Answers to Frequently Asked Questions About Hospice

Q: Does hospice mean we are “giving up” on our loved one?

A: When a patient is admitted to hospice, it usually means there is no further curative treatment to offer. However, that does not mean that all treatment will be discontinued. The focus of hospice is on improving the patient’s quality of life and encouraging him or her to live life to its fullest. Aggressive pain and symptom management as well as personal hygiene, specialized therapies and psychological, spiritual and grief support are all included in hospice care for patients and their families.

Q: Should I tell my loved one he/she is dying?

A: The hospice team will answer questions concerning death when asked, either at the time the patient is admitted to hospice, or when plans or decisions need to be made. Hospice staff members encourage families to be honest with the patient about their terminal prognosis. This is a time for the patient and family to discuss issues that may need to be resolved before the patient dies. More often than not, the patient is already aware of his prognosis, but doesn’t want to say anything for fear of causing emotional pain to his family. Don’t be afraid to be honest with your loved one and say the things that need to be said.

Q: Is hospice only for people with cancer?

A: Although many hospice patients have cancer, patients diagnosed with any life-limiting disease may qualify for hospice. Some other life-limiting conditions include: end-stage heart, lung, liver and kidney diseases, Alzheimer’s disease, and end-stage ALS and AIDS. Patients are referred to hospice care when they continue to decline after receiving optimal therapy for their condition. Any patient facing a life-limiting illness or injury may be eligible for hospice care.

Q: A criteria for admission to hospice is a prognosis of six months or less. What if the patient lives longer than six months? Will he/she be discharged from hospice?

A: Hospice can care for patients as long as they meet the criteria. It is the responsibility of the hospice team to continually monitor the patient’s appropriateness for hospice. It is not uncommon for patients to “improve” under the care of the hospice team. This occasionally occurs due to the aggressive pain and symptom management provided by experts in palliative care. Often, when debilitating symptoms are controlled, quality of life improves and a patient feels like living again. In fact, our hospice team has discharged patients who have experienced a significant level of improvement and no longer meet the criteria for hospice.

Q: Is it true that hospice uses drugs to hasten death?

A: No. The goal of hospice care is to increase comfort while allowing the natural dying process to occur. This is often done through the use of medications that relieve symptoms without sedation. In hospice, family members are educated on how to assess their loved one for pain, and how to safely administer medication. It’s not uncommon that when a patient is provided with pain control, their bodies and minds “relax” and death may occur. In these cases, death was already imminent. The difference is the patient experienced a comfortable death, free of pain.

Q: My dad wants to die at home. What if I am not able to care for him?

A: Our skilled hospice team understands that concern and can offer support to not only the patient but to you and your family. As the disease progresses, the hospice team will educate you about how to meet the special needs of your father. Should the situation call for additional care, the hospice team is able to offer respite care in the case of “caregiver burnout,” and continuous care during a medical crisis. If you and your family feel the need to admit your father to a nursing facility, hospice will assist you with this as well, and is able to continue providing hospice care after the transfer to his new home.

Q: My mother has been taking morphine for two months. Yesterday, her physician increased her dose because she was experiencing increased pain. Does this mean she is becoming addicted to morphine?

A: Addiction occurs when a person takes medication to get a “high” or a psychological effect, not for pain. Morphine is recommended for moderate to severe pain and is safe when used as recommended. Over time, tolerance to the medication occurs, and an increase in the dose is required. This does not mean your mother is addicted. When providing pain management for our patients, we may need to increase the dose several times. The right dose is the dose it takes to control your mother’s pain.

Q: Is hospice care expensive?

A: Hospice is covered by Medicare, Medicaid and most private insurance plans. Medicare and Medicaid Hospice Benefits cover all hospice services related to the terminal diagnosis, and require little, if any, out-of-pocket expense. Private insurance plans pay differently, and out-of-pocket expenses for the patient and family may vary. In this case, the patient will be informed of any possible costs when admitted to hospice.

Q: Is it too early to call hospice if my brother is not experiencing pain or other discomforts? Should we wait until he has only a few days to live before calling hospice?

A: No to both questions! The purpose of hospice care is far greater than just managing physical suffering. Hospice care is designed to maximize the quality, relationships and experience at the end of one’s life. The appropriate time to refer a patient to hospice is when his or her physician determines there is no further curative treatment available. When a referral is delayed until the last few days of a patient’s life, the full benefits of hospice care are missed. Hospice can make a valuable difference in the quality of your brother’s remaining life experience and provide both him and your family with the compassionate care and support to allow his death to occur with comfort and dignity.

Q: If I am admitted to hospice, can I keep my own physician?

A: It is your choice of whether or not you want to continue seeing your own physician. Hospice has working relationships with many of the physicians in your area. If your current physician admits you to hospice, our hospice team will work closely with and monitor all treatments and medications he prescribes. If some of your treatments and/or medications are not included on the Hospice Plan of Care, you may be responsible for some out-of-pocket expenses.

Q: Is it true that hospice will let my Mom starve to death?

A: Absolutely not! As your mother’s disease progresses, her appetite may decrease. This is part of the natural dying process. When a body is preparing for death, hunger and thirst are experienced differently than in someone who is healthy. It is natural for a person to have a decreased appetite or to desire only certain foods or beverages. Your hospice team will help you to understand this and other symptoms of the dying process and help you to be comfortable with the natural changes your mother is going through. This may be difficult to accept since eating is regularly associated with vitality, but it is okay for your mother to want or need less food. Sometimes eating may only increase your loved one’s discomfort. Hospice care is about making choices based on your mother’s changing needs during the dying process and being comfortable with any decisions made.