What You Should Know

• Hospice is a special concept or philosophy of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments.
• Hospice affirms life. It does not seek to prolong the life expectancy of a patient or to shorten it.
• Hospice is composed of a team-oriented group of medical professionals and volunteers that have specialized training in end-of-life care with a holistic approach.
• The goal of hospice care is to improve the quality of a patient’s last days by offering comfort and dignity.
• Hospice places more focus on the patient – not the disease. Hospice addresses all symptoms with a special emphasis on controlling a patient’s pain and discomfort while also dealing with the emotional, social and spiritual impact.
• Hospice isn’t just for the patient. Hospice offers continued comfort and support to family before and after a patient’s death.
• Our hospice team will promote a strong bond between the patient, their loved ones and the health care provider.

When Hospice and Palliative Care of Tidewater receives a referral, a call is made to the patient and their family to set up a time for a consultation. The consultation may take place in the patients home or wherever makes them most comfortable. On some occasions a social worker will accompany the registered nurse upon the initial consultation. During the consultation, the hospice philosophy and services offered will be reviewed. Any questions/concerns that the patient or family may have will be answered to the best of our knowledge.

At this time, if the physician has approved the hospice services, the patient or patient’s representative may choose to be admitted to the hospice program – the registered nurse and/or social worker will review over all of the necessary paperwork required to begin services.

The hospice team will consist of:

• Registered Nurse (RN Case Manager) – The RN will visit the patient 1-7x/week and as needed depending on the level of acuity or needs of the patient/family. The RN will coordinate the patients care with other disciplines as well as other resources needed in the community.
• Certified Nursing Assistants or hospice aide – The aide completes visits according the plan of care set forth by the RN. The aide may assist or complete the patient’s activities of daily living such as bathing, mouth care, incontinence care, dressing, helping with light house duties and preparing small meals. The CNA may also provide companionship and respite under the direction of the RN.
• Social Worker – A social worker is utilized for psychosocial support, resource utilization, counseling and bereavement support.
• Chaplain – A chaplain will be available to the patient and their family/friends for spiritual support.
• Volunteer – Volunteers are available on an as needed basis in a variety of ways including but not limited to companionship, respite, and support.
• HPCT Medical Director – The medical director works closely the primary care physician to coordinate the patient’s medical care, especially when symptoms are difficult to manage. The hospice medical director is also available to answer questions you or the patient may have regarding hospice medical care.
• Physical Therapy, Speech Therapy, Occupational Therapy, Respiratory Therapy and Dietician services may also be utilized when the patient’s plan of care indicates a need for such services.

HPCT will provide all medications related to the terminal diagnosis of the patient. The RN Case manager will assist the patient and family to obtain any other medications that the family wishes to continue as prescribed by their physician. Medical supplies, incontinent products and equipment will also be provided by HPCT.

HPCT provides different levels of care to the patient and family at no extra cost. These levels of care change according to the patients/family’s needs and or goals.

• Routine Care is the basic level of care that is provided on an ongoing basis in the home.
• Respite Care may be initiated when the family or caregiver decides that they need time for themselves and time away from the intensity of caring for a terminally ill person. The patient will be transported to a contracted facility with HPCT and remain there for a 5 day period. All services provided by HPCT will continue while the patient is on respite care.
• Continuous Care (Crisis Care) is an expanded level of care that provides an invaluable resource for helping the patient to stay in the home. It allows up to 24 hours a day of nursing care to help with a sudden increased or uncontrollable symptoms – preventing hospitalizations.
• General Inpatient Care is a level of care for acute symptoms that are unable to be controlled in the home setting. It requires a short term admission into a facility or hospital. The facility must be one contracted with HPCT. This level of care may only be initiated with the physician’s approval.

“Hospice is a place”

• Hospice is a philosophy in which the focus is on quality of life for a patient suffering from a life limiting illness. The care can be provided wherever the patient calls ‘home’.

“Hospice means that the patient will die soon”

• Receiving hospice care doesn’t mean that death will occur in the next few hours or days. Patients who elect to receive hospice sooner – rather than later, report having an increased quality of life with better pain and symptom management.

“Hospice is just for cancer patients”

• Hospice is for anyone with a life-limiting illness. Diagnosis’ may include but are not limited to: COPD, heart disease, dementia, multiple sclerosis, liver disease, HIV/AIDS, Muscular dystrophy, Parkinson’s disease, stroke/coma.

“Hospice is only for 6 months and patient can only receive services for a limited amount of time”

• Patients are continuously re-evaluated for hospice services by the physician and the interdisciplinary team for (2) 90 day periods and an infinite number of 60 days thereafter.

“All hospice programs are the same”

• All hospice programs are to provide designated services however the scope of services may differ. Styles and approach may differ. Some may be for-profit and others non-profit.

“Hospice means giving up”

• Hospice is about living!

The hospice benefit is comprehensive, which means that all services, medications, and equipment related to the patient’s hospice diagnosis are paid by HPCT. This can save patients and families a tremendous amount of money in co-pays and direct expenses.

Additionally, Medicare covers 24-hour on-call access to hospice staff support for patients and families as well as grief support and complimentary therapies.

Now is the best time to learn more about hospice and ask questions about what to expect from hospice services. Although end-of-life care may be difficult to discuss, it is best for family members to share their wishes long before it becomes a concern. Most individuals wait until a crisis moment to think about end of life decisions or hospice. Having early conversations can greatly reduce stress when the time for hospice is needed. By having these discussions in advance, patients are not forced into uncomfortable situations. Instead, patients can make an educated decision that includes the advice and input of family members and loved ones.

Typically, hospice care starts as soon as a formal request or a ‘referral’ is made by the patient’s doctor. HPCT will make an effort to visit the patient within 24 hours of that referral, providing the visit meets the needs and schedule of the patient and family/primary caregiver. Usually, hospice care is ready to begin within a day or two of the referral. However, in urgent situations, hospice services may begin sooner.

HPCT has a registered nurse available 24/7 to answer any questions, address any concerns and provide on-site visits as necessary.

Many patients may have pain and other serious symptoms as an illness progresses. Our staff receives specialized training to care for all types of physical and emotional symptoms that cause pain, discomfort and distress. Our staff will work with the patient’s physician to make sure that medication, therapies, and procedures are designed to achieve the goals outlined in the patient’s care plan.

Hospice services can be provided to a terminally ill person wherever they live. The facility is specialized in caring for the patient’s needs, while our hospice team provides an additional layer of specialized care related to the needs at end of life. Our staff will work very closely with the facility staff to ensure that the patient’s needs are met.