Talking About Hospice (Before It Is Needed)

Have you talked to your loved ones about your health care choices? Do they know what type of care you want if you are unable to tell doctors? This is the type of information that you need to share. And when confronting choices for end-of-life, having the conversation now is especially important. This helps make sure your choices are respected, and it helps your loved ones in the middle of a difficult situation.

Advance planning can lead to better end-of-life care and can reduce the need for unwanted and expensive procedures. It can also help surviving family members cope with difficult health care decisions. Several studies on living wills found that relatives who made choices according to their loved one's wishes had significantly less anxiety, stress, and depression. The respondents also indicated they felt that they did the right thing. When patients control their final care decisions, everyone can be more at peace with the process.

Reasons for Making an Advance Care Plan

People of all ages have strong feelings about the type of medical care and life-sustaining treatments that they would (or would not) like to receive, but only 30 percent discuss their wishes with family and friends. About half of adults over 60 have advance care plans. Unfortunately, 72 percent of home health care patients don't have a living will that details their choices regarding life-sustaining treatments. With the variety of procedures available today, it's more important than ever to decide what type of intervention you would want. In Florida, an advance directive is defined as a witnessed statement where the principal describes his or her wishes regarding health care and personal decisions. Some living wills refer to a patient's choices and decisions about getting hospice involved at the earliest stage possible.

What is Hospice Care?

Hospice care can provide pain relief and medical services that can make patients more comfortable in the later stages of a terminal illness. Services are often performed for the patient, but the hospice care might also offer grief counseling and support to help patients and family members say goodbye in a positive way.

Who is Eligible for Hospice Care?

According to the National Hospice and Palliative Care Organization, 1.7 million patients receive hospice service annually. Years ago, cancer patients were the most likely candidates, but now a greater number of patients are receiving care for terminal heart disease, Alzheimer's, and COPD among many other illnesses and diseases.

Hospice Eligibility and Costs

Hospice services are typically available to patients with a life expectancy of six months or less. However, if the patient lives longer, there's no penalty. People of all ages are eligible for care, including children with terminal illnesses and the elderly.

Patients who are over 65 and have a terminal diagnosis with less than six months to live can typically receive Medicare hospice services for free. The coverage is part of original Medicare Part A and the Hospice Care Benefit. Patients may still have to make co-pays for medications and continue paying for other regular nursing home services. Medicare, though, covers most hospice services, except volunteer work and bereavement for family members. In fact, the federal program spends some $15 billion on hospice services annually.

Some individuals who are under age 65 and meet financial requirements can get coverage through Florida Medicaid. Patients under 21 might qualify for benefits through the Children's Health Insurance Program (CHIP).

For those not eligible for the above forms of coverage, most private insurance plans today cover hospice care. Some non-profit hospices use grants, donations, and volunteers to reduce the cost of their services and to help uninsured patients who cannot afford to pay the full amount themselves.

Care Options

About 60 percent of hospice patients receive care for 30 days or less. Nineteen percent of patients receive hospice care for more than 90 days and up to six months (and some longer). These services involve nurses, social workers, end-of-life counselors, and physicians. Hospice can be provided at the patient's home, an assisted living facility, a hospital, or a nursing home.

Physicians Don't Always Bring Up Hospice Care Until the Very End

Even stage 4cancer patients and people who are likely to require palliative care don't always know what their options are. Frequently, doctors fail to start these important discussions; doctors, after all, tend to focus on healing and treatment. To make matters more complicated, many patients don't bring up important concerns in the doctor's office because they don't know where to start or they aren't sure what to ask or because hospice is a difficult topic to confront.

When people hear the word hospice, they often think that the end is imminent, but that's not always the case. Hospice care can last for several months or longer. In addition to improving a patient's comfort, hospice offers an alternative to invasive treatments when those treatments are unlikely to change the outcome or extend the patient's life.

Many people prefer their last several months to be spent without aggressive treatments that will have few benefits. Your preferences regarding hospice care and invasive treatments should be included in an advance directive or living will. These documents can help you. They can inform your family, and they can make your physician aware of your choices so that you have support throughout the process.

Hospice Care and Your Rights

Patients who face acute, terminal, or life-threatening conditions have a right to choose the type of care they would like to receive. Palliative care administered during hospice is intended to alleviate the patient's pain and symptoms rather than cure the disease. It also helps everyone come to terms with a difficult issue that one's life is ending.

Sharing Your Plans

To be effective, you family and your doctors need to be aware of your advance care plan. Follow these tips to make sure that your family knows what you want.

• Talk to your physician about health care options.
• Let your doctor know that you have an advance directive (a living will).
• Make sure that your living will is included in your medical records.
• Distribute photocopies to family members and health care surrogates.
• Tell decision-makers where you keep the original document.

The Next Step

There are many good reasons to have your estate planning attorney prepare an advance directive. You can decide what type of care you want to receive, and you should express your choice. If you change your mind, your plan can always be updated. Confronting difficult issues can help to provide peace of mind. If you're ready to create an advance care plan, call an estate planning attorney.