Hospice care for cancer

DEFINITION: Hospice care is care intended for terminally ill individuals who are expected to live for six months or less. It is focused on allowing terminally ill patients to spend their last days with family and friends in the most meaningful way possible and to die with dignity. Hospice care focuses mainly on palliative care, or care intended to provide comfort and reduce pain, rather than trying to cure the disease or prolong life. In addition to palliative care services for patients, hospice care provides spiritual and emotional support and counseling to the patients and their family members, friends, and caregivers. Services are most frequently provided in the home, but they are also available at hospitals, nursing homes, and other long-term care facilities. Many hospice care providers have live-in facilities of their own that are available if desired. According to the National Hospice and Palliative Care Organization, approximately 40 percent of all people in hospice care have cancer, although hospice care is available for people with any disease.

Hospice services: A wide range of hospice services are available and are provided based on the specific needs of the terminally ill person and their family and friends. The services provided may change during the course of the illness. Hospice services are intended not only to help the terminally ill person but also to provide support to the family during the difficult time and, even afterward, during the bereavement process.

Hospice care focuses on making the individual as comfortable as possible during the final weeks or months of life. Relief from pain and other symptoms that interfere with enjoyment of the time remaining is a primary focus. A doctor will prescribe medications as necessary to relieve pain or reduce other symptoms, and they may be administered by a nurse or trained family member. Many hospices have pharmacy services to fill prescriptions. If hospice care is provided in an outpatient setting, nurses will regularly visit the patient to check on progress and administer any necessary services. There are also nurses available twenty-four hours a day to answer any questions the primary caregiver may have and who can send someone out to help immediately if necessary.

The emotional experience of those needing hospice care and their families can be devastating. Skilled therapists, bereavement counselors, and others are available to help the terminally ill person and family through the painful experience and to help set realistic goals for the remaining time.

Hospices often offer ways for the primary caregiver to take a break from providing round-the-clock care, either to take care of necessary issues such as running errands or meeting with lawyers or just to take a break and relax. Respite care is the care provided in an inpatient setting, such as at a hospice or in a hospital, in place of the care normally provided by the primary caregiver. This leaves the caregiver free to do things, such as travel or taking care of chores that have been piling up. Respite care can last for up to five days.

The hospice team: The hospice care team may differ from situation to situation, depending on the needs of patients and their families and the services provided by a specific hospice care provider. The main members of the hospice care team are always the terminally ill person and the family members or friends who are providing the primary care. The patient makes the decisions about what kind of care is desired and what services would be most helpful, usually by talking to a representative from the hospice care provider to set up services and define goals for the care. The family member who is the primary caregiver helps determine when services such as respite care will be desired and will be responsible for most of the day-to-day care of the patient for as long as possible. Some hospice care providers have training to help the primary care provider better care for the terminally ill individual.

A doctor leads the hospice care team's medical members and oversees the terminally ill patient's care. The doctor can prescribe medications to alleviate pain or other symptoms that are reducing the patient’s quality of life. Typically, this doctor is a doctor from the hospice provider. The patient’s personal physician is also involved in the patient’s hospice care and can work with a hospice-provided doctor to ensure that the patient is as comfortable as possible. One or many nurses are also an important part of the hospice care team. They provide services such as administering medications to the individual and also report needs or changes to the doctor providing care.

Counselors or therapists with experience in providing support for terminally ill patients and their families are an integral part of the hospice care team. The amount and type of support provided depend on the needs and desires of the individual and the family, but often, helping family members talk about how they are feeling and helping them through the bereavement process is the job of the hospice counselor or therapist. Spiritual counselors or religious leaders such as priests or rabbis are often available to help the individual or family and to provide assistance with any desired religious rites or ceremonies.

Volunteers are often an important part of the hospice care team. Usually, they have been specially screened and trained to provide support services to the terminally ill person and family. This may include activities such as housework, providing light meals, or helping the patient’s caregiver with other basic tasks. The volunteer may stay with the terminally ill person to give the primary caregiver an opportunity to rest or run errands. Even just reading to the patient or playing board games can be a valuable service provided by volunteers from the hospice care provider.

Paying for hospice care: Hospice care, like other medical care and services, can be extremely expensive. However, Medicare covers hospice care for eligible individuals, and all fifty states and the District of Columbia also have Medicaid benefits that cover hospice care. Most private health insurance plans will cover all or part of the cost of hospice care. Generally, to be eligible, a doctor must certify that the patient is expected to live six months or less if the disease continues as predicted. Many patients with fit this description. Many hospice organizations provide benefits on a sliding scale for those individuals and their families who do not have insurance to cover the costs and cannot afford to pay very much out of pocket. Some offer free services for people who cannot afford to pay at all.

When the hospice benefit is being paid, it usually means that insurance will not continue to cover treatments that are intended to provide a cure, just those treatments intended to reduce pain or improve quality of life. There generally is not a limit to the length of time that hospice benefits can be provided, although often, a doctor must recertify that a patient is expected to live six months or less. If a patient improves such that life expectancy increases past six months, such as when the cancer unexpectedly goes into remission, the patient will be discharged from hospice care. Hospice care can begin again if appropriate at a later time.

Bibliography

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