Hospice/Home Care Information
Information approved by the American Society of Clinical Oncologists
Hospice care is a health service delivery program available in the Frederick community to help you maintain quality of life when you are faced with a life-limiting illness. The emphasis of hospice care is on relieving pain and discomfort and helping you and your loved ones cope with the emotional, psychological and spiritual impact of incurable illness, dying and grief. It is normal to feel overwhelmed when your doctor tells you there is little chance that treatment will cure or reverse the disease. Hospice can help. Hospice care brings a multifaceted team of professionals to focus on your individual needs and goals and allows you to approach the end of life with confidence in comfort, peace and dignity.
According to the National Hospice and Palliative Care Organization, most hospice care takes place in the home, although there are some freestanding hospice centers (such as the Kline Hospice House), hospitals, nursing homes and other long-term care facilities that provide hospice care programs.
Eligibility for Hospice Care
Hospice care is most beneficial when treatments intended to cure have been exhausted, and you are facing a limited life expectancy. In the United States, acceptance into a hospice typically requires a statement by a doctor that you have a life expectancy of six months or less if the disease runs its natural course. You will need to discuss certain issues regarding your disease progression, outlook for recovery and individual medical condition with your doctor to determine if hospice is appropriate for you. If your condition should improve or your disease goes into remission (temporary or permanent absence of symptoms), hospice care can be discontinued and active treatment can resume. As necessary, hospice care can begin again at a later time.
Finding a Hospice Facility or Program in the Frederick Area
The National Hospice and Palliative Care Organization provides a database of hospices that you can search by state and city. For patients in Frederick County, Hospice of Frederick County (a division of the Frederick Regional Health System) is available to help.
Goals of Hospice Care
Comfort and quality of life are the primary goals of hospice. Hospice care focuses on your and your family's individual needs and acknowledges the fact that every person is unique with their own set of personal beliefs, hopes and fears. The overall aim of hospice is to promote your well-being as long as you live.
Hospice Programs and Services
In order for hospice to be successful in achieving its goals, it requires input from you and your loved ones, as well as a variety of medical, nursing and allied health professionals. This interdisciplinary hospice team typically consists of:
A doctor and/or medical director
Nurses who provide direct care and case management
Home health aides, including bath aides, to assist with basic needs
Chaplains and pastoral care counselors
Physical, occupational and rehabilitation therapists
Trained hospice volunteers
Your primary care doctor and/or specialist
The hospice team works closely with you and your family or caregivers to develop a plan of care tailored to meet your unique needs. The hospice staff is also responsible for meeting with you and your family to explain the approach to care and the types of services offered.
Hospice at Home
In many cases, a family member or close friend will assume the majority of the responsibility in caring for you at home and serves as primary caregiver. The hospice staff will regularly meet with you to evaluate your needs on a continual basis and provide you with any services necessary under the supervision of your doctor or the hospice staff. The hospice staff is on-call 24 hours a day, seven days a week. This plan of care will include measures to help with pain, other symptom management and counseling.
The American Hospice Foundation developed a checklist to help you and your family learn what to expect from high-quality, in-home hospice care. You can expect the hospice staff to:
Teach you (and your family) to care for yourself as much as you comfortably can
Enable your family to provide some of the care under supervision from hospice care staff and hands-on training
Let you know how often they will visit and set up appointments with you and your family, so you know when to expect them
Order the necessary equipment and supplies, and ensure that they arrive promptly
Explain how pain and other symptoms will be controlled
Make certain that you are comfortable, with least possible pain, or other troubling problems
Answer calls and urgent questions at any time of the day and night, and respond immediately to urgent calls from you or your family members
Include you and your family in planning your care
Determine if you need or want spiritual support from the hospice program
Arrange for brief stays in a hospital or nursing home if family caregivers need time away from their responsibilities at home
Explain to you and your family what is likely to happen if you should die
Work with you and your family to prepare advanced directives in the event you become unable to vocalize your preferences near or at the end of life
Explain what needs to be done at the time of death
Offer grief support to help your family adjust to life changes after death
Hospice Care Outside the Home
If you are admitted to an inpatient hospice facility, the location and hours should be convenient for family visits; provide peace and quiet; and ensure privacy for you, your family and other visitors. Consider discussing the following issues with the hospice staff:
- How will pain and other symptoms be managed?
- How will family members be involved in day-to-day care, such as eating, bathing, giving medication and monitoring changes in condition?
- What services are provided to help with the emotional and spiritual aspects of death and dying?
- Who can my family members call if they have any questions, and what are the phone numbers?
- Can family and friends visit at any time?
Medicare Hospice Benefits
The cost of hospice care, whether at home or as an inpatient, is covered as a benefit under Medicare Hospital Insurance (Part A). The Medicare Hospice Benefit (PDF) entitles all Medicare beneficiaries to the benefits of hospice care. A doctor must determine that you have a limited life expectancy of six months or less if the condition runs its natural course to be eligible for the Hospice Benefit, and you will be required to sign a statement choosing hospice care instead of the standard Medicare benefits for a terminal illness. Under Medicare, hospice is primarily delivered in the home setting by a Medicare-approved hospice provider and covers:
- Services provided by the doctors
- Nursing visits to the home with 24-hour on-call services
- Medical appliances and supplies related to the terminal illness
- Medications for symptom management and pain relief
- Short-term, acute care either in a hospital or nursing home, including respite care. Inpatient respite care is provided to give family caregivers temporary relief and is limited to a stay of five days or less.
- Home health aide and homemaker services
- Physical therapy, occupational therapy, speech and language therapy and medical social services
- Supportive counseling
- Spiritual support and counseling
- Nutritional counseling
- Bereavement support for your family
What Medicare Does Not Cover
The following services are not covered under Medicare:
- Treatment for the terminal illness that is not for pain control and other symptom management
- Care given by another healthcare provider that was not arranged through the hospice program
- Care given by another healthcare provider that duplicates care the Medicare-approved hospice provider is required to provide
For Medicare benefit information, visit the United States Department of Health and Human Services at www.hhs.gov.