Hospice care is a vital service that provides compassionate and specialized support to individuals with life-limiting illnesses, particularly when they receive care at home. Understanding what home hospice covers is essential for patients and their families to ensure comprehensive and personalized end-of-life care. This article aims to shed light on the various aspects of home hospice care, including medications, durable medical equipment, staffing support, and expertise in managing the natural dying process. By delving into these details, individuals can make informed decisions and better comprehend the valuable assistance hospice care provides during this sensitive time.
Hospice at Home
It’s quite common to ask what hospice provides when the patient is living at home. Let’s go over the meat and potatoes.
1—Medications: Hospice covers all comfort medications and medications related to the terminal illness. OTC, supplements, and medications not directly related to the terminal illness are typically handled as they were before hospice.
2—Hospice typically covers durable medical equipment (DME) for basic DME needs, such as electric hospital beds, oxygen concentrators (basic models), oxygen tanks, rollators, walkers, etc. Specialty equipment such as sit-to-stand chairs and electric/powered wheelchairs is not typically covered by hospice.
3- Support/Staffing: 24-hour per day availability without regard to weekends and holidays. CNA (certified nursing assistants — often mistakenly called a nurse BUT not a nurse!)/HHA to help with bathing, changing, and light housekeeping (generally directly around the patient’s area) as well as educating family members in how to do the same tasks when they are not present, RN case managers (RN CM) who come on-site to assess the current needs, provide education on the disease process and progression, medications, working with the patient’s attending physician and the hospice medical director on changes to the plan of care, managing the entire care team, social workers to help with community resources as well as provide education, chaplain (often non-denominational) to provide spiritual and emotional support.
One of the most misunderstood areas of staffing and support is that none of us are onsite 24×7 with the patient, and none of us work “blocks” of time (though Medicare’s standard is to try to be with the patient and family for no less than 30 minutes). We visit, do assigned tasks, work through any essential issues to deal with before we leave, and then leave to see the next patient and family, and so on. The social worker can often provide information on how to obtain 24/7 support on-site, but the hospice does not cover that financially.
4- IMPORTANT: We are experts in the natural death and dying process encompassing all terminal illnesses, discomfort/lack of comfort/pain issues your loved one and family will go through. Outside of palliative specialists, there are absolutely no substitutes for the expertise we bring to the table. There are times we unintentionally prolong the loved one’s life because it is widespread for medications not to be reviewed regularly to determine if the medicines are causing outright harm to your loved one and should be discontinued or modified. Good hospice professionals will sugarcoat nothing and help you know what to expect over time (not exact dates and times, to be clear).
I cannot stress #4 above. I’ve case-managed situations where the doctors did not have a clue how to manage the patient’s pain, where the hospice team got the pain so well managed the patient was able to go on a final vacation before passing, cases, where the patient was so restless non-hospice/palliative care doctors were clueless to get the situation, managed so the patient could come home and so on.
The word “hospice” is a philosophy, not a location. The word “hospice” is a philosophy, not one big organization. The word “hospice” is a philosophy, not a setup like EMS, where there are strategically located buildings/locations (stressing the first sentence) from whom staff operates. There are typically two to dozens of hospice agencies servicing various geographic areas (though be careful that two separate agencies may still be owned by a larger corporation). It’s always a clever idea to interview two or more hospice agencies to find out how they would manage your situation vs. just interviewing one. During the interview, ask who owns the agency (i.e., Aseracare is owned by Amedisys (a huge public company focused on profit).
Conclusion
Home hospice care encompasses a wide range of services designed to prioritize the comfort, dignity, and well-being of patients with terminal illnesses. From covering essential medications and durable medical equipment to providing round-the-clock staffing support and expertise in managing the natural dying process, hospice care is tailored to meet the unique needs of each individual. It is essential for patients and their families to be aware of the comprehensive nature of home hospice care, as this knowledge empowers them to make informed choices and ensures that their loved ones receive the highest quality of compassionate end-of-life support. By embracing the philosophy of hospice care and understanding its various components, individuals can navigate this challenging journey with the valuable assistance and guidance offered by hospice professionals.
