Hospice care is a common option for people nearing the end of life. However, some people have misconceptions about what hospice entails. A common question is whether going into hospice means you will die soon. The quick answer is no – hospice does not guarantee or hasten death. Hospice provides comfort care and support for terminally ill patients and their families. With hospice, the focus shifts from aggressive treatments to improving quality of life in a patient’s final months. Hospice can provide relief from distressing symptoms and create meaningful moments during a difficult time. While hospice indicates a life expectancy of six months or less, some patients live longer with continued support. So hospice itself does not cause death – it surrounds patients with comprehensive care as they complete life’s journey.
What is hospice care?
Hospice is a type of palliative care for patients with a terminal illness and limited life expectancy. It focuses on comfort and quality rather than seeking a cure. The goal of hospice is to allow patients to live their remaining days in dignity, surrounded by loved ones, with symptom relief and spiritual support. Hospice can be provided in a patient’s home, nursing facility, or dedicated hospice centers. Services may include:
- Pain management
- Symptom control
- Medication and equipment
- Medical supplies
- Therapies
- Counseling
- Spiritual support
- Nutritional guidance
- Social services
- Volunteer assistance
A team of doctors, nurses, social workers, chaplains, and volunteers work together to meet the patient’s physical, emotional, and spiritual needs. Hospice allows patients to have more control over their end-of-life care in the comfort of their chosen setting. It aims to make patients’ last chapter meaningful instead of prolonging life with invasive, often futile treatments. Hospice provides support for loved ones as well. It eases difficult transitions and provides bereavement services. While hospice does not accelerate dying, it acknowledges one’s prognosis and helps impart quality to remaining life.
Who is eligible for hospice?
To qualify for hospice care, two physicians must certify that a patient has a terminal prognosis with 6 months or less to live if the illness runs its normal course. Patients must agree to forgo curative treatments for their terminal diagnosis. However, they can continue therapies for comfort or secondary conditions. To start hospice, the primary doctor and hospice medical director review medical records and assess the terminal diagnosis and life expectancy. Eligible diagnoses include:
- Cancer
- Dementia
- Heart disease
- Lung disease
- Liver disease
- Kidney disease
- Stroke
- Coma
- Amyotrophic Lateral Sclerosis (ALS)
- HIV/AIDS
- Neurological disorders
Some patients improve on hospice and live longer than 6 months. They can be recertified and continue receiving care as long as the hospice team verifies ongoing decline. Hospice is covered by Medicare, Medicaid, and most private insurance plans. The focus is on needs, not prognosis. Hospice provides personalized support regardless of how long a patient lives.
Does hospice hasten death?
One misconception about hospice is that it accelerates dying. However, research shows hospice does not hasten death compared to usual medical care. A 2007 study in the New England Journal of Medicine found the median hospice patient lived 29 days longer than the median non-hospice cancer patient. Hospice focuses on comfort and symptom relief, allowing nature to take its course. It does not administer medications or treatments to intentionally end life prematurely. In fact, hospice may prolong life for some by:
- Optimizing comfort to reduce stress on the body
- Providing medications and therapies that improve quality of life
- Offering nutritional support
- Monitoring changes closely to modify care as needed
- Avoiding risky medical procedures and their complications
- Empowering patients to reduce hospitalizations
The care team follows patients’ wishes and helps them define their goals. With individualized plans centered on relieving suffering and strengthening relationships, hospice can enhance the end-of-life experience. High quality, compassionate care leads to longer survival for many terminal patients.
How are hospice patients supported?
Hospice uses an interdisciplinary approach to address patients’ multifaceted needs:
Medical Care
Doctors, nurses, and pharmacists manage pain, symptoms, and medications. They are on-call 24/7 to treat issues that arise and modify plans as needs change.
Nursing Care
Nurses coordinate care services and provide bedside care and education. They monitor patients in their home to achieve symptom control.
Social Work
Social workers offer counseling services and help access resources. They advise on financial aspects and facilitate transitions.
Spiritual Care
Chaplains nurture the spirit through conversations, rituals, and connections based on patients’ beliefs.
Therapies
Physical, occupational, speech, or music therapists enhance functioning, mobility, communication, and engagement.
Volunteers
Volunteers socialize with patients, run errands, help with tasks, and give caregivers respite time.
Bereavement Care
Counseling before and after death helps patients and families process grief and loss.
This comprehensive, team-based approach allows patients to live fully and focus on meaningful moments during their last phase of life. Hospice staff are guided by the patient’s goals and preferences. They work together to foster dignity, serenity, and quality of life until the end.
