Tag Archive | hospice care

Understanding Hospice Care

Hospice is a belief in specialized care. This viewpoint accepts death as the final stage of life. Hospice care is end-of-life care or palliative care which is provided by health professionals. Palliative care is treatment to help relieve disease-related symptoms, but not cure the disease; its main purpose is to improve your quality of life.

The goal of hospice is to allow patients to continue an alert, pain-free life and to manage other symptoms so that their last days may be spent with dignity and quality, surrounded by their loved ones. Hospice affirms life and does not accelerate or postpone death. Hospice provides humane and compassionate care for patients in the last phases of incurable disease so that the person may live as fully and comfortable as possible. The person may have lived a long life, but they deserve to be afforded dignity and compassion. Our elder population often gets over-looked when it comes time to let them complete the life cycle.

In order for a patient to be placed in hospice they must have a terminal illness such as cancer or an end-stage diagnosis. They must also be expected to live 6 months or less. In the elder population the patient usually has an end-stage diagnosis of dementia, Alzheimer’s, cardiac, renal insufficiency, or debility. Of course, there are other diagnoses, but these are the most common.

Hospice care begins when the patient is admitted to the program because of a terminal illness such as cancer or end-stage illness, which generally means that a hospice team member visits the home or long term care facility to learn about the patient’s needs. If the patient is elderly and the hospice is Medicare-certified then the hospice company must provide nursing, pharmacy, and doctor services around the clock. If the patient resides in a nursing home the hospice will pay for the nursing care, but they do not pay for room and board charges. Those charges will be paid either through private funds or via Medi-cal if the patient qualifies for the service.

It is important to know that home hospice may always require that someone be home with patient. This may be a problem if they live alone, or if other people in the home have full-time jobs and work outside the home.

Who is involved?

A team of professionals

In Hospice care there is a team of professionals and some volunteers that help provide the care. The health care team also called an interdisciplinary health care team manages hospice care. This means that many interacting disciplines work together to provide care for the patient. Doctors, nurses, social workers, counselors, home health aides, clergy, therapists, and trained volunteers interact and provide care for the patient and their family. Each team member offers support based on their expertise. The team treats the person rather than the disease; it focuses on quality rather than length of life. They not only focus on the care of the individual that is ill but also on the family. They give medical, psychological, and spiritual support.

Volunteers

Hospice volunteers play an important role in developing and providing hospice care. They may be health professionals or lay people who provide services that range from hands-on care to working in the hospice office or fundraising.

What Services are provided?

Coordination of care

The interdisciplinary team coordinates and supervises all care 7 days a week, 24 hours a day. This includes when the patient resides in a nursing home. This team is responsible for making sure that all involved services share information. This may include the inpatient facility, the home care agency, the doctor, and other community professionals, such as pharmacists, clergy, and funeral directors. The patient, the family and the caregivers are encouraged to contact hospice team if any problems arise. It does not matter what time of day or night the problem occurs. There is always staff on call to help with whatever may arise. Hospice care assures the patient and their family that they are not alone, and help can be reached at any time.

In a long-term care facility and/or assisted living facility the staff at the facility will also act on behalf of the patient and family. The hospice company does not remain at the facility unless it is an inpatient hospice facility. The family or patient can speak to the charge nurse at the facility to have questions answered.

Staff support

Hospice care staff members are kind and caring. They communicate well, are good listeners, and are interested in working with families who are coping with a life-threatening illness. They are usually specially trained in the unique issues surrounding death and dying. Yet, because the work can be emotionally draining, it is especially important that support is available to help the staff with their own grief and stress. Ongoing education about the dying process is also an important part of staff support.

Respite care

While you are in hospice, your family and caregivers may need some time away (this pertains the patient that is residing at home).Hospice service may offer them a break through respite care, which is often offered in up to 7-day periods. During this time the patient will be transferred out of the family home to a hospice facility or to a long-term care facility. This allows families to take a mini-vacation, go to special events, or simply get much-needed rest at home while the patient is cared for in an inpatient setting.

Pain and symptom control

The goal of pain and symptom control is to help the patient be comfortable while allowing them to stay in control of and enjoy your life. This means that side effects are managed to make sure that the patient is as free of pain and symptoms as possible, yet still alert enough to enjoy the people around them and make important decisions. With the elderly population the family would be more likely to make decisions regarding the medications and pain control by discussing any issues with the hospice nurse. In the elderly population there is often a diminished mental capacity making it difficult for an elder to make proper choices. Keep in mind that if the elder is still able to make decisions that the decisions will remain in their control.

Spiritual care

Hospice care also tends to the patient’s and family spiritual needs. Since people differ in their spiritual needs and religious beliefs, spiritual care is set up to meet the patient’s and/or the family’s specific needs. It may include helping them to look at what death means to them, helping them say good-bye, or helping with a certain religious ceremony or ritual.

