Only you and your family can know whether it is the right time for a loved one to enter hospice, or even whether entering hospice is the right choice for your loved one. This article will explore the advantages and disadvantages of hospice and what legal arrangements should be made prior to hospice.
What is Hospice Care?
Hospice care is a residential medical service that is intended to maintain a resident’s quality of life and keep them comfortable when they suffer a life-limiting illness, disease, or condition.
Know that the term “hospice” is often used to refer to in-home, part-time end-of-life health care when the patient remains at home or with family and medical professionals visit periodically to administer medication or therapies or to assess the patient’s condition. This article is about residential hospice.
Who is Eligible for Hospice?
The following end-stage diagnoses generally qualify a patient for hospice:
- Acute or chronic renal failure
- Cardiac disease
- Pulmonary disease
- Cerebrovascular accident (CVA) (stroke)
- Amyotrophic lateral sclerosis (ALS)
- Parkinson’s disease
- Multiple sclerosis
- End-stage liver disease
- End-stage AIDS
Whether a disease, illness, or condition is considered “end-stage” is for the patient’s physician to determine, considering whether one or some of the following are present:
- Decreased appetite
- Weight loss
- Increasing weakness or fatigue
- Decline in cognitive status
- Increasing pain
- Increasing difficulty in controlling pain at home
- Increasing dyspnea
- Dependency on oxygen
- Recurring infection
- Increased nausea and vomiting that is difficult to control
A physician also considers the wishes of the patient if the patient is still capable of expressing them. Many people enter hospice not because they are in cognitive decline, but because they decide they no longer want to go to the hospital periodically or they want to discontinue treatment such as dialysis or chemotherapy.
The Advantages of Hospice Care
A Resident Receives Comprehensive Care
The goal of residential hospice care is to provide medical, practical, social, and emotional support to residents near the end of life. All of a resident’s needs are attended to in hospice, inclusive of palliative medical treatment and personal care such as bathing and dressing. The goal is to alleviate the resident’s suffering while managing any disability such as dementia.
Care is Available 24 Hours a Day
Generally speaking, members of a resident’s care team are available around the clock to attend to their needs and address problems or emergencies as they arise. This is meant to ensure that a resident’s quality of life and comfort are maintained to the end.
Medicare, Medicaid, and Private Insurance Usually Covers Costs
Residential hospice care patients must qualify financially for hospice, and most do. Terminally-ill people who do not qualify to enter hospice generally have the financial means to pay for private end-of-life care.
The Disadvantages of Hospice Care
Medical Treatment is Limited
A hospice resident is not expected to improve, and very few do. Because hospice is considered an end-of-life care solution, some diagnostic tests and forms of treatment may not be available to a hospice resident. For example, Medicare only provides a flat rate of payment per day of hospice residence, which disincentivizes the hospice agency from approving expensive diagnostic tests that may not benefit the resident.
Know also that life-prolonging treatment will not be approved for a hospice patient, nor will hospitalization in most cases. It follows that experimental treatments and participation in clinical trials will not be allowed once someone enters hospice.
A patient and family should be fully informed of what procedures and treatments will and will not be available once they are admitted to hospice.
Legal Arrangements to Be Made Prior to Entering Hospice
Gather all of Your Loved One’s Legal Documents
These will include a will, life insurance policy, deeds to real property, titles to vehicles, documents related to bank accounts, investments, and retirement accounts. Having everything in one place will assist the person with power of attorney, called the “agent,” and expedite settling the estate when the time comes.
Establish Power of Attorney
This person will pay your loved one’s bills, make decisions regarding your loved one’s property and possessions while they are in hospice, and enforce your loved one’s decisions regarding end-of-life procedures. They will ensure that your loved one’s finances are in order and pay any life insurance premiums as they come due, avoiding life insurance not paying out for nonpayment of premiums.
“Durable power of attorney” remains in effect after your loved one becomes incapacitated, and is most useful when they enter hospice. In the alternative, while your loved one is still mentally sound, they might establish “springing durable power of attorney” which comes into effect once they become incapacitated. Your loved one might prefer to establish a “healthcare power of attorney” in someone other than the agent managing their financial matters.
Discuss Hospice with Your Loved One
While this can be a difficult conversation, it is important to broach the subject with your loved one then they are in the early stages of a terminal disease, illness, or condition, to ensure that their wishes are honored and that they are comfortable and retain their dignity to the end.
About the Author
Veronica Baxter is a writer, blogger, and legal assistant living and working in the great city of Philadelphia. She frequently works with and writes for Boonswang Law, a national life insurance attorney firm based in Philadelphia.