Hospice and Palliative Care
Unfortunately, many people still do not understand what the hospice philosophy of care encompasses for the individual patient. Most people incorrectly believe that hospice is the place you to go die. Actually, hospice is just a term to describe a different philosophy of medical treatment. The hospice patient has a terminal diagnosis for which there is either no cure or in which no further medical treatments, testing, or therapy is wanted or warranted. This type of philosophy in healthcare is also known as palliative medicine. Palliative medicine is not just for those in hospice and can be extended to many kinds of patients with many diseases and levels of function. In order to be eligible for the Medicare hospice benefit, the patient is usually expected to pass away within six months; there are no parameters for expected time until death for a palliative medicine patient.
The hospice patient also makes an additional request to be kept comfortable, pain free, and is seeking support for themselves and their family during the last phase of their lifetime. Although not a requirement for either hospice or for palliative medicine, the patient usually requests that they not be resuscitated if they should begin to fail. The same group of patients prefer not to go to hospitals for further testing and curative treatments, and shun extensive outpatient testing; these burdens begin to be viewed as futile for many patients and their families as they accept the final stages of their lives.
When in a hospice, the team of professionals directs their medical efforts towards comfort and caring, rather than curing. The patient usually maintains his or her own primary care physician while in hospice. Consultations with the medical director of a hospice program can be pursued when issues such as pain control arise. In addition, almost all hospice programs try to direct the care of the patient in the patient’s home. Sometimes the patient is transferred to an inpatient unit for special circumstances; for example, if the burden of care becomes too large at home, if pain needs to be controlled better, or when the patient becomes terminal.
The hospice movement received a tremendous boost when the government began supporting the movement financially, allowing for reimbursement through specific programs akin to Medicare. Many insurance programs have a hospice benefit; seniors are completely covered through a special government allowance. In a Medicare-approved hospice, Medicare pays almost the entire cost, including physician services, nursing care, medical appliances and supplies, drugs for symptom management and pain relief, short-term inpatient and respite care, homemaker services and home health aid, physical and other therapies as needed, and counseling.
If you believe you or a family member may be a candidate, you can contact your physician about recommendations to specific hospice programs in Tucson. The sooner a hospice is involved, the better it can help make a patient’s last moments be as comfortable and as satisfying as possible.
© Scott Matthew Bolhack, MD, MBA, CMD, CWS, FACP, FAAP
