Having the Hospice Conversation
Having the Hospice Conversation
Having a conversation about hospice is never easy. Asking your patients to explain what they understand about their illnesses conﬁrms what they have understood and can be a good way to initiate a dialogue and to gauge their impression of their condition. This can also be an opportunity to talk about their care options.
Hospice emphasizes comfort and quality of life when a disease is terminal, meaning the prognosis for life expectancy is six months or less if the illness runs its normal course.
We understand having the hospice conversation can be difficult. Here are some talking points to help, and a member of our team can have this difficult conversation with your patients and their family members if you prefer. We are here 24 hours a day, 7 days a week, 365 days a year.
Dispel Myths About Hospice
Hospice Means Giving Up — The hospice benefit is set up, and hospices are required to give patients control and choices for themselves. The hospice team can guide the patient but all decisions are up to the patient and his/her family for aggressive treatment plans or palliative care.
Hospice is a Place — Hospice services can be provided wherever the patient lives. Many patients are most comfortable in their own homes, with their own families. Our hospice would prefer to come to the patient rather than move them to unfamiliar surroundings. We go wherever “Home” is.
Bigger is Better — The choice for a hospice should be based upon the patient and family needs and preferences. Bigger is not always better. There are many hospices that choose to remain small to ensure that they can provide well-managed care on a more intimate level with smaller ratios, to have quality time for the Nurse/CNA visits.
There is only one Hospice in the Valley — There are many hospices, and all operate as individual, independent businesses in the valley. They are not of a larger agency. All must be Medicare-certified and follow the same rules and regulations but are NOT one company.
Different Hospice, Different Services — Medicare has set the rules and regulations regarding hospice services to beneficiaries. The hospice Medicare benefit was designed to provide end-of-life comfort care, based on the patient’s disease qualifications. Hospices must provide and/or make arrangements for all basic Medicare-mandated services. However, each company may have specialized programs above and beyond regulations, that they provide at their own discretion and cost. None of these programs should cost families or patients any money.
No Choice for Hospice Services — Medicare requires that patients and their families be given a choice when palliative comfort care is being considered. Patients should make their decision after researching and asking questions. Patients/Families should hear the same answers from each hospice interviewed, as each must follow the same rules and regulations. The patient and his/her family have the right to choose the hospice services they feel the most comfortable with, without regard to what a hospital or healthcare person has possibly mandated.
All Hospice Have In-Person Units (IPU) — Most hospices in our valley do not own the buildings because of the cost to operate one. To be a Medicare Provider Hospice, all are required to have in-patient services available to patients in crisis. Smaller hospices tend to contract with in-patient units owned by other hospice or skilled nursing facilities. The hospice that sends the patient to an in-patient unit (IPU) still maintains service for the client with their own team and visits the patient at the facility to ensure good transition and continuity of care.
Patients Must go Into an IPU for Their Last Days — Medicare is very specific on the reasons for placement in an IPU facility. It must be a crisis situation, based on a patient’s symptoms needing to be managed by licensed medical staff on a constant basis. When the symptoms are stabilized and controlled, most patients return to where they were living. In-patient/IPU placement is usually for a very short period of time until the symptoms are managed. It is NOT long-term, it is NOT permanent and it is NOT used to keep patients in bed to prevent falls. In addition, it is NOT to assist with living arrangements, or as a pit stop, until assisted living accommodations are found.