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 (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. But, patients have to be eligible!
Dying at home is often a better experience than in hospital because the latter usually follows a “medical model”: meaning there tends to be a focus on a particular disease, rather than the ‘whole’ patient, with multiple tests, drugs, and constant interruptions. Whereas at home, with hospice, it’s more “personal and holistic”: meaning more patient/family-centered 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 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 condition could be called), they need to do so and to ask for a hospice evaluation as soon as they see their loved one beginning the so-called ‘downward spiral’: indicated by more frequent doctor visits and hospitalizations combined with increasing need for more assistance with daily activities.
If they don’t yet meet hospice criteria, then a palliative care approach is certainly appropriate until the patient declines to the point where they are eligible for hospice.