By Toni L. Eaton, RN, BSN, MS, President & CEO of Old Colony Hospice & Palliative Care
Talking about hospice can be a sensitive matter. Few people want to think about the end of life, whether for themselves or for someone else. So, many families delay broaching the topic. But after working in hospice for decades, I can tell you this—most people say they wish they had started the conversation about end-of-care earlier. Still, how do you know when it’s time to start talking about hospice?
If you are asking yourself when it is time to contact hospice, there is a good chance that you or your family member may already be eligible for this healthcare service. Hospice is indeed end-of-life care, but what many people do not know is that going on hospice earlier rather than later is also life-fulfilling and life-affirming for many people.
What do I mean by this? People who go on hospice earlier actually often live longer and are in less distress, allowing them to enjoy more meaningful time with family and friends, studies show.
Still, many families wait until the last days of their loved one’s life to call hospice, not knowing that they could have started receiving specialized health care, medications, palliative care, medical equipment, support systems, and supplies related to their illness much earlier. This kind of care improves the patient’s quality of life by reducing stress and managing pain. It also improves the lives of family caregivers who can benefit from having someone to lean on and get guidance from during this difficult time.
We also find that while end of life can be a sensitive subject, oftentimes, the patient is relieved when loved ones are willing to talk about it. They are sometimes afraid to raise the topic themselves because they fear it will upset those around them. It is also empowering for patients to voice their wishes instead of having someone choose for them.
Patients today can live for years with a terminal illness. So, how do you know when it’s time to consider hospice? First, to be considered for hospice care, the patient’s doctor must diagnose the patient as having a terminal illness with less than six months to live, if that illness were to follow the typical progression.
If the patient continues to live beyond the six-month prognosis, and often those who get early hospice care do, they can continue on hospice care as long as a physician recertifies eligibility. If your loved one’s condition improves, or if they want to pursue curative treatments over comfort care, they can end hospice care and do that whenever they want and resume hospice at a later date.
There are a few indicators that can help guide you as you consider the question of whether it is time for hospice options. Are there frequent visits to emergency departments or hospital admissions? Has it become more difficult to perform daily tasks such as getting dressed, eating, walking, or using the bathroom? Are there signs of deteriorating health, such as falls, changes in mental abilities, and infections? Are medical treatments no longer working? Does the patient want to end aggressive interventions and lean more toward comfort care? Are symptoms and pain getting more difficult to manage?
If the answer to any of those questions is yes, it may be time to get more information about hospice. Hospice care is covered by Medicare, Medicaid, and most private insurance companies. Hospice works with the patient, the family, and the patient’s care team to support them in their home or chosen care facility.
If your aging parents or loved one has a terminal illness and their goals include comfort care, time with loved ones, and improved quality of life, hospice care may be the answer. Hospice care focuses on pain relief and symptom management rather than curing the illness.
Some of the most common illnesses in hospice care include cancers, lung disease, heart disease, liver and kidney disease, and diseases of dementia, among others.
Research has shown pain increases for people in the last two years of life and becomes most intense in the last four months. Uncontrolled pain can lead to a host of other issues, including difficulty breathing, anxiety, nausea, and trouble swallowing, among other symptoms. Hospice can help ease this.
When you decide it is time to start the hospice conversation, here are a few tips:
Research. Learn as much as you can about end-of-life care and the hospice organizations in your area so you can provide answers and offer reassurance to your loved one.
Be Patient. Provide information but be patient. Empathize with the difficult decisions they face. It can take time to understand the benefits of hospice care.
Offer a listening ear. Listen to their concerns. Talk through different scenarios, ideally before their health is failing.
Be supportive. Ask to attend a doctor’s appointment with them. If your parent or loved one agrees, share your concerns with their doctor and ask to have a conversation about hospice.
Reach out. Hospice organizations such as Old Colony Hospice have people who can help you find answers to your questions. They are knowledgeable about end-of-life care and can help you assess your situation.
Talking about hospice can feel daunting, but know you are not alone. And know, too, that it may be one of the most important conversations you may ever have.
Toni L. Eaton, RN, BSN, MS, is the President & CEO of Old Colony Hospice & Palliative Care of West Bridgewater, a dynamic non-profit hospice serving more than 55 communities south of Boston. OCH also runs the Dr. Ruth McLain Hospice Home in Braintree. A native and resident of the South Shore, Toni brings her compassion and experience as a nurse, veteran, and community leader to her insightful columns for South Shore Senior News. She is also the founder of Sunny Paws Dog Rescue. Several groups have honored her leadership, including the South Shore Women’s Business Network. She currently sits on the board of the Hospice & Palliative Care Federation of Massachusetts. For more information, call (781) 341-4145 or visit Old Colony Hospice & Palliative Care at www.oldcolonyhospice.org.
