Frequently Asked Questions For Hospice Patients & Families
Q: How Do I Know If It Is Time To Talk About Hospice?
Quality time with loved ones is always the ultimate goal of hospice. When continued medical treatment might provide a few more weeks or months of life but could make the patient too ill to benefit from that time, consider the quality of that time to make the best decision for the patient.
Patients can be eligible for hospice after a physician certifies they have a life expectancy that may be six months or less. If patients live beyond the six months, they can continue to receive hospice services as long as they show decline and their doctor continues to document their eligibility.
A doctor can best determine when the time is right to consider hospice, but here are some signs to watch for:
- The negative effects of current treatments outweigh the benefits
- Frequent hospitalization
- Chronic weight loss
- Consistent pain
- Frequent nausea or vomiting
- Inability to move about or maintain personal care
Q: What Are The Eligibility Requirements For Hospice?
Hospice is provided to patients who have a terminal illness – which is defined as having a prognosis of six months or less if the disease or illness runs its normal course.
MEDICAL REQUIREMENTS TO COVER HOSPICE:
- Physician’s order
- Estimate of six months or less to live if the disease follows its normal progression
- Patient must agree to palliative care for the terminal diagnosis rather than curative care
Hospice service can begin as soon as a referral is made by the patient’s doctor. A prospective patient, family member or friend can either request services through a local hospice provider — which then consults with the patient’s physician — or go directly to the patient’s physician for a referral.
Once the referral is made, the hospice provider contacts the patient to review the services they will offer and have the necessary forms signed. Typically, care begins within one or two days of the referral, but in urgent situations service can begin sooner.
Note: If you or a loved one are currently benefiting from treatments intended to cure an illness — you may want to consider Palliative Care.
Q: Why Sooner Rather Than Later?
Now — before it is needed — is the best time to learn about hospice. Even if end-of-life care is hard to discuss, it’s wise for loved ones and family members to talk before there is an emergency. Decisions like this are best made when there is time to carefully consider all options, not when the need is immediate, and emotions are running high. This can greatly reduce stress, emotion and anxiety when the time for hospice is at hand so the patient can enjoy the most quality time possible with friends and family.
Q: What Is The Process To Get Started Receiving VNA Hospice Care?
Please contact VNA directly at gethelp@vnatexas.org or call 1(800) CALL-VNA, or let your physician know that you request VNA as your hospice provider. You have the right, by law, to choose your hospice caregiver and VNA will provide the quality of care that you know you can trust.
Q: Can I Keep My Own Doctor?
Yes. Your own physician can continue to oversee and direct the care.
Q: What Services Should We Expect?
VNA Hospice Care involves a range of medical care and emotional support for terminally ill patients and their loved ones.
Our services include:
- Alzheimer’s & Dementia Care
- Heart Failure Program
- Oncology Care
- Pain Management
- Physician Oversight
- Nursing Services
- Hospice Aide Services
- Chaplain Services
- Social Worker Services
- Bereavement Services
- Volunteer Support
- Equipment/Supply Ordering & Setup
- Medication Ordering & Management
Q: How Do We Set Up Our Home For Hospice?
Your VNA Hospice Care Team will order all the appropriate equipment, medical supplies and medications to ensure the patient’s comfort in the home. At some stage this might include a hospital bed, oxygen and other equipment.
Q: How Is Hospice Care Paid For?
Hospice is covered for those with Medicare, Medicaid and Medicare Advantage programs. VNA also accepts many commercial insurance plans, as most plans have a hospice benefit for end-of-life care, including:
Aetna
Baylor Scott & White Healthcare
BlueCross BlueShield of Texas
Humana Managed Care
Medicaid
Medicare
United Healthcare
All Medicare Managed Care plans (must be verified)
All Medicaid Managed Care plans (must be verified)
Q: What’s The Difference Between Hospice And Palliative Care?
Both hospice and palliative care provide symptom management and comfort for serious and life-threatening illnesses. The most important difference is that palliative care allows a patient to maintain their current curative treatments and physician visits while also receiving in-home support. In hospice, one can still maintain the physician of choice to oversee care, but when one elects the hospice benefit, they are choosing to forgo curative treatments for comfort measures and the focus shifts from quantity of life to quality of life.
Selecting the right care at the right time is an important decision.
The National Hospice and Palliative Care Organization (NHPCO) provides this helpful guide to navigate these options:
https://www.nhpco.org/wp-content/uploads/2019/04/PalliativeCare_VS_Hospice.pdf
Q: What Are The Levels Of Care In Hospice?
