Making the decision to seek hospice care is an important one, but equally important is choosing which hospice provider to use. It’s not necessarily a difficult choice but it can seem daunting at first due to the sizable amount of care providers probably available to you.
We’ve talked about the benefits of not delaying hospice care , and it bears repeating since it is easier to choose the hospice right for you when you have a little time to decide. With those things in mind, let’s take a look at some helpful guidelines for selecting the right hospice provider for you and your loved ones.
Seek a recommendation from a trusted source
Most hospice providers offer the same basic services but not all may be the right fit for your situation. Word-of-mouth from a source that you know and trust remains one of the best ways to find an appropriate hospice provider. Your doctor and social worker should be able to direct you to some quality choices as well as have experience working with them and understanding the services they can provide. Friends or family members that have had experience with hospice care can also offer their unique and personal insight as well.
Make a list of questions to ask your preferred provider(s)
Specific and direct questions can be great guidelines in helping you to determine what is important for hospice care in your situation. When you meet with a community liaison or representative from the hospice provider, they will be able to answer your questions and explain how their care fits your needs. A few common questions to think about are:
- How quickly will care be implemented and symptoms managed?
- Which specific services does the hospice team provide or not provide?
- What will be the relationship with the family caregiver?
- What is the process for after-hours or weekend care, specifically in the event of a crisis?
How you feel about a specific provider?
While it is important to keep a clear and rational head during these difficult times, it is still a very emotional stage of life. Don’t ignore your own feelings with regard to the chemistry of the hospice provider and/or their representative. If everything sounds good on paper but it still doesn’t “feel right”, don’t be afraid to seek other options. Remember that this is more than a medical decision, this is a decision about the final moments and connections between you, your loved one and the hospice care team. There needs to be a personal connection of some kind for the best results.
Making the decision to pursue hospice care is not an easy one and, while we hope you consider Bridgeway Hospice, we wish you and your loved ones comfort and peace no matter which hospice provider you choose.
When a patient enters hospice care, who actually provides the care? The hospice care team is a full, interdisciplinary team including fully trained and certified nurses, aides, counselors and more. While it may be confusing at first as to which roles these team members play, they all fulfill vital needs within the scope of hospice care.
Physician – Every hospice team is overseen by a physician or medical director. This leader will closely monitor the patient’s illness, medications and care direction throughout the duration of care. The medical director physician may also work with the patient’s preferred doctor.
Nurse – Specially skilled, nurses are both caregivers and links between the hospice team, the patient and the family. They provide regular care for the comfort of the patient as well as the family. They also help the family to give the best possible support and care to the hospice patient
Aide – Certified Nursing Assistants (CNAs) also known as home health aides, they provide personal care to the patient such as help with feeding and grooming. These aides specially tend to the more sensitive and personal needs of the hospice patient in a kind and gentle manner.
Social Worker – Kind and listening, this part of the team helps tend to the emotional and social needs of the patient and their loved ones. They also help those in their care by providing access to community resources and assistance, such as transportation and financial aid. The social worker also handles the logistics of insurance, Medicare and other financial methods so that the family doesn’t have to.
Volunteer – A crucial piece of the hospice team, volunteers serve in many roles. They can provide compassion and companionship to hospice patients and their families. Often they will lend a helping hand through pet therapy, music therapy and story sharing with the hospice patient. Additionally, they provide support to the caregivers as needed.
Chaplain – In such a sensitive time as hospice care, it is natural for patients and their loved ones to seek spiritual guidance, in whatever capacity they choose. Hospice chaplains are there to honor and uphold the patient’s cultural and religious values while offering spiritual guidance in this difficult time. They will also work with leaders and clergy of the patient’s own faith, as requested.
Bereavement Counselor – A bereavement specialist is available for the family during and after a patient’s time with hospice. They are trained and skilled in providing individual counseling and support for over a year after the patient’s passing. Regular contact, education and support groups are just some of the ways bereavement counselors help guide the bereaved through this transition.
Bridgeway Hospice is very proud of all of the members of our hospice teams and works consistently to help them grow while bringing the best service to you and your family.
Bridgeway Hospice is proud to partner with We Honor Veterans, an awareness program and collaboration between the National Hospice and Palliative Care Organization (NHPCO) and the Department of Veterans Affairs (VA) with the goal of guiding veterans to a peaceful end of life. The NHPCO is the largest nonprofit hospice and palliative care organization in the US. It is committed to expanding access to hospice care and to enhance quality of life for veterans and their loved ones to “guide them through their life stories toward a more peaceful ending.”
“America’s veterans have done everything asked of them in their mission to serve our country and we believe it is never too late to give them a hero’s welcome home. Now it is time that we step up, acquire the necessary skills and fulfill our mission to serve these men and women with the dignity they deserve,” says J. Donald Schumacher, NHPCO president and CEO.
