I am currently caring for my husband's grandmother in our home. I have 2o plus years as a nurse and caregiver in the geriatric and hospice fields.
Hospice is a Medicare benefit that requires a terminal diagnosis that has a life expectancy of 6 months or less.
This does not mean that if the client is still alive at the end of the 6 months they would be left to fend for them self. There is a renewal process that validates the terminal diagnosis remains. There is a web site that can address many of the issues connected with this difficult and painful decision it is: http://www.hospicefoundation.org.
While working in the nursing home I had a patient who had fallen at home and broke her arm. She was admitted to the nursing home for rehab. During her stay it was discovered she had terminal cancer, the reason for the broken bone was the cancer had spread to her bones. As her nurse I was aware that her Doctor was going to share this with her when he did rounds that day. He stopped by the desk before starting his rounds on my floor. I asked for a hospice order for her. He said I don’t think we need that, giving the fact that he would give orders that would keep her comfortable, and being she was in a Religious nursing home she would have spiritual support. I did not disagree. After the doctor left my floor, this patient’s call light was on. I answered it. Entering the room I asked “can I help you”; her reply “could you sit down and talk with me for 10 minutes without looking at your watch, my doctor just told me I am dying.” I turned off the call light I told her “l will be back in one minute.” I paged the doctor to return to the floor I was working. On my way to her room I began trying to grasp what I would be feeling. Just the second before I saw my doctor’s face I was going to go home in a week and now knowing I would never return there but die instead. Entering my patients’ room I took off my watch and cried with her. I never put my watch back on, it is the gift she taught me, the gift of being were you are, and not thinking of where you have to be.
When the doctor returned to the floor I told him my story. I asked him how many nurses would have taken this time. I reminded him that if his patient was on hospice she would have a nurse that came to see her only. Volunteers would be there just to hold her hand.The nursing assistant would not have to worry about the resident down the hall. I explained that though he was willing to give us orders to keep her comfortable, it would not be so easy to get these orders from an on call doctor who had never seen this patient. I reminded him of how reluctant some of his colleges are when it comes to ordering narcotics. Gratefully he is a doctor who heard, hospice was ordered.