Hospice is appropriate when a terminal disease is present; terminal is defined as having an incurable condition 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 because hospice not only improves quality of living and dying, it saves money for both the healthcare system and families. But, patients have to be eligible!
Dying at home is often a better experience than in hospital. Home is often more “personal and holistic”: meaning more patient/family-centered convenience, avoids the many tests hospitals feel obligated to do, 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 with a comfort focus, patients have fewer medicines, tests and procedures, and enjoy life more. However, a patient needs to be in hospice at least several months before this benefit is really felt: once the family and their doctor recognize that the patient is in the ‘downward spiral’, better to enroll sooner than later.
Although families are often reluctant to talk about this “elephant in the living room” (the worsening terminal condition), once they do so, accept their loved one’s situation and sign-on with a hospice, it’s usually a great weight off their shoulders. Our hospice staff are particularly skilled in these discussions.
If patients don’t yet meet hospice criteria, then a palliative care approach is still appropriate (meaning focus on controlling their symptoms) until they decline to the point where they are eligible for hospice [see previous articles or go to my website – comfortcarechoices.com – to find out who is eligible].