Hospice Care

Choosing hospice care does not mean that one is giving up on life but rather choosing to  end treatments aimed at attempting to cure the disease or condition and elects treatment that eases pain and discomfort Hospice services are available once a patient is thought to be in the final 6 months of life. Hospice nurses receive special training in both pain management and grief counseling.

The Medicare benefit for hospice care does not cover expenses for room and board at nursing homes or long-term care and assisted living facilities. Medicaid and some personal insurance plans, however, cover these room and board expenses.  You should discuss this with your private insurance companies to find out what your benefit options are.  There is no stigma attached to having your loved one admitted to a facility. Many of you require complex care, have caregivers with multiple health problems or feel ill equipped to render the necessary care.  Many skilled nursing facilities have hospice services so if you have extended care insurance you will be able to obtain inpatient hospice as well.   Find out which facilities are  covered and visit them to see if they meet your expectations.  If you are currently receiving visiting nurse services  some have contracts to render hospice care as well.  This can be so comforting as you will already have established a relationship with many of the nursing staff.

The decision to accept hospice care should be made by the patient.  There should be a frank discussion with the oncologist about his/her present condition and if any further treatment would be thought to be beneficial.  Sometimes chemotherapy is not given for a ‘curative” effect but to relieve symptoms such as shortness of breath or pain control.  Radiation therapy is also given for the same reasons.  Some insurance companies will permit short term therapy aimed at relieving symptoms while on hospice but this usually entails a process of denials and appeals.  The most difficult time for the caregiver and family is to accept the patients’ decision to enter hospice.  So many view this as giving up and feel that if they all rally behind the patient they can encourage them to change their minds.  This can cause quite a bit of tension among family members and results in the patient retreating and not being able to express their wishes.  If the oncologist thinks that hospice is appropriate and if the patient is in agreement then the decision should be supported.  If on the other hand the oncologist is not a mesothelioma specialist and you have doubt about whether all options were explored, then seeking a second opinion might be valuable.  If the patient is exhibiting signs of depression and you feel that in their normative state they would make a different decision than they should be treated for depression.  Remember, there is no harm in choosing hospice nor is it a decision that cannot be reversed.  Patients often times leave hospice care if they feel stronger and some begin treatment at a later point in time.  There is definitely the exception to the rule but the possibility always exists.

If you have not chosen hospice and your loved one dies outside of these services it does not mean that you cannot access their bereavement services.  Most hospice facilities offer support groups and grief counseling and this can be so helpful to those of you who have lost a loved one.  While I am not going to address grief and dying in today’s blog I am going to encourage all of you who might read this to call a friend or family member who has lost a loved one.  It is all too common that we are all there to offer our support in the immediate mourning period but forget that grieving takes place over a prolonged period of time and anniversaries and holidays are especially difficult.

~Mary Hesdorffer, NP