COLUMN: Hospice collaborates to meet patient’s wishes

Published 7:30 am Saturday, December 16, 2023

My goal as a hospice and patient advocate is to collaborate with all healthcare professionals, continue to broaden education, and enhance understanding of how best to honor and respect the patient’s wishes and concerns at the end of life. It is no secret that for more than three decades, hospices in the U.S. have been trying to encourage healthcare providers (and families) to choose hospice for the exceptional care provided during end-of-life. Nevertheless, many misconceptions and myths about hospice prevent patients and families from receiving all the hospice benefits.

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

Hospice care is available for advanced terminally ill patients who are no longer seeking curative treatment. The patient’s primary physician or specialist usually initiates the referral process; however, case managers, hospital or nursing home personnel, and family members may also refer patients with the physician’s agreement for the hospice order.

Hospice recognizes the need for compassion and support during the critical end-of-life time in someone’s life. Hospice staff uses an interdisciplinary team approach, providing end-of-life care that encompasses the physical, emotional, spiritual, and social needs of everyone involved. Hospice offers patients and their families various services, regardless of race, ancestry, color, religion, gender, age, disability, sexual orientation, or national origin.

Since no one can predict the course of a terminal illness, there is no limit on the number of days a patient can receive hospice care. The Medicare Hospice Benefit consists of two 90-day benefit periods and unlimited 60-day benefits. Each benefit period requires medical certification of the life-limiting illness at the beginning of the period. The Medicare Hospice Benefit covers the cost of hospice care and service for every medically certified benefit period, regardless of the patient’s length of stay in the hospice program.

For some medical professionals, families, and patients, the wording on the Hospice Benefit Certification of Terminal Illness may be seen as a deterrent to hospice care as it states the patient prognosis should be “six months or less, if the disease takes it’s normal course.” However, Medicare acknowledges that life expectancy is not an exact science, and there are no penalties if the patient lives longer than 6 months. Many patients live far longer than 6 months, especially after hospice care is initiated, due to the personalized care they receive.

Incidentally, financial concerns can be a significant burden for many patients and families facing a terminal illness. Hospice care is covered under Medicare, Medicaid, and most private insurance plans, and patients receive hospice care regardless of their ability to pay. In other words, hospice offers significant savings for patients and families by providing durable medical equipment (for example, oxygen, hospital bed, walker, wheelchair, overbed table, shower chair), medical supplies (for example, wound care supplies, diapers, wipes, pull-ups), and medications specified in the patient’s Plan of Care.

Also provided under the hospice benefit are home visits made by members of the interdisciplinary team. Specifically, routine visits made by Nurse case managers who are specially trained in pain and symptom management, Hospice Aides to provide personal care, a licensed Medical Social Worker who provides emotional support, chaplain services for spiritual support, and trained volunteers for companionship. Hospice is only a phone call away 24 hours a day, 7 days a week for emergencies as well.

I hold dear to my heart the words of Dr. Cicley Saunders (1967): “You matter because you are you. You matter to the last moment of your life, and we will do all we can not only to help you die peacefully but also to live until you die”.

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