Does hospice provide assisted death?
Hospice does not provide or facilitate assisted death by euthanasia or physician-assisted suicide. These practices go against the ethical principles of hospice and palliative medicine. However, hospice follows patients’ advance directives regarding the extent of treatments desired as they approach death.
Patients have the right to stop or forgo procedures that artificially prolong life without medical benefit. Hospice doctors can prescribe medications to relieve suffering even if they potentially hasten death as an unintended side effect. But they do not administer drugs with the aim of deliberately ending a patient’s life. The focus is entirely on comfort and dignity.
Key differences:
Hospice Care | Assisted Death |
---|---|
Allows natural death | Causes death |
Manages symptoms | Ends life |
Goal is comfort | Goal is control |
Physicians follow ethics | Physicians provide means |
Timing is uncertain | Timing is planned |
Patient chooses options | Process is prescribed |
So while hospice does not seek to prolong life unnecessarily, it also does not seek to deliberately shorten life. The team helps patients navigate their final days as comfortably and meaningfully as possible based on their values.
What are the outcomes of hospice care?
Research shows hospice care has many benefits compared to continuing active treatments alone in end-of-life care:
Pain Relief
Over 90% of hospice patients report their pain is brought to comfortable levels through hospice care.
Patient Satisfaction
Hospice improves satisfaction with care in 88% of patients and 98% of families based on surveys.
Lower Costs
Hospice reduces ineffective treatments and hospitalizations, saving an average of $2,300 per patient in Medicare expenditures.
Fewer Hospitalizations
Patients on hospice are hospitalized less often – especially for unplanned, emergency care.
Bereavement Benefits
At least 80% of bereaved family members receive hospice grief support and counseling services.
Survival Time
As mentioned, hospice patients often live longer than those with usual care alone for terminal diagnoses.
By focusing on quality of life and patient-centered care planning, hospice produces numerous advantages over standard end-of-life medical treatment. Patients and families overall express great appreciation for the comprehensive, compassionate comfort provided through hospice.
When should hospice be considered?
Hospice is most beneficial when integrated early enough to establish relationships between patients, families, and the care team. This allows time to optimize comfort, complete unfinished business, and create meaningful experiences. General recommendations for considering hospice include:
- Cancer diagnosis – when treatment fails to control or cure
- Organ failure – when debilitating symptoms develop
- Neurodegenerative disease – when function significantly declines
- Elderly frailty – when health status spirals downward
- Palliative treatments exhausted – when no further options remain
- Quality of life diminished – when daily living becomes difficult
Of course, the right time is unique for each person and situation. Discussions with doctors and loved ones can help determine when hospice could provide the most benefit. Some tips for discussing hospice with a provider:
- Ask about prognosis and expected disease course
- Discuss goals, values, and acceptable quality of life
- Review benefits and limitations of all options
- Inquire about estimated life expectancy
- Voice concerns and preferences
- Consider trial period to experience hospice
With realistic information from the medical team, patients and families can make informed choices alignment with their wishes. If a terminal prognosis is 6 months or less, earlier integration of hospice often allows for more optimal closure and comfort.
What are typical trajectories in hospice?
Each person’s end-of-life journey on hospice is unique. But patterns emerge among diagnoses that provide general expectations. Typical trajectories include:
Cancer: Long period of stability, followed by steady functional decline in final weeks
Organ Failure: Periods of acute exacerbations and hospitalizations with decline over months
Frailty: Prolonged gradual decline over years punctuated by serious infections
Neuromuscular Disease: Very slow progression over years with intermittent steep declines
Dementia: Years of gradual deterioration with plateaus and eventual death by infection
While these trajectories are common, patients may experience different courses. The hospice team follows the individual’s changing needs and helps families know what to expect. With holistic support focused on relief from suffering, patients can experience the best possible final chapter despite illness.
Conclusion
Hospice care does not intentionally hasten death – its goal is to enhance life. By providing comprehensive comfort care, emotional support, and close monitoring, hospice enables patients to find meaning at life’s end and make the most of their remaining time. While prognosis guides eligibility, the services are tailored to each patient’s unique needs and wishes. With improved quality of life and dignity, some patients even survive longer than expected with hospice support. So while hospice indicates the final phase of life, it can enrich the patient-family experience and add valuable days of comfort and closure. With its specialized care at the bedside, hospice compassionately accompanies people on their last sacred journey.