When is the right time to call in hospice?

Question from Susan, Shaker Heights OH

Is hospice only for end of life care, or could I use it sooner?

Expert Answer by Barbara Kate Repa

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Barbara Repa, a Caring.com senior editor, is an attorney, a journalist specializing in aging issues, and the author of WillMaker, software enabling consumers to write their own wills, health care directives, powers of attorney, and final arrangements.

Hospice care is by definition reserved for terminally ill patients, who can no longer benefit from traditional medical care and are most in want of care that keeps them as comfortable and free of pain in their final days as possible. In fact, most hospice services require a doctor's certification that death is likely to occur within six months before they will make their services available.

To find the specific requirements of the nearest hospice providers, check out the "Hospice Search" function at the American Hospice Foundation.

But it sounds as if you're feeling the real need for some type of help in caring for your parent. If your mother or father doesn't qualify for hospice care, consider other forms of help, including:

Home care, which includes assistance with the activities of daily living such as bathing, dressing, and walking
Home health care, which involves skilled nursing or therapy services
Adult day health care, for people who need treatment for multiple, chronic health conditions as an alternative to entering some type of skilled nursing facility, or
Adult day care centers, which provide personal care and social activities -- along with daytime supervision and a variety of social and support services.

The specific services available and the types of care they can provide vary dramatically. You may best begin a search for local services the old-fashioned way: by looking in the telephone book under "Adult Care."

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I have been there answered:

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.

My story:

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.