How to Set Up Hospice Care
A referral to hospice has to come from a physician who is willing to manage the care under hospice. Sometimes a hospice agency may have a physician on staff that will assume this responsibility or will work with the patient's physician to direct hospice care, but the initial referral has to come from the patient's physician. This may be the PCP or it can be an oncologist, cardiologist, or other specialist treating the terminal diagnosis.
The patient has to have a terminal diagnosis and usually less than six months to live. Sometimes, an expected lifespan of less than one year is appropriate. Even if the patient outlives this six months, she can still remain on hospice care.
In far too many instances, hospice care isn't initiated until the last few days, or sometimes hours, before death occurs. This doesn't always provide the best experience for the patient or his family, as sometimes maximum symptom control can't be achieved and the patient has to suffer more than necessary. Counseling and bereavement services may be compromised as well.
It is often best to explore the hospice option when the terminal diagnosis is first made. The choice to pursue curative treatment may indeed be made at this time, but the connection to hospice is also made and can be optioned when the patient is ready.
Once the referral has been made, the patient or designated family member will be contacted within twenty-four hours to arrange an evaluation visit. At that time, a registered nurse or medical social worker will explore the hospice option with the patient, primary caregiver, and family members. Appropriate documentation will be signed and a plan of care specific to the needs of the patient will be made, and subsequently reviewed and approved, by the hospice team.
What happens if my father, who has a terminal illness, falls and breaks a hip? Can he have surgery to repair it or does he just have to live with it until he dies?
If the patient sustains an injury or other illness not related to the terminal diagnosis, it can be treated as if he wasn't on hospice. If he chooses not to treat it, only palliative care will be provided, as determined by the patient and the hospice team.
As the patient's condition worsens from her terminal disease, the team will work together to provide symptom control to keep her comfortable. Upon death, a member of the hospice team will pronounce the patient gone, notify the hospice team including the physician, and the preap-pointed mortuary will pick up the body.
There are no resuscitative measures taken; however, should the patient change his mind, hospice care can be revoked or stopped at any time and reinstated again if he decides to resume hospice care. This is not common practice, but the option is always there.