Bereavement care

Bereavement is the time of mourning after a loss. The hospice care team works with surviving loved ones to help them through the grieving process. A trained volunteer, clergy member, or professional counselor provides support to survivors through visits, phone calls, and/or letter contact, as well as through support groups. The hospice team can refer family members and care-giving friends to other medical or professional care if needed. Bereavement services are often provided for about a year after the patient’s death.

Family conferences

Through regularly scheduled family conferences, often led by the hospice nurse or social worker, or in the case of a long-term care facility the IDT members family members can stay informed about the patient’s condition and what to expect. Family conferences also give everyone a chance to share feelings, talk about expectations, and learn about death and the process of dying. Family members can find great support and stress relief through family conferences. Conferences may also be done informally daily as the nurse or nursing assistant talks with patient and their caregivers during their routine visits.

Where can Hospice care take place?

Hospice care can be given in the patient’s home, a hospital, skill nursing facility, or private hospice facility. Most hospice care in the United States is given in the home, with a family member or members serving as the main hands-on caregiver.

Hospice is a wonderful service for anyone one with a terminal illness or an end-stage illness. But one of the problems with hospice is that it is often not started soon enough and in the case of the elder population not started at all. Sometimes the doctor, patient, or family member will resist hospice because he/she thinks it means that they are giving up or that there is no hope. Of course, this is not true. If the patient’s condition improves the patient would be re-evaluated and possibly taken off hospice if the improvement changes their life expectancy. The patient can always be placed on hospice later if their condition worsens. The hope that hospice brings is the hope of a quality life, making the best of each day during the last stages of advanced illness.

Resident Rights in Long-Term Care

Resident Rights

Long Term Care Facility/Nursing Home patients/residents have rights. These rights have certain protections under the law. The long term care facility must list and give all new residents a copy of these rights upon admission. These rights should also be addressed with the patient(s) at least annually.

Resident(s) rights usually include:

  • Respect: A patient/resident has the right to be treated with dignity and respect. Some examples are as follows:
  1. A patient/resident should never be treated like a child or talked “down” to.
  2. At no time should any staff member yell at the patient/resident or call them names.
  3. The patient/resident should always be called by their proper name.
  4. The patient’s/resident’s dignity must be protected while using the restroom or while dressing. The curtains should always be drawn and the door closed. Staff must not before entering.
  • Services and Fees: Each resident/patient must be informed in writing about services provided and fees before they enter the nursing home. Some of the things that need to be discussed are:
  1. Their insurance coverage. Those that have Medicare, for example, have 100 days of coverage. The first 20 days are at 100% and on day 21 the co-insurance days begin. The fees will vary depending on the facility. If the patient/resident has Medicare/Medi-cal there may be no co-insurance. The Medi-cal patient/resident often times has a share of cost . The facility is required to give full disclosure of the amount.
  2. Covered services that are a part of your room and board.
  3. Barber/hair-dresser cost
  4. Medical services included such as podiatry and vision care.
  • Money: Every patient/resident has the right to manage their own money or to choose someone else they trust to do this for them.
  • Privacy: The patient/resident has the right to privacy, and to keep and use their personal belongings and property as long as it doesn’t interfere with the rights, health, or safety of others. Things to keep in mind are:
  1. Because of the HIPAA regulations facilities are not allowed to disclose private medical information to the families. Privacy of the patient/resident is critical even if the family believes they are entitled to the information. The only time medical information disclosure to someone other than the patient is allowed  is when there is a POA(Power of Attorney) for health care appointed and it is in effect. The POA only takes over when the patient/resident no longer has capacity to make decisions, which is determined by the physician. The POA in this case would be the only one that would be able to obtain medical information. All other family members cannot gain access to the requested information.
  2. All mail must be given to the patient/resident unopened. If the patient needs help opening the mail or reading the mail the facility can have a staff member assist them.
  3. Items such as scissors, metal nail files, and pocket knives are a danger to others. These items should not be brought into a facility if possible. But if the resident feels they need these items ask for a locked drawer or lock-box to store them in.
  • Medical Care: The patient has the right to be informed about his/her medical condition, medications, and to see their own doctor.
  1. The patient/resident can refuse medications and treatments. The patient must be informed by the appropriate medical staff (i.e. the doctor or charge nurse) of all the possible outcomes.
  2. The patient/resident may see their own physician. If their physician does not follow their care at the facility the patient can choose to make other arrangements to see their primary care physician.
  3. The patient/resident also has the right to change physicians. The facility staff must assist the patient in finding a more suitable physician at the request of the resident or person designated to make decisions.

Patients/residents are people too and they deserve  respect. Just because they are in a Nursing Home does not mean that they cannot make decisions for themselves nor does it mean that they has less of a citizen. Cherish our elderly.