Ask Bethany2018-07-25T17:17:14+00:00
What is hospice?2018-07-25T17:12:14+00:00

First and foremost, hospice is a philosophy of care. It emphasizes palliative or comfort care for those with a life-limiting illness who are either choosing not to pursue aggressive treatment or no longer have aggressive treatment options available to them. Hospice focuses on the patient and the family as a unit, providing not just physical support but emotional and spiritual support as well, so the patient can make the best of every day.

What services does hospice provide?2018-07-25T17:12:27+00:00

Hospice services are for the patient and family, coordinated with your physician. We provide a medical director, case manager, home health aide, social workers and spiritual coordinators. We have volunteers who provide services such as pet therapy and massage therapy, and we offer bereavement services.

Who makes the decisions about a patient’s care after hospice care begins? Does our primary doctor lose control?2018-07-25T17:12:30+00:00

Your physician, the patient and the family are all part of our hospice team. The entire team works together so that we can develop an individualized plan of care to meet each patient’s specific needs. Our hospice nurses are required to call the physician for any changes in orders that would affect the plan of care.

How do I know if my loved one may need hospice?2018-07-25T17:12:34+00:00

We have found that the best way is to simply ask your family member. Ask what their goals are. If they say things like “I don’t want to go the hospital anymore,” “I just want to go home,” or “I’m tired of being in pain,” it’s probably time to have a hospice discussion. If they say they want to continue aggressive treatments or they want to do everything possible, then maybe it’s not quite time to have that discussion.

Is hospice just for cancer patients?2018-07-25T17:12:51+00:00

Hospice is not just for people who have cancer. Hospice is available to any patient with an end-stage condition. Actually, less than 50 percent of our patients have cancer. Five other leading diagnoses for hospice are heart disease; debility; dementia, including Alzheimer’s disease; lung disease; and stroke.

I thought about hospice care, but I thought it was only for people at home.2018-07-25T17:12:57+00:00

You can have hospice at home, but you also can have hospice in a personal care home, assisted-living facility, a skilled nursing facility, independent living, and also, if appropriate, you can have hospice services in a hospital. We go to wherever you are.

I was told by a doctor that if my loved one enters hospice care, they can’t return to the hospital. Is that right?2018-07-25T17:13:03+00:00

That’s a question we receive quite often. If someone’s already on hospice care, are they able to go back into the hospital for further treatment? We promote comfort, so anything that is going to make them more comfortable, we are going to do. We will certainly coordinate with the case manager and the rest of our team, and if it’s something that will make the patient more comfortable, most definitely we will move forward with that.

Who pays for hospice? How are other services paid for when hospice is involved?2018-07-25T17:13:10+00:00

Hospice is covered by Medicare, Pennsylvania Medicaid, and most private insurances. The services that are covered include medication, equipment and supplies related to the hospice diagnosis, as well as the patient care team that is assigned. In addition, if you have a condition that is unrelated to the hospice diagnosis, your insurance continues in the same manner as it did prior to the hospice start date.

How can I talk to my family about hospice care?2018-07-25T17:13:16+00:00

Talk about how hospice services can help patients achieve their goals. Explain that the nurse coming to their home will help them remain pain-free, that the nurse’s aide can help them with their activities of daily living, that the social worker can help them resolve any issues that they have. Explain to them that hospice will help them have the end-of-life experience that they desire.

Do you offer respite for family caregivers?2018-07-25T17:13:23+00:00

We provide a respite level of care for families who may need a break from taking care of their loved one. To accomplish this, we pay the patient’s room and board for up to five days at a skilled nursing facility, and we cover all the medications, equipment and supplies related to the terminal diagnosis. For the patient’s safety, we also provide transportation to and from the facility.

Can’t a doctor just control the pain of my loved one?2018-07-25T17:13:30+00:00

Hospice focuses on much more than just the patient’s physical pain. The hospice nurse does a full physical assessment during each visit and reports back to the physician. With that information, the physician can make recommendations for pain and symptom control, which the nurse can then implement. Medications will be delivered right to the patient’s door. In addition, hospice provides emotional and spiritual support for the family and the patient. Bereavement services are initiated once the patient passes away.

I knew a person who was dying. Hospice was called, but they didn’t do anything.2018-07-25T17:13:36+00:00

Hospice is best utilized in the six months prior to the stage in which the patient is actively dying. Regulations prohibit hospices from providing services until the responsible party or the patient signs consent forms. After the consents are signed, then the nurse does a visit, provides a full assessment of the patient, and coordinates care and medications with the primary care physician.