The We Honor Veteran program has 4 main goals:
- Promote education of veterans and their needs.
- Increase the organizations ability to serve veterans.
- Support community partnerships.
- Increase the access and quality of care available to veterans.
We Honor Veterans recognizes their community partners through a wide and comprehensive set of resources provided to the organizations to implement best practices for end-of-life care to the veterans in their charge. Through these resources and recognizing the special needs of our country’s veterans, hospice and palliative care partners can best guide our veterans and their families toward a peaceful rest.
In many cases there are special needs related to the veteran’s service, experience and possible traumatic events. Through We Honor Veterans, care providers can find the resources they need to give the best support to the veterans in their care.
Through programs like these and the partnerships and resources that We Honor Veterans provides, Bridgeway Hospice is proud to offer the care and compassion that our veterans have earned and deserve.
A common concern with hospice care is the use of morphine and some myths regarding its use. In our last post we discussed an overview of these concerns and why hospice uses morphine. This week we’d like to address the most common objections to its use and some of the myths surrounding that.
“But morphine is for drug addicts.”
While it is true that there is a growing health crisis involving opiates, the sort of Morphine administered in a hospice setting is quite different from the drugs at the center of the opioid addiction crisis. The type of opioids involved in the current health crisis are usually prescription pills unlike the vials, syringes and patches used in hospice.
Morphine use in a hospice setting also consists of much lower, managed doses administered by a trained healthcare professional. An essential part of addiction is the drug-seeking behavior. Hospice patients generally do not exhibit this behavior. When their pain is managed, they don’t go after more opiates. It’s also a good idea to keep a log near the medicine to track the timing, volume and effectiveness of each dose.
“Morphine will make my loved one sleepy and they won’t be themselves.”
Allowing a patient and their family time to share together is one of the primary goals of hospice. Morphine is only given to manage pain and symptoms, not as a means to sedate the patient or make them “high” so that they are not themselves. Morphine, especially in low doses, helps with the patient’s symptoms so that they may be more of themselves than a product of their ailments. It does not affect them mentally or change their personality.
Just as with any medication, when first starting the patient may take some time to adjust. This may include initial drowsiness but after the first few days, these effects go away. Every person is different however, and some may react in different ways to opioids. In these cases it is up to the patient, their family and their care team to consider alternate forms of pain management.
There is no evidence that opioids speed up the process when a person is already terminally ill as long as they receive the proper dose to control their symptoms. The opposite may actually be true. Troubled breathing and constant pain drain hospice patients of their energy and strength. When these symptoms are relieved, the patient can be made more comfortable and even slow down the rate of decline.
This myth stems from the circumstances in which morphine is used. If a patient is in hospice and prescribed morphine, they are usually in the advanced stages of terminal illness. The person is in the process of transitioning with or without the morphine. Sometimes the patient’s final moments may come shortly after a dose of medication, but this is just a coincidence.
Hospice seeks to provide a comfortable passage through the end of one’s life. Hospice never intends to speed up this passage, only to make it more peaceful. Morphine is nothing more than a tool to aid in this goal.
If you’re reading this, chances are high that you’re interested in hospice care. While not an often-discussed concept, it is a very important and highly beneficial option for terminal diagnoses. Consumer Reports and The Washington Post recently published a great story outlining the benefits of choosing hospice care sooner than later. According to a recent study , most people that choose hospice care wait too long to do so and at the expense of their symptoms and quality of life.
The study’s author, Dr. Thomas Michael Gill, goes on to say that if hospice is delayed too long, its benefit may be reduced.
People who put off hospice care might spend months in and out of hospitals, with their families struggling to attend to them. “At some point, patients and their families and doctors realize that hospice is appropriate, but that happens perhaps later than it should,” says study author Thomas Michael Gill, a professor of medicine, epidemiology and investigative medicine, and the Humana Foundation professor of geriatric medicine at Yale University. “When folks are referred to hospice only in the last days of their life, it’s difficult to have a meaningful benefit.”
The study followed over 750 people over age 70. More than 40% of them entered hospice toward the end of their lives but the average time they spent there was less than two weeks. Dr. Diane Meier, the director of the Center to Advance Palliative Care explains that these people could have avoided many hospital visits and suffering of symptoms by choosing hospice care earlier.
Many of their most debilitating symptoms—including pain, nausea, depression, and shortness of breath—decreased substantially only after hospice began. That means many patients might have been suffering needlessly for months, says Diane Meier, M.D., the director of the Center to Advance Palliative Care and a professor of geriatrics and palliative medicine at The Mount Sinai Hospital.
Health crises, emergency-room visits, and hospitalizations can become routine toward the end of life, and “that is a very distressing and stressful experience for patients and family members,” says Meier. “Remaining in your own home [something hospice makes possible], a familiar place with familiar people, is safer and offers better quality of life.”
