When to have a conversation about hospice

Published 7:30 am Saturday, September 9, 2023

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I often say two things: whatever is going to happen is going to happen with or without hospice, and I know hospice will offer the support that is genuinely needed as individuals and their loved ones journey together toward the end. Though suggesting hospice is not a conversation anyone ever hopes to have, or looks forward to having, when you know the benefits of having hospice versus not having hospice, you have the conversation because you care and believe with all your heart everyone deserves the best care from the time they are conceived until we say our final earthly goodbyes.

Vickie Wacaster, Patient and Hospice Advocate with Aveanna Hospice (formerly Comfort Care Hospice)

Unfortunately, hospice is often not recommended to patients when they would first qualify due to life expectancies being so difficult to predict. Also, a physician may think their patient may not be ready to consider hospice, therefore, hesitating or delaying the conversation, fearing that suggesting it will upset the patient or loved ones or be seen as dashing their hopes. However, it is vital to realize that the earlier a patient is admitted to hospice, the sooner they and their loved ones can focus on their quality of time together. By receiving hospice care early, patients can have more time with their loved ones while being pain or symptom free, instead of only having the last few days or weeks of life comfortable. With hospice, the patient can focus on the meaningful aspects of their lives while the caregivers receive support and guidance.

It’s important for physicians and healthcare referral sources to know that Medicare has disease-specific guidelines (known as LCD’s or local coverage determinations) that will aid the physician by providing a list of conditions/symptoms that must be present to determine if a patient would meet the criteria outlined by Medicare for hospice admission. Therefore, using the LCD guidelines, hospice services can begin when a patient’s physician determines that the patient’s life expectancy is 6 months or less if the disease follows the normal course, the patient is no longer seeking a medical cure, and the patient wishes to redirect their focus from cure to pain and symptom management.

Once hospice service is initiated, the hospice professionals come into your home, not as strangers but as compassionate healthcare professionals who often turn into friends. They educate, guide, instruct, listen, offer encouragement, support, and help you manage complex tasks, care, and paperwork associated with end-of-life issues and situations. Hospice gently guides you in what to expect while offering suggestions and support on understanding what is happening to your loved one.

Despite efforts to increase hospice awareness, access, and utilization, myths about hospice are still prevalent in today’s society, contributing to the under-utilization of hospice services. Though hospice is beneficial to the patient and their loved ones any time hospice care is provided, the family and the patient obtain the most benefit from hospice when the hospice team has weeks or months, rather than a few days or weeks, to assess and provide the desired services the patient and families need.

It would be an honor to speak with you if you have questions or want to know more about the services and benefits of hospice. I can be reached by calling 334-892-4123.

“Beginning today, treat everyone you meet as if they were going to be dead by midnight. Extend to them all the care, kindness, and understanding you can muster, and do it with no thought of any reward. Your life will never be the same again”. — Og Mandino

— Vickie C. Wacaster is a Patient and Hospice Advocate for Aveanna Hospice (formerly Comfort Care Hospice).