Hospice Care, Part 2: Dad’s Hospice Experience

Please be aware I am not a health care worker, nor an expert on hospice and end-of-life issues, but I am sharing my family’s hospice experiences with you in the hope it will lead to more knowledge and a greater understanding of this aspect of life.

This is Part 2 in a series on hospice care.  You can read Part 1 here.

Admission to Hospice Care

I probably shouldn’t have been surprised when the board & care administrator suggested Dad be evaluated for hospice care.  It was just after his 98th birthday after all! While he was in above average shape for someone that old, he had deteriorated physically and mentally in the preceding weeks.

Plus the administrator actually listened to my words and my true but unspoken desires underlying the words I’d said in the months prior: “I don’t want my father to ever be put in a hospital again.”

Why did I feel this way?  Two years before I’d witnessed how confused and agitated being in the hospital and medications made him when he had hip replacement surgery.  And I didn’t want him to go through that mental angst and the physical discomfort hospital stays usually cause in the elderly.

Not every senior is placed on hospice just because a family member asks for an assessment.  A nurse examined and interviewed us both as one part of the admission process to see if my dad met the eligibility guidelines.  My dad’s doctor did an examination, as did the doctor affiliated with the hospice company.

Hospice doesn’t pay for all of your loved one’s medications, but it did cover all medications relating to the diagnosis hospice gave him, end stage cardiovascular disease. My father wasn’t taking much medicine at all, so the cost for the non-covered medication wasn’t a financial burden for us.

I eventually saw how much the hospice care bills were, and they were very expensive, but at no out-of-pocket cost to us — except for the monthly Medicare premium taken out of his social security check.   Payment for hospice services is covered through Medicare and most Medicaid programs. Most, but not all, private insurance programs offer a hospice benefit. It is important to research whether your health insurance coverage offers hospice benefits and determine exactly which services are included. Some hospice companies will help you with this analysis, too.

I didn’t interview more than one hospice company.  I just went with the one that the board & care recommended.  I didn’t realize I could have chosen any one I wanted to, but I liked the people I met through this hospice company and my instincts said to proceed with them.  I wasn’t disappointed.  As time went on and I learned more about hospice, I became aware that all hospice companies are not alike.  I happened to select a large, nationwide hospice company, however there are smaller, “Mom and Pop” types of hospice companies as well.

If I was going to do it all again, I might have interviewed more than one company just to get a feel for the various staff members, as well as to compare and contrast their approach to our family’s situation.  A hospice company is only as good as its staff makes it.  Like any service you are paying for (even if Medicare is picking up the tab in this case), make sure they provide good customer service and you are very satisfied with the patient care.  If not, look around until you find a hospice company that is a better “fit” for you and your Golden Oldies.

What Does Hospice Do When Your Loved One Already Lives in a Board & Care?

Hospice provided another entire layer of care for my dad.  There was a wonderful RN who would visit and examine him thoroughly two or three times a week.  A home health aide came every other day to bathe, shave and attend to any personal care he needed.  This was above and beyond the regular caregivers’ daily assistance in the board and care.  The RN would call me with periodic reports by phone about my dad’s condition and I was able to reach her (or her supervisor) whenever I had questions or concerns. There was also a detailed log book about my Dad recording every statistic about his health condition and medicines, contact information, and a detailed report for every visit made by each hospice team member.

Beyond patient care, phone calls were made to me on a regular basis by the hospice social worker, whom I also saw sometimes while visiting my dad.  She would call me every few weeks just to check in and see if I had any questions  or needed emotional support in any way.  The hospice company also had a chaplain who contacted me within a week of my dad’s admittance but I let him know we already had wonderful clergy to help us with religious and spiritual issues.  The hospice team (MD, RN, home health aide, social worker, chaplain, team manager) meet on a weekly basis in their offices to discuss each patient and update their care plan.

Hospice Philosophy

The goal of hospice care is to keep your aging parents comfortable and to maintain a decent quality of life while they are in their final stage of life. This philosophy is different than traditional medicine, in which health professionals strive to cure a person’s disease. Hospice services are not intended to speed up or prolong the dying process, but focus instead on relieving pain and other symptoms. Hospice caregivers are concerned with enhancing the quality of remaining life by keeping seniors as alert and comfortable as possible in a familiar environment with family and friends nearby.  Hospice care also helps family members manage the practical details and emotional challenges of caring for a dying loved one.

In Part 3 of this series, I’ll share more with you about my family’s experiences with hospice and what I learned during my mom’s final months.

Outside Resources:

The Hospice Foundation of America

Medline Plus about Hospice Care (A service of the U.S. National Library of  Medicine and the National Institutes of Health)

American Cancer Society