Will choosing hospice restrict what I can and cannot do?2018-07-25T17:13:42+00:00

Hospice is about making patients as comfortable as possible. We encourage patients to continue to engage in all their activities as they can tolerate them. You do not have to be home-bound to be on hospice. With adequate pain and symptom control, you can focus on living.

Is hospice brought in because the family thought the nursing staff at a facility wasn’t doing a good enough job?2018-07-25T17:13:49+00:00

The facility is still considered the primary care giver. We don’t replace them. We come there and give them the additional support they need. We create a bridge between the family and the facility so that all parties understand the patient’s objectives and work together to achieve them.

A doctor told me that hospice may cause my loved one to lose hope. Does that happen?2018-07-25T17:13:54+00:00

Almost all our patients are aware they are nearing the end of their lives. For them, hope means having the end of life experience that they desire – to be in the location of their choice, surrounded by family and friends, pain free, symptoms under control, and enjoying the most of every day.

General Indicators2018-07-23T19:03:05+00:00
  • Patient/family desires comfort or palliative care
  • Patient no longer wishes to be hospitalized
  • Physical decline
  • Increased assistance with ADLs
  • Multiple co-morbidities
  • Weight loss
  • Serum albumin < 2.5 g/dL
  • Frequent hospitalizations or trips to the ER
  • Increasing pain or weakness
  • Life limiting condition
Heart Disease2018-07-23T19:10:51+00:00
  • Poor response to treatment
  • NYHA Class IV heart failure
  • Discomfort with physical activity
  • Supporting indicators:
    • History of cardiac arrest
    • Unexplained syncope
    • Cancer
    • No aggressive treatments available or being sought
    • Patient showing decline
  • Clinical findings of malignancy with widespread, aggressive, or progressive disease
  • Impaired performance status
  • Increasing symptoms, worsening lab values
  • Refuses further curative therapy or no additional therapies are available
Alzheimer’s Dementia2018-07-23T19:04:31+00:00
  • Stage seven or beyond on the FAST scale
  • Unable to ambulate without assistance
  • Unable to dress without assistance
  • Unable to bathe without assistance
  • Urinary and fecal incontinence, intermittent or constant
  • Unable to express needs
  • One or more of the following:
    • Aspiration pneumonia
    • Recurrent UTI
    • Septicemia
    • Stage 3-4 decubitus ulcers
    • Recurrent fevers
    • Weight loss
    • Renal disease
    • No dialysis
    • Creatinine clearance < 10cc/min (15cc/min in diabetics)
  • Supporting indicators:
    • Signs of uremia
    • Intractable fluid overload
    • Oliguria <400cc/24 hours
  • Dyspnea at rest
  • Poorly responsive to bronchodilators
  • Decreased functional capacity
  • Fatigue
  • Recurrent infections
  • Increasing ER visits
  • Weight loss
  • Resting heart rate > 100
  • Oxygen dependent
Acute or Chronic Kidney Failure2018-07-23T19:11:52+00:00
  • Not seeking dialysis or transplant
  • Creatine clearance <10cc/min, <15cc/min for diabetics
  • Serum creatine >8.0mg/dl, >6.0mg.dl for diabetics
  • Supporting conditions
    • Uremia
    • Oliguria
    • Hyperkalemia
    • Albumin <3.5mg/dl
Liver Disease2018-07-23T19:11:46+00:00
  • PTT > 5 sec above control
  • Serum albumin < 2.5 g/dL
  • Ascites despite diuretics
  • Peritonitis
  • Hepatorenal syndrome
  • Encephalopathy
  • Recurrent variceal bleeding
  • Supporting indicators:
    • Malnutrition
    • Muscle wasting
    • Hepatitis C
    • Active alcoholism
  • Impaired breathing capacity
  • Increased assist in ADLs
  • Decline in speech
  • Progression from normal to pureed diet
  • Progression from independent ambulation to wheelchair
  • One or more of the following:
    • Weight loss
    • Aspiration pneumonia
    • UTI
    • Sepsis
    • Recurrent fever
    • Stage 3-4 decubitus ulcers
CVA (Stroke/Coma)2018-07-23T19:06:30+00:00
  • Karnofsky 40% or less
  • Nutritional status decline
  • Dependent for all care
  • Weight loss
  • Dysphasia
  • No consistent or meaningful speech
  • Supporting indicators:
    • Aspiration pneumonia
    • UTI
    • Sepsis
    • Stage 3-4 decubitus ulcers
    • Recurrent fevers