COLUMN: Hospice is gold standard for end-of-life care

Published 7:30 am Saturday, February 24, 2024

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Hospice is now considered the Gold Standard for excellent care at the end of life. Nonetheless, it can be challenging to bring up the subject of hospice to assist with the care of a loved one or friend. However, as I’ve written before, I agree with a statement made by Dr. David Casarett, associate professor of medicine at the University of Pennsylvania, “People in hospice don’t want to die. They want to live and want to live well; they want to use whatever time left to live the best way they can. Hospice is not about giving up but about making a careful choice.” Many of you have often heard me say, “We (hospice) are only as good as the care we provide. It is not one of us – it is all of us on the hospice team.

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

Although patients enter hospice programs at various stages of their illnesses, the earlier they begin, the greater the benefits. Care starts with the coordination of services with all team members. Coordination of services includes a medical assessment to determine a personalized plan of care plan, delivery of medical equipment and supplies that are needed, as well as a review of all medications, volunteer needs, hygiene assistance, spiritual support, and social work services. Your hospice team will prepare you for everything likely to happen and will help you understand how to use community and financial resources to your best advantage.

In hospice, our team is all-embracing and includes professionals focusing on providing care for the patient and working with the caregivers. The team consists of:

  • Patient/caregiver: The patient and those entrusted with their care.
  • Patient-physician: A key hospice participant who, along with the hospice medical director, makes medical decisions to help maintain the patient’s comfort level. The hospice team provides regular updates to keep the physician fully aware of the patient’s condition.
  • Hospice Medical Director: A medical expert in symptom management who supervises plans of care and maintains close contact with other team members.
  • Registered nurse: Works closely with physicians and other team members to manage pain, educate and support caregivers, monitor medications, and help make every day count.
  • Certified home health aide: Assists patient with personal care and daily living activities. Maintains close communication with nurses, notifying them of changes in patient needs.
  • Social worker and grief counselor: Meets the emotional needs of patients and their caregivers through all stages of a patient’s illness. They can recommend other community resources for additional guidance and support when necessary.
  • Clergy: Plays a vital role in hospice care, offering spiritual support to patients and caregivers. Our clergy will work with a patient’s preferred clergy or, if requested, refer patients and caregivers to other community faith organizations or the hospice chaplain.
  • Volunteers: The essence of hospice care is its carefully selected volunteers who can sit with patients, help with chores, run errands, make phone calls, assist with children, and provide small periods of respite for caregivers. When patients and caregivers need to talk, volunteers are there with a quiet touch and a sympathetic ear.
  • Physical Therapy: (when available) if ordered by the attending physician and deemed necessary to improve quality of life.

While all Medicare-certified hospices must offer the same core services: physician, nursing, social work, hospice aides, spiritual support, and volunteer services, how they provide them and how often they offer them vary dramatically. Therefore, there are several things to consider and questions to ask when choosing a hospice agency to care for you or your loved one. When selecting a hospice, be sure to ask the following:

  1. Where is the agency physically located?
  2. What is the coverage area from this location?
  3. What is the nurse-to-patient ratio?
  4. Are all hospice team members local to your area?
  5. Is there a local Medical Director?
  6. How many on-call staff nurses are there, how often are they on call, and what area do they cover? (hospice agencies provide on-call nursing services 24 hours a day, 7 days a week).

Please remember it is always the patient’s right to choose the hospice they want to use.

In conclusion, as much as we do not want to think about it – there are two undeniable, unavoidable, natural facts of life. We all are born, and if Jesus tarries, we all will die.

I am always readily available to assist with any questions you may have about end-of-life care.

“Be brave enough to have a conversation that matters.” — Author unknown

— Vickie C. Wacaster is a Patient and Hospice Advocate for Aveanna Hospice.