When Is It Time to Call Hospice?
“I wish I had chosen hospice care sooner” is a common sentiment expressed by hospice patients, their families, cuidadores and even physicians and nurse practitioners who refer patients to VITAS.
The concept of timely hospice care is verified by a 2016 study¹, which found that patients who receive hospice care early in the process of a life-limiting illness often improve temporarily, able to experience the benefits of pain relief, symptom management and cuidados de confort to ease anxiety, depression and fatigue.
Hospice care at the optimal time gives patients the gift of time. They can come to terms with their diagnosis, spend time reminiscing, say goodbyes, get their affairs in order and focus on calidad de vida al final de la vida. Optimally timed hospice care also relieves healthcare professionals, caregivers and families of the crises, stress and challenges of increasingly challenging symptoms and situations as a patient declines.
When is it time to call hospice? The following questions can help.
1. Is the patient facing one of these life-limiting diseases or conditions?
The most common disease and conditions associated with hospice care, according to the National Hospice and Palliative Care Organization, are:
- Cancer (28%)
- Cardiac and circulatory diseases (19%)
- Dementia/Alzheimer’s (17%)
- Respiratory diseases (11%)
- Stroke (9%)
Other conditions include end-stage liver and kidney disease, amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) and other degenerative neurological diseases.
2. Is the patient or loved one showing these signs of decline?
The following factors are good indicators that it’s time for hospice:
- A doctor has certified the patient has six months or less to live if the condition/disease follows its normal course
- Curative treatments (medications, chemotherapy, rehab, etc.) are no longer effective or create side effects that prolong suffering, discomfort and pain
- The patient has decided to stop testing, hospitalizations and treatments in favor of palliative care
- The patient is increasingly unable to perform the activities of daily living (personal hygiene, dressing, eating, maintaining continence, transferring)
- Over 4–6 months, the patient has experienced any of these:
- Loss of 10% or more of body weight
- More than 3 hospitalizations or emergency room visits
- Presence of other co-morbid conditions
- Declining physical activity
- Declining mental alertness/cognition
3. Have you taken the patient’s wishes into consideration?
A patient's preferences for end-of-life treatment will be spelled out and easy to follow if they have an advanced care plan (ACP). This includes a living will, durable power of attorney for healthcare, or (in some states) a Five Wishes document. If the patient has made it clear that certain procedures or interventions should or should not be pursued in the face of a life-limiting illness, the hospice team can craft a care plan that honors the patient's wishes while focusing on the quality, not the quantity, of time that remains.
If you have questions about hospice appropriateness, contact the admissions department of a local hospice. The staff should be able to answer questions or send a clinician to evaluate the patient and meet with the family at no cost. Aided by this information, you'll have a better sense of when the time is right for hospice care.
Family members and caregivers: Call 800.723.3233 to ask questions or schedule a VITAS consultation. To start the end-of-life discussion, visit HospiceCanHelp.com and download our free family discussion guide.
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¹Gill, et al. Restricting Symptoms Before and After Admission to Hospice. JAMA. 2016; July, 7-15.