Common reasons people may delay hospice care are often rooted in misconception. For instance, hospice is not a death sentence. Patients may leave hospice care at any time and it does not have a time limit—only a standard time of six months which can be extended.
“Many people are fearful that if they choose hospice, they won’t be able to return to mainstream medicine should they improve or new treatments become available—that’s not true,” says Meier. “Hospice is not a one-way street.”
And some evidence suggests that hospice patients actually live just as long or even longer than similarly ill patients who are not in hospice.
So, when is the right time for hospice? Meier lists two main criteria: difficulty with self-care through daily life as well as debilitating symptoms such as pain, shortness of breath and depression. Hospice helps with both of these factors. According to Dr. Gill, the most important factor of all, however, is honest communication.
“It’s challenging to have honest discussions with patients and families about death and the dying process,” says Gill. “But leaving the conversation until the very end makes it more difficult.”
So, you’ve decided to try volunteering with hospice and you want to know how to get started. If you haven’t yet made this wonderful and life-impacting decision, check out our article on the benefits and rewards of volunteering with hospice.
Bridgeway Hospice is a great hospice to volunteer with and, if you’re in the Atlanta area, we have a location near you. The process is thorough, but you will have someone guiding and assisting you throughout the time you are with us.
Bridgeway serves all of Metro Atlanta stretching through Northeast Atlanta and into the Athens area ( Click here to see a list of our locations ). As a volunteer you are welcome to volunteer as little or as much as you are available. No long-term commitment is needed to volunteer with Bridgeway Hospice.
After initial contact is made through phone or email, a volunteer coordinator will contact you to set up an orientation meeting. This first meeting will mostly be an informative session including a comprehensive training program. Topics range from hospice philosophy and services offered to individual needs and boundaries. This meeting is important to determine how you can best serve the patient through your strengths, skills and talents.
Bridgeway Hospice’s volunteer coordinators try to set honest and real expectations for new volunteers into what can be an impactful and rewarding volunteering endeavor. “I give them the true facts of what this experience could be and what to expect. Volunteers often tell me ‘it was exactly what you said, and I appreciate it,’” says LaShonn Waller, one of Bridgeway Hospice’s volunteer coordinators.
After the first meeting, the local volunteer coordinator will match you with patients based on their proximity to you, and the needs of the patient relative to the volunteer services you can provide.
On the first day of volunteering with a hospice patient, the volunteer coordinator will accompany you on the visit. This initial visit will be rather short and also include caregivers and other staff to determine if it is a good fit for you both. Additionally, the volunteer coordinator may take you to meet other patients in this same manner on the same day to determine which patient will be the best fit for you.
The coordinator will keep you updated and current, especially with regard to the patient. “I have 35 volunteers and I talk to each one of them every week to give them updates and just to see how they are doing,” Waller says.
Volunteering with Bridgeway Hospice will help you gain great personal satisfaction from knowing that you have made a positive impact in another person’s life. For more information please contact any of our wonderful volunteer coordinators at www.bridgewayhospice.org/volunteer/
Volunteering with hospice is an immensely rewarding experience for the volunteer and those they serve. Hospice is a form of remedy for a difficult and often depressive time for patients and their families and hospice’s goal of comfort, peace and quality of life is greatly enhanced by its volunteers.
Studies have repeatedly shown that volunteering is linked to greater levels of happiness and well-being. Additionally, caring for others has also been found to lead to happiness and fulfillment. Volunteering with a hospice is an excellent method to accomplish both.
A passion to care for others makes a real and tangible difference in people’s lives. A warm person’s smiling face increases positivity and uplifts a hospice patient and their family. Having someone new to talk with and spend time with can be a tremendous gift and blessing.
Photo by Crown Agency
Volunteers can serve in a large variety of roles. No matter your abilities or situation, you can help provide comfort and peace to others in a difficult season. Primarily, volunteers provide companionship by spending time with the patient and simply being there with them. By telling stories, listening to the patient’s stories, reading or even pet and music therapy, volunteers are a ray of light to hospice patients.
In addition to providing company to those in hospice care, volunteers are also needed to help with more practical matters. Bridgeway relies on volunteers to help with office work, fund-raising, community outreach and other operational areas.
Depending on the situation, volunteers sometimes keep vigil with the patient and/or their families during the end. However, volunteers are never asked to do something they don’t feel comfortable doing. Additionally, “In Georgia, volunteers do not participate in any hands-on care such as bathing, feeding or moving the patient,” says Shari Koch one of Bridgeway Hospice’s volunteer coordinators.
Photo by Elijah Henderson
Bridgeway serves all of Metro Atlanta stretching through Northeast Atlanta and into the Athens area. ( BridgewayHospice.org/Locations/ ). As a volunteer you are welcome to volunteer as little or as much as you are available. No long-term commitment is needed to volunteer with Bridgeway Hospice.
