What Exactly Is Hospice?
Find out what hospice is, when it’s appropriate, and why it’s important.
Rob Lamberts, MD
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What Exactly Is Hospice?
Today’s article is about a subject people like to avoid: dying. Yes, most people try to avoid dying and also don’t want to talk about it. Even doctors feel uncomfortable talking about death. But avoiding thinking or talking about death can be very costly and can lead to a whole lot of unnecessary suffering and pain. I believe that this may be the most important article I’ve done so far, and recommend you share it with your family members.
As a primary care physician, I’ve been alongside of a lot of dying people. Although it’s certainly hard to see people go through pain and loss, it is also an incredible opportunity to be there when help is most needed. Some of the most moving times I’ve been privileged to share with people comes during their last days.
Why Talking About Death is Important
Sometimes life’s end comes suddenly and unexpectedly. But much of the time, people have time to prepare for death. The problem is, despite obvious clues that a person’s life is ending, doctors, family, and the patient himself too often do little to prepare. One of the most underused resources that can greatly improve a person’s last days is hospice care.
What Is Hospice?
Hospice, also called palliative care, is end-of-life care, which specifically focuses on people who have 6 months or less to live. The goal of hospice is to improve the quality of life for both patients and their families, by aggressively treating pain and offering resources that are not available in other circumstances. A crucial fact that most people (even doctors) don’t know is that hospice care is 100% covered by Medicare, and by most private insurance plans as well.
What Are the Advantages of Hospice?
There are many advantages to hospice, including:
Complete care: Hospice care includes comprehensive care by a team including doctors, nurses, and social workers. It also provides access to help twenty-four hours per day, seven days per week.
Home visits: Insurance severely limits the availability of home nurse-visits, but not when the visits fall under hospice care.
Fewer expenses: Hospice care leads to a reduction in out-of-pocket expenses for medications and medical equipment.
Respite care: Most hospice care is done in the home, but brief inpatient care is offered by many hospices to take stress off of family members.
The key is that hospice takes the burden off of patients and family members so they can focus on each other instead of on medical care. This is one of the most important times of a person’s life, and hospice allows them to focus on what’s most important instead of figuring out how to get care.
The Goal of Hospice
Most of my job involves keeping my patients healthy, but there comes a time in most people’s lives when the focus needs to change. We’ve got to stop thinking about preventing colon cancer and reducing cholesterol, and instead focus on reducing pain and maximizing the number of good days a person has. People are afraid that getting hospice involved is the same as giving up. It’s not. I explain hospice this way: the focus is no longer on the next three years; it’s on the next three months, three weeks, or three days. The goal is to make those months, weeks, and days as good as possible.
Why People Don’t Like to Talk About Hospice
But hospice is an admission that the end is near, and that scares a lot of people. The sad fact is that most people wait far too long before getting hospice care, which means a much bigger burden on the family and much more suffering for the patient. I think one of the main reasons people don’t get hospice is that doctors are afraid to bring it up. The truth is that it’s difficult to tell when someone has six months to live. Some people who you think will live for a year, only last a month, whereas others far outlive your expectations. But a friend of mine who is a specialist in palliative care explained it this way: if you wouldn’t be surprised if the person died in the next six months, then the person probably qualifies for hospice.
And hospice doesn’t just focus on the elderly or people with cancer. Anyone with an approximate life-expectancy of six months or less, regardless of age or disease, qualifies for hospice. So what if a person lives beyond the 6 months? That’s actually fairly common, and it’s perfectly fine. As long as the person reasonably qualifies up front, the care will be covered as long as the hospice deems it appropriate. I once had a patient survive for three years on hospice.
What Are the Disadvantages of Hospice?
So what are the disadvantages? The main thing is that the scope of care is limited. Hospitalizations are discouraged, as are any treatments that are solely for the extension of life. Visits to the intensive care unit, or aggressive treatments of cancer can prolong life a little more, but they often greatly reduce the quality of that life. Limiting the scope of care to services that improve quality of life allows a person to die with dignity at home, instead of in a hospital hooked up to machines and tubes.
So here is probably the most important quick and dirty tip I’ve given so far: if you think you or a loved one may qualify for hospice, talk to your doctor right away and ask for an evaluation. The hospice team will come out and make an assessment. They will describe the services they offer and address fears you may have. Don’t wait for your doctor to bring it up. And to those doctors who read this article, I give this tip: don’t wait too long. Take advantage of the wonderful resource of hospice care. People need to be given the opportunity to die at home surrounded by their loved ones. Doing so is possibly the best thing you can do for someone.
That’s it for today’s topic. I hope it was helpful.
This month we welcome a new podcast host to the Quick and Dirty Tips network. Kenny Herzog is taking over hosting duties for the Modern Manners Guy podcast. Want to know how much to tip your hairdresser, he’ll tell you. Want to know if it’s ever ok to break up with someone over email? He’ll answer that too. Check out the Modern Manners Guy podcast and if you have an etiquette question of your own, email it to manners@quickanddirtytips.comcreate new email.
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Let me once again remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!
Hospice image courtesy of Shutterstock