When is Hospice Called in?

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Published:  March 1, 2022
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When is Hospice Called in?

Hospice care, by definition, is reserved for terminally ill patients. As such, patients who elect to begin hospice care have decided that they no longer wish to try to recover from their illness, but instead have opted to try to remain as comfortable and pain-free as possible as their illness runs its course. Although the motivations that underlie hospice care are relatively clear, the point at which hospice care should be used remains an area of debate.

When is Hospice Called in?

A 2009 article published in the New York Times illustrates why it is important to understand the need for open and frank discussions with loved ones and healthcare providers on when hospice should be used. “But even if you did call, odds are you’d have waited so long that the hospice team would have very little time to do what it is good at doing — providing care and comfort to the dying and their families.” Overall, the median length of hospice care is just 20 days, and almost one-third of patients enroll a week or less before the end of their life.

If one is in search of a specific point that would require hospice care, they are likely to be disappointed. They are unlikely to find a single condition or point in time in the progression of an illness in which one can definitively say that it is time to call hospice care. Rather the decision to use hospice care is normally the culmination of many conditions that can all lead to the conclusion that hospice care is needed.

It is useful to look at the criteria hospice providers and insurance providers require before providing and paying for hospice care. Most hospice services require a doctor’s certification that the end of life from an illness is likely to occur within six months before services will be made available. Similarly, individuals who are covered by Medicare Part A (Hospital Insurance) and who meet the following conditions can receive covered hospice care.

  • Both the hospice doctor and a treating doctor (if one is used) certify that the individual is terminally ill (with a life expectancy of 6 months or less)
  • The patient accepts palliative care (for comfort) instead of care to cure the illness
  • The patient signs a statement choosing hospice care instead of other Medicare-covered treatments for a terminal illness and related conditions

Private insurance hospice benefits typically have different guidelines that might allow for hospice care to be considered much earlier than the last six months of life. The conditions listed above involve the technical conditions that offer a patient the chance to enter hospice; however, some personal factors also dictate when a patient is ready for hospice.

Based on the criteria presented above, one can conclude that if a patient is still benefiting from curative treatment, it would not be an appropriate time to call hospice care. The individual patient and the particular disease or illness that affects them will largely affect when and whether a patient is no longer benefiting from curative treatment. For some terminally ill patients, there is a point when treatment no longer works. Continued attempts at treatment may even be harmful or unnecessarily painful, or, in some cases, treatment might provide another few weeks or months of life but will make the patient feel too ill to enjoy that time. While hope for a full recovery may be gone, there is still hope for as much quality time as possible to spend with loved ones, as well as hope for a dignified, pain-free end.

Assessing Symptoms

Often, the presence of a number of symptoms or certain medical events can provide guidance for determining when hospice care may be appropriate. The following are signs that a patient or loved one may want to explore hospice care.

  • Multiple trips to the emergency room to have the patient’s condition stabilized
  • Rapid increases in symptoms that affect the quality of life
  • Multiple admissions to the hospital in a short period of time coupled with worsening symptoms
  • Failure of recognized or alternative curative therapies to stem the progress of the terminal illness
  • The patient wishes to remain at home rather than spend time in the hospital
  • The patient has clearly decided that the discomfort caused by curative treatments outweighs the benefits received from these treatments
  • Increased or uncontrolled pain
  • Progressive weight loss
  • A decline in ability to perform activities of daily living (ADLs)
  • Frequent infections
  • Increased weakness and/or fatigue
  • Increased skin problems
  • Withdrawal from social activity
  • Confusion

The signs above represent a list of general indicators that a patient may be medically ready for hospice care. In addition to the general signs presented above, medical providers rely on extensive evaluation criteria that are specific to a particular disease in order to evaluate whether a patient is medically appropriate for hospice care. These criteria will vary depending on the patient’s illness or disease. Under Medicare and other insurance payer guidelines, a physician must certify that a patient will live fewer than 6 months if their illness runs the usual course.

Regardless of the medical evidence present, the decision to discuss whether it is time to begin hospice care can be difficult. However, one should not fall victim to the misconception that hospice care is giving up; rather, it is a phase of care that focuses on comfort and symptom management rather than focusing on curative treatments. Also, it is important to consider that a patient may decide after they have entered hospice that they want to resume curative treatment. Regardless of the situation, the decision to call in hospice should be made in conjunction with the patient, their loved ones, a hospice provider, and the patient’s care team. When viewed in light of the various opinions on the patient’s well-being and the patient’s goals, the decision to call in hospice can be made in a clearer and more decisive fashion. For more information about when to call hospice in, contact Traditions Health.