When to consider hospice for end-of-life care

Keais Pope, MD

Hospice and Palliative Care

Caring for someone facing the end of their life can feel overwhelming. You may be asked to make decisions on your loved one’s behalf about the care they will receive. How can you know when hospice is appropriate?

Hospice and palliative care physician, Keais Pope, MD, answered some important questions about hospice and when to consider hospice for end-of-life care.

What is hospice and how is it different from palliative care?

It’s easy to confuse hospice care and palliative care because they can seem very similar. Hospice care helps patients with chronic, terminal illnesses live the remainder of their lives as fully as possible and die in comfort and with dignity.

“With hospice, the plan of care is more comfort-focused as opposed to a life-prolonging plan that includes curative and aggressive treatments,” Dr. Pope explained. “Palliative care is similar to hospice care, but is just upstream of hospice care where patients are still pursuing curative and active treatments such as chemotherapy, hospitalizations, etc. Both specialties mainly focus on symptom management, honest and open communication, and quality of life. The purpose is to improve quality of life as much as possible for those who are suffering from chronic illness.”

Patients do not have to be actively dying to benefit from palliative care, and, in fact, many improve.

“The research is very conclusive in that patients who receive palliative care earlier, overall, do better,” Dr. Pope said. “They have better quality of life, and they live longer.”

He said the same is true when hospice care is involved earlier in a patient’s care.

“Research suggests that with earlier hospice admission, patients actually live longer and more comfortably because their symptoms are more controlled, and we are not pursuing overly aggressive, and sometimes harmful, medical interventions. They’re able to stay at home and focus on the things that bring them joy and to live their life as fully as they can.”

When is it appropriate to consider hospice for end-of-life care?

If the burden of the disease outweighs the benefits of treatment, it might be time to consider hospice care. For patients who are tired of pursuing aggressive medical interventions, hospice can help improve the patient’s quality of life and guide them through the last stages of life in greater comfort.

For example, if someone has cancer and they’re not tolerating chemotherapy or radiation therapy well, or if they have dementia and they’re either not tolerating the medications or they’re progressing despite those medications, hospice can help provide patients and families with the extra love and support they need.

“Many times, hospice care is started late, and people don’t get to realize all the benefits of hospice,” Dr. Pope said.

Is hospice expensive?

Hospice is generally covered by insurance, and for patients who have Medicare, it’s typically covered by Medicare Part A at a hundred percent. This includes nursing, social work and chaplain visits, as well as medications and supplies to manage symptoms and provide comfort.

What services are available for caregivers of people who are dying?

“One of the greatest strengths of hospice care is the support provided to caregivers,” Dr. Pope said.

This support is provided by a multidisciplinary team of doctors, nurse practitioners, nurses, social workers, home health aides and spiritual counselors.

“Our nurses are really the main drivers,” Dr. Pope said. “They’re compassionate and kind human beings who really care for patients in the home and help manage and coordinate the day-to-day care.”

This care can include:

• Help with navigating the difficult mental and emotional aspects of dying.
• Spiritual counseling for people of all faiths and backgrounds.
• Personal care services such as bathing, dressing and cleaning.
• Respite care for families.

“We understand that hospice is a full-time job for a lot of caregivers, and so we have volunteers who are able to come in and help give a little bit of respite to patients and their families,” Dr. Pope said.

Does hospice care end when the patient dies?

Hospice care also includes bereavement services. This can include outreach to families through cards and phone calls, but it can also include support groups and other help through the grieving process.

The main takeaways on when to consider hospice for end-of-life care

Dr. Pope said to not avoid choosing hospice out of fear of hastening your loved one’s death.

“We allow the patient’s body to take a natural path while providing as much medical, emotional and spiritual support as possible to help patients and families get the most out of every moment,” he said. “Even when we’re dying, life still has so many wonderful moments to offer us. Some of the best, most beautiful golden moments in life can happen while in hospice care.”

He also said the true benefit of hospice is seen when hospice care is started sooner rather than later.

“Often, hospice care is started much too late. If started earlier, patients can not only have a better quality of life for longer, but they actually live longer. The human body is amazingly resilient, and we can sometimes see that improvement while they’re on hospice services.”