The previous article discussed the importance of knowing prognosis particularly when a terminal condition is present; terminal defined as having an incurable disease which is steadily worsening and life expectancy is less than 6-12 months.
Medicare encourages patients to enroll in hospice when they meet that definition (terminal) because it has been shown that hospice not only improves quality of living and dying, it saves money for both the healthcare system and families.
Dying at home is often a better experience than in hospital because the latter usually follows a “medical model”: focusing on a particular disease, there are tests, drugs, and constant interruptions. Whereas at home, with hospice, it’s a “personal model”: more patient/family centered with greater convenience, and the hospice’s doctor and staff are the ones to make appointments to visit rather than the opposite.
Paradoxically, it has been shown that hospice patients live longer on average than a similar group not in hospice. That’s because when the focus is on comfort, patients take generally fewer medicines, have fewer tests or procedures, and enjoy life more. However, this benefit is not optimized unless the patient has been in hospice for at least several months: better to enroll sooner than later.
Although families are often reluctant to talk about this “elephant in the living room” (as the worsening chronic/incurable disease could be called), they need to do so and ask for a hospice evaluation as soon as they see their loved one beginning the so-called ‘downward spiral’: more frequent doctor visits and hospitalizations combined with increasing assistance with daily activities. If they don’t yet meet hospice criteria, then a palliative care approach is an option until the patient declines to the point where they are eligible for hospice.