Last week, I attended a brown bag lunch on the topic of … hospice.
If you’re like me (and most of the population), when you hear that word, you immediately think of death. However, the seminar focused on “modern hospice,” which, as it turns out, is so much more than the stereotypical hospice of the past.
Amy Mestemaker, MD, was the speaker, and she really shed a new light on all of this for me. Dr. Mestemaker is a physician for HomeReach Hospice and Kobacker House here in Columbus and is Board Certified in Hospice and Palliative Medicine. Her compassionate nature and passion for her work were apparent almost instantly.
Some facts about modern hospice:
- To paraphrase one NHPCO definition of hospice, it exists to help people live as fully and comfortably as possible, for as long as possible.
- A well rounded hospice team includes not just a physician and nurse, but also a Chaplain, social worker, bereavement counselor, art/massage therapists, pet therapists, psychologists, home health aides, pharmacists and physical and occupational therapists. The team cares for all aspects of the patient and their family, from physical to emotional and spiritual.
- Hospice is covered by Medicare, and provides a variety of items and services including, but not limited to, medications, equipment and supplies, labs, x-rays, transportation, inpatient respite for caregiver relief, bereavement counseling, and limited inpatient stays for acute symptoms.
- Most hospice facilities do NOT require that a DNR be in place.
- Contrary to popular belief, patients on hospice can receive blood transfusions and IV antibiotics, and can have feeding tubes.
- Hospice services can be provided in the home or on an inpatient basis (i.e. nursing home, hospice facility).
- Hospice provides for maintenance drugs such as those prescribed for blood pressure, heart failure, or diabetes. It also provides for antibiotics and even flu shots if they are thought to prolong the patients quality of life.
- A patient can stop hospice care at any time and revert back to curative care. There are no limits or restrictions around going off of and back onto hospice.
- To qualify for hospice benefits under Medicare, a patient must be terminally ill with a life expectancy of six months or less, as certified by a physician. Hospice care under Medicare includes both home and inpatient care and provides benefits for a number of services that are not otherwise covered.
- Bereavement care and counseling is provided to family members for up to a year following death.
- Physician referral is NOT required. Hospice can visit the home or facility to assess the patient for eligibility.
When looking for a hospice, Dr. Mestemaker suggests you ask the following questions:
- Are the docs certified in palliative and hospice care, as well as pain management?
- Is the hospice non-profit or for profit?
- What is the general philosophy on care? For instance, if an infection develops, will they offer antibiotics?
So, the key to all of this is that hospice is intended to prolong the quality of life, not to prolong death and suffering. It aims to provide the patient the best quality of life possible for as long as possible, whether that means managing pain, helping the patient come to terms with the end of life, both practically (advance directives, etc.) and emotionally and spiritually, and helping families through the grieving process.
The focus is on care, not cure. Emphasis is on the whole person, as a human being, rather than on a disease. A terminal illness is just that – terminal. But, hospice can provide comfort and guidance during those last weeks and months, and the ultimate gift is peace of mind for both the patient and their family.
Dr. Mestamaker admitted that the challenge is in the when. Obviously, in many cases, it’s difficult, if not impossible, to predict whether an individual has 6 months left, or 9 months or a year…or more. While cancer patients often decline steadily, patients with heart failure sometimes ebb and flow, going through cycles of good and bad. Think of Alzheimer’s patients, and the challenge becomes even greater. This is one reason that hospice care has been a hot topic in debates surrounding Medicare reform.
As I was doing my own research, I came across this article on the NHPCO website discussing a recent Brown University study on hospice for dementia patients. The article is definitely worth a read if you are facing these issues. The findings concluded that without question, those patients and families who received hospice services not only had a more calm and comfortable end of life experience, but also had a more peaceful transition and a feeling of closure.
Dr. Joan Teno, the Brown University gerontologist who led the study was quoted as saying, “People whose loved ones received hospice care reported an improved quality of care, and had a perception that the quality of dying was improved as well.”
I found this to be comforting, as I was never really sure if/how/when hospice care applied to Alzheimer’s patients. Unlike cancer or other terminal illnesses, this disease is so nebulous in nature; it is truly the epitome of ambiguity and vague uncertainty. That being said, it’s good to know that we can benefit from the support hospice offers. The challenge will be in knowing when the time is right…