Hospice care is available to patients in a variety of settings. While home is the most common and the preferred place for many patients, it is not always possible or even desirable for all hospice patients. Individual patient needs determine the location for delivery of hospice care. Patients can receive the services of the hospice team at home, in the hospital, or in a long-term care or other residential facility.
Nine out of ten Americans said they would prefer to be cared for and die at home.
Hospice Care in the Home
Hospice patients in the home receive regular visits from the interdisciplinary team. In addition, hospice nurses will triage phone calls 24 hours a day from patients and families, communicating with the physician as necessary. Pain, nausea, vomiting and bowel management are special areas of expertise. Hospice nurses can handle many of these issues, using standing orders from the physician. Patients at home can continue to make clinic visits or may receive visits from the physician in the home.
Most hospice patients at home are cared for by family caregivers, but more and more hospice programs are able to offer care to those patients who choose to live alone. In such cases, the hospice team assists in making special arrangements. Check with the hospice to see if this option is available.
Hospice Care in the Inpatient Setting
An acute care setting is sometimes necessary for the management of symptoms related to the terminal disease. General inpatient care is available in acute care facilities which contract with the hospice program. These facilities have made arrangements for such things as direct admission of the hospice patient to the unit and waiving of routine tests which may not be appropriate. In addition, the inpatient staff has been oriented to the special needs of the dying patient and grieving family.
The hospice nurse remains case manager for the patient throughout the inpatient stay and communicates with the physician about the patient’s care. Other hospice team members make visits to the patient to ensure continuity of care.
Respite care in an inpatient setting is also available for brief periods of time when family members are in need of a rest from caregiving duties. Respite care is covered under the Hospice Medicare Benefit.
Residential Hospices
Home-like, residential facilities exclusively for hospice patients and their families are available in some areas. The hospice team remains in charge of patient care and visits frequently. Payment for residential room and board is made privately. The Medicare Hospice Benefit provides coverage for services related to the terminal illness except room and board.
Hospice in Long Term Care Facilities
Palliative care and hospice services are available for individuals living in long term care facilities. Collaborative agreements between hospice programs and long term care facilities make it possible for residents, family and staff to benefit from a unique multi-disciplinary approach to care delivery. The patient and family focus of care provides for innovative delivery of care interventions. Interventions such as pain and symptom management lead to patient acceptance of the dying process, greater patient and family satisfaction of care and improved quality of life.
The coordination of an individualized plan of care determined by the patient and family, hospice team, long term care staff and attending physician utilize the skills of nursing, social services, spiritual care, volunteers and bereavement specialists. Benefit of these services foster a relationship of trust and quality care.
Surviving family members and long term care staff receive support through hospice bereavement services for a period of time after the individual’s death. This support leads to healthier expressions of grief and loss and stress management.