Is It Time For Hospice Care?

 

At Hospice of San Angelo, we are often told by our patients and families that they wish they had known about us sooner. Hospice care is a choice that is reversible. Should you or your loved one decide during the course of treatment that hospice care is not for you, you may withdraw from services at any time. Many verbalize that they don't know how they managed without us. Read on to learn more about hospice care and if it may be an appropriate care alternative for you or your loved one.

 

General Guidelines include:

  • Dependence in most Activities of Daily Living (ADLs)
  • A recent decline in functional status/physical decline
  • Recent decline in nutritional status with progressive, unintentional weight loss
  • Multiple diseases or conditions
  • Increased frequency of visits to ER/hospitalizations

Common Hospice Diagnoses And Guidelines For Admission

Cancer

  • No longer seeking curative treatment and meets general guidelines for hospice admission
  • Mets to multiple sites

Heart Failure

  • Class IV/Stage D heart failure
  • Cardiac symptoms at rest
  • Recurrent hospitalizations/ER visits
  • Not a candidate for heart surgery
  • Optimally treated with beta blockers and diuretics

Stroke/CVA

  • Dependence for most ADLs
  • Decline in nutritional status with weight loss
  • Dysphagia with inability to take in adequate nutrition and no feeding tube planned

COPD

  • Dyspnea at rest
  • Poor response to bronchodilators
  • Recurrent pulmonary infections/hospitalizations
  • O2 sat of <88% without O2 or other evidence of severe oxygen de-saturation without O2
  • Bed to Chair existence/poor activity tolerance

Amyotrophic Lateral Sclerosis (ALS)

  • Unable to walk, needs assistance with ADLs
  • Barely intelligible speech
  • Difficulty swallowing
  • Weight loss
  • Significant dyspnea
  • Co-morbidities of pneumonia, URI

Renal Failure

  • Has discontinued dialysis
  • Creatinine clearance <10cc/min (<15cc/min for diabetes)
  • Serum creatinine >8.0 mg/dl (>6.0mg/dl for diabetes)
  • Co-morbid conditions and/or signs and symptoms of renal failure

Liver Disease

  • Ascites despite use of diuretics
  • Peritonitis
  • Hepatorenal Syndrome
  • Serum albumin <2.5 or INR>1.5
  • Recurrent variceal bleeding

Failure to Thrive/General Debility

  • Increasing need for help with ADLs
  • Steady weight loss
  • Co-morbidities/secondary conditions
  • BMI <22 for Adult failure to thrive

Dementia

  • Steady weight loss and/or
  • Needs help for all ADLs
  • Incontinence
  • Speaks few intelligible words
  • Needs help to sit up and hold up head

HIV

  • CD4+ count <25 cells/mcL or persistent viral load>100,000 copies/ml
  • Secondary conditions
  • Dependence for most ADLs

Common Myths About Hospice Care

You must have cancer to be a hospice patient.

The fact is that hospice care is for anyone living with a life limiting illness with a prognosis of 6 months or less to live should the disease process follow its expected course. Many of our patients do NOT have cancer.

Hospice patients die sooner than they would without hospice care.

The fact is that studies have shown that patients with some diagnoses live longer with hospice care than those with the same condition who did not receive hospice care. While the reason for this is not known, it may likely be attributed to the increase in level of observation of the disease process and increased response time to problematic situations under the care of hospice. The goal of hospice care is to neither shorten nor to extend the length of life.

Hospice patients cannot go back to the hospital or continue to see their primary physician.

The fact is that it is typically not necessary for hospice patients to go to the hospital related to their hospice diagnosis due to the availability of their hospice care team. Should a hospice patient decide to aggressively pursue treatment related to their hospice diagnosis they may withdraw from the program at any time. Hospice patients have the option of continuing to keep appointments with their attending physician but many opt to cancel these appointments due to the availability of medical professionals to assess them in home. Hospice patients may elect to seek aggressive treatment for any non-hospice related diagnoses while remaining in hospice care.

Hospice patients are no longer able to enjoy activities or time with their family due to the side effects of medications.

The goal of hospice care is always to improve or maintain quality of life for as long as possible. Medications are used judiciously in order to help the patient maintain optimal symptom control while minimizing side effects. The patient and caregiver are always included in the care planning process and have control over the medications that the patient receives.

We can't afford hospice care.

At Hospice of San Angelo, no patient is denied care based on inability to pay. The fact is that hospice care may be paid for by Medicare, Medicaid and/or Private Insurance. A patient who does not have access to any of these payers is still eligible for all care that would customarily be provided to any of our patients. As a community based, not for profit organization our goal is to provide care to anyone who needs our services and meets criteria for admission.

I'm not sick enough for hospice care

As mentioned above many find that they wish they had found hospice care much sooner. You do not have to be bedbound or unable to function to be on hospice care with many diagnoses. Earlier referrals and admissions lead to better overall care. You and your hospice team will have more time to get to know each other before your illness gets worse which lends itself to increased feelings of trust and confidence in your hospice care team. Hospice also offers support to your family and loved ones to help them through this difficult time as well.

Once we choose hospice care there is no going back

Electing hospice care is always reversible. Some of our patients "graduate" from our program because they do, in fact, do too well to continue to qualify for our services. Should you decide to pursue more aggressive treatment or just experience an improvement in condition you can be discharged from the program or choose to revoke your hospice benefit depending on the situation.

If you have any questions or concerns about whether Hospice of San Angelo may be right for you, please call us at 325-658-6524 and let us help you make an informed choice.