Every hospice is required to provide the same levels of care. This includes the routine homecare level, which makes up about 97% of all hospice care and can be provided wherever the patient calls home (skilled nursing facility, assisted living, congregate setting or in a traditional home). Also included are crisis care (or continuous care), which is provided by a nurse at the bedside 24/7 to acutely manage uncontrolled symptoms, and General Inpatient care (GIP), which is provided in a hospital or skilled nursing facility, and is also for uncontrolled symptoms that cannot be managed in another setting. Once a patient stabilizes, they will return to the routine level of care. Another level of care is respite care, which occurs when a patient is moved from the home setting to a skilled nursing facility to provide up to five days of care to allow for caregiver relief. Many families enjoy this benefit for a short time if they have a planned trip or other family event or just need to take a break from the difficult work of caregiving.
Q: Who Makes Up The Hospice Team?
Hospice is a unique form of healthcare that is community based and provided by an interdisciplinary team of doctors, nurse practitioners, RN case managers, chaplains or spiritual support providers, social workers, volunteers and many other therapists including music therapy. The care plan delineates what care a patient needs and will receive, and the family and patient’s input is critical to determine what the best plan will be for each independent patient. The visit frequency is also highly individualized and determined by the care team in conjunction with the patient and family and based on what is needed to best meet the needs and support of each patient.
Q: I Want To Help My Loved One Receiving Hospice, What Can I Do To Help?
None of us like to think about dying, much less talk about how we envision the last days of our life. But often life intervenes and our first conversation about end-of-life is with a terminally ill parent, spouse or friend. Here are some tips for family and friends to help their loved one:
Be there. Call and visit your mom, dad, relative or friend as often as possible. If you are unable to visit, stay in touch. Write notes about memories and the love you share.
Be a good listener. Allow your loved one to talk about their terminal illness and impending death at their own pace. Don’t force your own opinions, but be ready to discuss various options for end-of-life care.
Educate yourself about the illness. Information is available through national associations, medical reference books and other readily available sources in your library or on the Internet. If appropriate, talk to the attending physician about the illness and its terminal stages. VNA’s physicians are experts in serious illness care and treatment options.
Be compassionate. Let your loved one express his or her feelings about their illness and condition without criticism. Let them verbalize how they are feeling, even if you may not agree with what they are saying. Tell them they are loved and that you are there for them.
Offer practical help. If possible, straighten up the house or apartment, bring meals, and/or provide transportation – both for practicality and companionship. Show you care.
Recognize your own limitations. If you’re thinking, “Why am I so uncomfortable with this?”, you may be feeling that you can’t cope with the situation. If so, try to understand your reluctance and deal with it honestly. Or maybe you wonder, “What can I do to show love and compassion?” If you can’t visit, then call or write notes. Find other ways to help, perhaps by arranging for in-home assistance. VNA Social Workers are here to provide counseling and resources any time you may need it.
Remember that you, too, will experience worry, fear, even anger. Loved ones and caregivers also experience anxiety, dread and denial upon learning that a family member or dear friend has a terminal illness. These feelings are normal and yet can be overwhelming. If you are the caregiver, you will need to learn to seek and accept help for your own physical and emotional strain. This is an area with which VNA Social Workers and spiritual support counselors can assist.
Q: What If The Patient’s Health Improves?
If a patient’s health improves while receiving hospice services, or illness goes into remission, the patient’s doctor may stop hospice services. Any patient has the right to discontinue hospice for any reason, and return to hospice at any time, if eligible. If a patient stops hospice services, the type of Medicare coverage he or she had before choosing a hospice program resumes.
Q: What Is The Hospice Patient’s Bill Of Rights?
The Hospice Association of America has developed the Hospice Patient’s Bill of Rights, which is generally accepted by all hospices in the United States. As a patient, you or your loved one have a right to be notified in writing of your rights and obligations before hospice services begin. Consistent with state laws, the patient’s family or guardian may exercise the patient’s rights when the patient is unable to do so. Hospice providers have an obligation to protect and promote the rights of their patients, including their right to:
- Financial Integrity
- Dignity and Respect
- Privacy
- Quality Care
- Decision-Making Authority
- Knowing What Responsibilities Lie with Hospice and with the Patient/Caregiver
Q: This Was Great Information. Who Should I Contact If I Have Additional Questions?
Please contact VNA directly at gethelp@vnatexas.org or call 214-689-0000.
Q: Does VNA Provide Grief Support?
Yes. For those experiencing loss and grief, our team is here to help. Please reach out to our grief support team at griefcare@vnatexas.org.