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Definition of Hospice and Hospice Eligibility
What is the Definition of Hospice?
The definition of hospice is relatively simple, but knowing when hospice is right for you requires some thought.
Hospice is a type of care focused on providing comfort and support to patients with terminal illnesses, typically when life expectancy is six months or less. Hospice care prioritizes quality of life by managing pain and symptoms rather than attempting to cure the illness. This care is provided by a multidisciplinary team that includes doctors, nurses, social workers, and chaplains, ensuring comprehensive physical, emotional, and spiritual support. Hospice services can be delivered at home, in hospice centers, or in other healthcare settings, offering compassionate care tailored to the patient's and family's needs.
Understanding Hospice Eligibility and Admission Criteria
When facing serious illness, understanding the options for care can be overwhelming. Learning the basic hospice definition can be a first step. Hospice care offers a compassionate approach to managing end-of-life needs, focusing on comfort and quality of life rather than curative treatments. Let’s explore the eligibility and admission criteria for entering hospice, how to make the decision to stop curative care, managing the emotional impact of this choice, and the differences in care once you begin hospice.
Eligibility Criteria for Hospice Care
To be eligible for hospice care, a patient must meet specific criteria:
- Life Expectancy: The primary standard is that the patient has a life expectancy of six months or less if the illness runs its usual course. This determination is typically made by the patient’s physician in consultation with hospice medical directors.
- Disease Progression: The illness should be in an advanced stage where treatments aimed at curing the disease are no longer effective or desired.
- Patient and Family Consent: Both the patient and their family must consent to receive hospice care, understanding that the focus will shift from curative treatment to comfort care.
Making the Decision to Stop Curative Care
Once you know the definition of hospice and the eligibility criteria for admission, take some time to weigh the pros and cons of ending curative care and transitioning to hospice.
Deciding to stop curative treatments can be one of the most challenging decisions a patient and their loved ones will face. Here are some steps to help guide this decision:
1. Evaluate the Effectiveness of Current Treatments
You may have heard the expression that sometimes the cure is worse than the disease. When deciding if and when to choose hospice, ask yourself whether the current treatments are improving quality of life or merely prolonging the process of dying. There are a lot of reasons why some people reach a point when they realize they just don’t want to continue treatments. If treatments are making you miserable, or have little to no chance of curing you - in other words, if they begin causing more harm than good - it might be time to consider hospice.
2. Discuss with Healthcare Providers
Open a candid conversation with your healthcare providers. Ask about the realistic outcomes of continuing treatment versus shifting to hospice care. Your doctors can provide insight into the progression of the illness and the benefits of focusing on comfort. Sometimes doctors are so focused on their mission to cure disease that the patient or family needs to be the one to begin the conversation. A good question to ask is, “Would you be surprised if I died in the next six months?” It lets the doctor know you are ready to speak candidly and you want straight answers.
3. Consider the Patient's Wishes
For family members and caregivers, it’s crucial to prioritize the patient’s preferences. Respect their wishes regarding quality of life, comfort, and dignity. Some patients might prefer to spend their remaining time at home surrounded by loved ones rather than undergoing aggressive treatments in a hospital. Others may feel safer in a facility where they have round the clock care. It’s an incredibly vulnerable time, and the patient’s questions, concerns, and choices must be heard and respected.4. Involve the Family
4. Involve the Family
Family discussions are essential. Think about the circle of family and loved ones who should be kept informed or allowed to participate in decision making. Ensure that everyone understands the patient's condition and the goals of hospice care. Address concerns and provide emotional support to one another during this time. An advance care plan can reduce suffering for all involved and create a clear, patient approved roadmap that helps avoid disagreements and misunderstandings during this emotional time.
Handling the Emotional Fallout
The decision to transition to hospice care can bring about a range of emotions, including grief, relief, guilt, and fear. Here’s how to navigate these feelings:
Acknowledge Your Emotions: It’s normal to feel a mix of emotions. Acknowledge these feelings and understand that they are a natural part of the process. Talk openly about your emotions with trusted friends, family members, or a counselor.
Seek Support: Hospice organizations often provide counseling and support groups for patients and their families, including grief support. These resources can help you process your emotions and connect with others who are going through similar experiences.
Focus on the Positive: Remember that hospice care is about enhancing quality of life. Focus on the comfort, dignity, and support that hospice provides, which can bring peace of mind to both the patient and their family.
Revoking Hospice
It’s important to know that choosing hospice care is not an irreversible decision. If a patient’s condition improves or if they decide they want to pursue curative treatments again, they can revoke hospice care. This flexibility ensures that patients and families retain control over their care decisions.
Differences in Care Under Hospice
Once you begin hospice care, the approach to treatment and support will change significantly:
Focus on Comfort and Quality of Life: Hospice care emphasizes symptom management and pain relief rather than curing the illness. This approach aims to make the patient as comfortable as possible, addressing physical, emotional, and spiritual needs. Many hospices - the best hospices - even work with patients and families to ensure that final wishes are addressed, and special requests are facilitated if at all possible. Truly, if you are with a good hospice, it’s like getting a warm hug, just when you need it most.
Interdisciplinary Care Team: Hospice care involves a team of professionals, including doctors, nurses, social workers, home health aides, spiritual care counselors, and volunteers. This team works collaboratively to provide comprehensive care tailored to the patient's needs.
Home-Based Care: Many hospice patients receive care in their homes, which can be a comforting environment. Hospice staff make regular visits to provide medical care, support, and education to the patient and their family. Talk to your family, caregivers and providers about whether home-based care or in-patient care is right for you.
24/7 Availability: Hospice services are available 24/7, ensuring that patients and families have access to support whenever they need it. This availability can provide significant peace of mind.
Grief Support: Hospice care extends to the family even after the patient passes away. Grief support is provided to help loved ones cope with their loss, offering counseling and support groups. In addition, some hospices offer anticipatory loss support for both patients and families who are living with the advanced illness. This aspect of care can be a lifeline during a sad and frightening time. I highly recommend, when choosing a hospice, that you ask about what kind of grief support is available, and whether you can access it before your loved one passes.
Your Wishes Come First
Choosing hospice care is a deeply personal decision that involves careful consideration of the patient’s condition, treatment goals, and quality of life. Understanding the eligibility and admission criteria can help guide this decision, and recognizing the emotional impact can prepare families for the journey ahead.
Remember the definition of hospice: hospice care focuses on providing comfort, dignity, and support, and offers the flexibility to change the course of care if needed. By prioritizing the patient's wishes and embracing support, families can navigate this challenging time with compassion and understanding.
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