Not All Hospices Are The Same!

Time and time again, I discover that many people in our community believe all hospices are the same – one part of some large nation-wide organization and often they believe that Hospice Savannah, Inc. is the only hospice serving our communities, rather than one of many.  

All hospices must provide basic core services: nurse, social worker, chaplain, volunteer, nursing assistant, medications and supplies related to the terminal diagnosis, etc. However, patients and their loved ones need to be aware that a hospice agency has a lot of latitude in determining services offered, so always remember to inquire about what is available. In addition, some hospices are non profit and many are for profit. “….hospice administrators, doctors and nurses say many Americans have misconceptions about hospice services. The advent of for-profit hospice complicates matters. The buyer-beware radar goes on, although it’s unfair to cast all the for-profit companies as “bad guys.”” (Harvard Health Letter July, 2008).

Here are some questions that you should ask when choosing a hospice program:

1. If my pain or symptoms can no longer be safely managed at home, where will I go?

At times there may be a need for receiving care in an in-patient setting. All hospices must provide a general in-patient level of care, but most send their patients to a nursing home or a hospital for pain and symptom management. The Coastal Empire supported the building of Hospice House so that Hospice Savannah patients can have their symptoms aggressively managed when necessary.

2. Do you have a full time Board certified Physician in Palliative Medicine available to visit me at home or in my nursing home?

A Palliative Medicine physician is trained to manage pain and other difficult symptoms and specializes in end-of-life care. The Medical Director of a hospice should be certified in Palliative Medicine and available to work with the patient’s own doctor or become the patient’s doctor if the patient does not have a physician. Patients should be encouraged to keep their own physician, but there is an advantaged to having a full-time board certified medical director who is actively involved in making home visits, consulting with other doctors, and providing expertise to nurses in the field.

3. What bereavement services can you offer me and my family?

Medicare requires hospice agencies provide bereavement services, however there is little oversight of this requirement and many hospice agencies may not provide a comprehensive program. Hospice Savannah, Inc. offers a free-standing grief and loss center (Full Circle, a Center for Education and Grief Support) where bereavement counselors can provide one-on-one or group counseling to Coastal Empire children and adults at no charge.

4. How much experience does your hospice have?

Always ask how long the agency has been providing services in the community. The Georgia Medical Society, United Way and local volunteers began Hospice Savannah, Inc. over thirty years ago!  When a hospice agency has a large group of volunteers you can expect more assistance with running errands, sitting with the patient, meal assistance, and much more. And if hospice encourages its employees to take the time and effort to be certified in Hospice and Palliative Care, then you can assume that the hospice is focused on quality. Experience does make a difference.

5. What additional therapies do you offer?

Hospices are only required to offer additional or alternative therapies based on Medicare guidelines (such as physical or occupational therapists), or they can choose to supplement their hospice programs by providing “extras” such as a full time licensed Massage Therapist, or  Board certified Music Therapist. 

When should hospice care be considered?

Hospice care should be considered for anyone with a life limiting or terminal illness when the goals of care have become focused on living as comfortably and as independently as possible. Hospice is not simply a place to go to die when you have finally given up. Hospice is a program that helps patients and their families to achieve their goals which should focus on comfort and support when cure is not possible. It is a team of people that helps meet the patient’s and the family’s physical, psychological, social and spiritual needs. Patients and families need to take advantage of this entitlement to care and not wait until the last few weeks or days of life.

Many health care providers have misconceptions about hospice care and think they can only refer when the patient is near death, but patients and families receive the most benefit when referred early. Any person with a life threatening illness should have a conversation with their health care provider early in the course of their illness about options for treatment and about end-of-life care.

Studies indicate that physicians, nurses, and other team members can underestimate the amount of information that patients want and misinterpret the kinds of information the patient desires. Physicians often want to talk about diagnosis and treatment, but patients more often want to know about the disease’s likely impact on their lives. Most patients with a terminal illness know they are dying; avoiding discussions about prognosis and hospice care has been shown to increase their sense of loneliness and abandonment and denies them opportunities for meaningful communication with loved ones.

When you or your loved one is experiencing a life-limiting condition, don’t wait for your physician to make a referral; know that you have the right to request hospice care. Patients and families are entitled to the Medicare hospice benefit; don’t wait until the last minute to access it! Remember – it is always up to you to discuss hospice as a choice with your physician.