Hospice care is still a relatively under-utilized area of medicine. With that in mind, the Birmingham Medical News spoke to several hospice providers to learn about aspects of palliative care that would be important to physicians and we came up with seven.
• Although there may be a reluctance to refer patients to hospice before the holidays, having hospice support in place can help keep patients out of the hospital, relieve the burden on families, and ease symptoms so patients feel better and can enjoy a better last holiday with the people they love.
• There have been changes in how diagnosis and prognosis are considered in qualifying for hospice benefits. This is primarily aimed at establishing a clearer, more accurate picture of the patient’s condition. For example, failure to thrive is no longer a primary diagnosis for referral. If the failure to thrive is due to end-stage Alzheimer’s Disease, the hospice will include that in the evaluation and may identify other factors that should be considered in qualifying for benefits.
• Hospice is not giving up. It is a shift in focus from aggressive curative treatment to aggressively treating symptoms. A growing body of evidence suggests that patients with hospice support have better quality of life, better function and sometimes may live longer.
• Although hospice benefits take the place of Medicare’s hospital benefit, patients are still covered if they need hospital care for a fall or other health emergency that is not part of the condition they are being treated for under hospice. If an exacerbation is related to the condition for which they are receiving hospice care, hospice should be called first to either provide care or make arrangements so that hospital benefits are available. Patients can be followed by their primary physician, a referring specialist, or by the hospice medical director.
• After actually experiencing hospice care, the most common comment is “If we had known how much it could help, we would have asked for hospice earlier.” This is in contrast to the typical reaction when hospice if first brought up, when patients often think that hospice is for someone whose illness is more advanced and who may only have a few days left. Informational consultations, videos and printed materials are available from many hospices. This information can be made available earlier, before patients need hospice, so they will have a better understanding of all their options and the support available if the need arises. Hospice may also be available to patients waiting for transplants to help them stay in the best condition possible for as long as possible to give them a better chance of surviving long enough to get a transplant.
• Just as a living will, long term care, and whether to be an organ donor are topics best discussed and considered well before they become an issue, how patients want to experience their last days and support available to help them do that, if needed, should be part of proactive management of life-long health. A bill is now before congress that would provide reimbursement for talking with patients about hospice and end of life care.
• When is it time to consider a hospice evaluation? Frequent trips to the ER, shortness of breath while resting, multiple falls in a 6-month period, an increase in pain, noticeable weight loss and spending most of the day in a chair or bed could suggest that a transition to hospice care may be soon be indicated.
