in my home before hospice care begins?

A: Hospice will assess your needs, recommend any equipment, and help make arrangements to obtain any necessary equipment. Often the need for equipment is minimal at first and increases as the illness progresses. In general, hospice will assist in any way it can to make home care as convenient, clean and safe as possible.

Q: Does hospice do anything to make death come sooner?

A: Hospice does nothing either to speed up or slow down the dying process. Just as doctors and midwives lend support and expertise during the time of child birth, so hospice provides its presence and specialized knowledge during advanced illness.

Q: Do hospice patients have to have a do not resuscitate order in place in order to receive services?

A: There is no requirement for a patient to have a do not resuscitate order.

Q: Is hospice affiliated with any religious organizations?

A: Hospice is not an off-shoot of any religion. While some churches and religions have started hospices (sometimes in connection with their hospitals), these hospices serve a broad community and do not require patients to adhere to any particular set of beliefs. UHR offers spiritual care to people of all faiths.

Q: Does hospice provide any help to the family after the patient dies?

A: Hospice provides continuing contact and support for family and friends for 13 months following the death of a loved one. United Hospice of Rockland also provides bereavement groups and support for anyone in the community who has experienced the death of a loved one.