Volunteering with Bridgeway Hospice will help you gain great personal satisfaction from knowing that you have made a positive impact in another person’s life. For more information please contact any of our wonderful volunteer coordinators at BridgewayHospice.org/Volunteer/
One of the most frequently asked questions concerns about hospice care is who pays for it and how is it paid for. As with any form of healthcare, cost is a valid concern. However, when you are dealing with an illness that may require hospice care, paying for it is the last thing you want to worry about. Fortunately, hospice care is covered under most types of health plans and requires very little to no out of pocket patient cost.
To qualify for under these health plans, the patient must meet the basic hospice requirements. These requirements state that the patient be diagnosed with a terminal illness and no longer be pursuing aggressive treatment and have a life expectancy of less than six months.
Nearly 90 percent of hospice costs are paid through government programs and most of it comes through Medicare. Most hospice patients are Medicare eligible and Medicare will pay all costs of hospice care except for co-pays on prescription drugs.
Medicare covers a broad range of services including nursing, therapy, social work and even equipment and supplies. Room and board is not included in these services. The only stipulation to Medicare coverage of hospice care is that it will not cover treatment to cure the illness or treat it, beyond palliative care of the symptoms. The upside to this is that there is no limit to how long Medicare will provide for hospice care as long as the patient remains eligible.
For those that do not qualify for Medicare, Medicaid also provides coverage in much the same way. Eligibility requirements for Medicaid vary from state to state and can be found on the program’s website, www.medicaid.gov
Additionally, if the hospice patient is a veteran or military personnel, hospice benefits are provided for by Tricare, the medical care benefit of the armed services. Eligibility and care stipulations are nearly identical to those of Medicare.
Finally, although most private insurers such as Blue Cross Blue Shield and Humana cover hospice care, their plans vary across providers. Of course self-pay is also an option and many charities exist to help those less fortunate to have the comfort and dignity they deserve.
We know that is a difficult time for all involved if you are considering or pursuing hospice care, so the cost of care should be the least of your concerns. Bridgeway Hospice will work with you to determine the best method of payment and provide the best level of care, no matter your situation to make this time as comfortable and peaceful as possible.
Bridgeway Hospice and Bridgeway Palliative Care share many of the same goals although there are some subtle but important differences. Whether you are considering palliative care for someone in your life or simply looking to learn more, in this article we’ll explore what palliative care aims to achieve and the primary ways in which it differs from traditional hospice care.
What is Palliative Care?
Palliative care is specialized medical care aimed at managing the physical, emotional and spiritual issues associated with serious illness. At Bridgeway we work with your current healthcare providers to support their efforts in managing your health, while focusing on your personal goals and values.
Patients with a serious illness, as well as their families, are impacted in all areas of their lives. Palliative care can manage these effects across the entire spectrum of care. In addition to physical problems such as pain, sleeplessness and appetite loss, palliative care also addresses the emotional and social side of illness including anxiety, stress and depression. Palliative care may also help patients and families affirm their thoughts and feelings through a therapeutic approach to emotional support.
A palliative care team will also help with more logistical and practical issues such as helping the family understand resources the community offers to help with financial counseling, transportation and housing. The team also acts as a medical liaison of sorts to the family, offering explanation and understanding of available options and treatment.
Differences of Hospice and Palliative Care
The primary difference between hospice and palliative care is that, unlike hospice, palliative care can be utilized while the patient is undergoing aggressive treatment for the illness and at any time during the illness. Hospice care is reserved for patients that are no longer undergoing life-prolonging treatment and typically have less than six months to live. Palliative care has no such time or treatment restrictions—it acts as an additional layer of medical care for those patients who need comfort, care and support.
Another notable difference between these two levels of care relates to how they are billed. Hospice is usually covered in full by Medicare and Medicaid. While Medicare and Medicaid may also help with palliative care, it is usually covered through the patient’s insurance. Some palliative care programs may operate out of hospitals and inpatient facilities, but Bridgeway Palliative Care is community-based—meaning that we will come to serve and care for the patient where they live.
Palliative care seeks to, and succeeds in, improving quality of life. The program aims to prevent unnecessary hospitalizations for issues such as dehydration and shortness of breath. By managing the symptoms at home, quickly, and in comfortable surroundings, patients benefit and costs are reduced.
Gabby Cornett, Director of Palliative Care Operations for Bridgeway, states that “studies have found that early introduction to a palliative care team can increase quantity and quality of life for cancer patients compared to a control group facing the same diagnosis. In our program, we have noted more than 70% of our patients reporting an increase in quality of life.”
The team at Bridgeway Palliative Care and Bridgeway Hospice are committed experts focused on bringing the very best care to any patient and their family through the appropriate approach to meet your needs.