Hospice Resources

Hospice care focuses on improving the quality of life for individuals coping with a terminal illness and on meeting each patient’s physical, psychosocial, emotional and spiritual needs. Our dedicated hospice teams provide comprehensive care at home, in the hospital or in a rehabilitation or long-term care facility.

When treatment is no longer available, effective or desirable for patients who are expected to live six months or less, although the right time for this care is highly variable and depends on when the patient and family are ready.

Although not required, a hospice representative can be readily available to help introduce our hospice care program, discuss the benefits and answer any questions from qualifying patients and their families.

Hospice takes a holistic approach to provide an appropriate level of care, compassion and comfort in a soothing setting for the patient and his/her family. Hospice does not shorten a patient’s life or hasten death but focuses on managing symptoms and allowing patients to live out the highest quality of life while the illness runs its course.

Can an independent attending physician who is not a hospice employee or does not receive compensation from the providing hospice for the same services bill for services related to the hospice diagnosis?

An independent attending physician, designated by the patient as attending M.D., who is not a hospice employee or does not receive compensation from the providing hospice for the same services, may furnish and bill for services related to the hospice diagnosis (modifier RV).

When an attending physician furnishes a terminal illness-related service that includes both a professional and technical component, only the professional component of the service should be billed to Medicare. The technical component is the responsibility of the providing hospice (e.g., X-rays).

Professional services unrelated to the patient's terminal diagnosis should be billed to Medicare by the rendering provider (modifier GW).

To qualify for the hospice general inpatient benefit (hospice inpatient-in-hospital), the patient must require an intensity of care directed towards pain control and symptom management that cannot be managed in any other setting.

Caregiver breakdown is the loss of an individual’s support structure. It should not be confused with the coverage requirements for medically reasonable and necessary care for pain and symptom management that cannot be managed in any other setting. Therefore, caregiver breakdown does not qualify the patient for general inpatient care (hospice inpatient-in hospital) unless the above coverage requirements for this level of care are met.

Hospice professionals provide 24-hour on-call triage and intervention for patients and families, reducing office calls for non-emergent reasons.

After the patient has been informed about the hospice program and acknowledges this course of treatment, a hospice evaluation and treatment order can be placed through Epic- CON802018.

Hospice is the philosophy of care that focuses on improving the quality of life for individuals coping with a terminal illness.

While the hospice philosophy affirms life, it accepts death as the final stage of life. In this way, hospice care treats the person and symptoms of his or her disease, rather than aiming to treat the disease itself.

Our comprehensive hospice program offers a full spectrum of services.

We address every facet of end-of-life care, including a compassionate team approach that addresses your physical, emotional and spiritual needs.

If your regular physician is agreeable, he or she can be involved in your hospice care as the attending physician.

Our hospice physician medical director will work with your doctor to oversee care.

We can provide hospice care in a home, hospital, long-term care or assisted-living facility.

Our care can be provided in various different settings, including:

• At home
• At a hospital
• Long term care facilities
• Assisted living facilities

Our hospice care is provided by an experienced interdisciplinary team led by a board-certified physician who supervises all medical care

The hospice care team includes:

• Physicians
• Registered Nurses and Certified Home Health Aides
• Counselors who address a full range of psychosocial needs from diagnosis through bereavement
• Clergy for spiritual support of all faiths
• Physical, Occupational, Speech and Nutritional Therapists
• Trained Volunteers who provide support and practical assistance to patients and families

Our team provides different levels of care based on your family’s unique needs.

• Routine: provided in the home, skilled nursing facility or assisted living facility
• Respite: provided in a skilled nursing facility, caregivers can receive up to 5 days of short-term relief
• Inpatient: a short-term, comprehensive level of care provided in a hospital or skilled nursing facility for complex symptom management
• Continuous Care: provided in the home or assisted living facility during a critical or prolonged period, addressing the unique needs of the patients

We provide resources, instructions and guidance to caregivers.

For example:

• Medical care
• Pain and symptom management
• Nutrition
• Home health aide assistance with personal care of patients
• Counseling and pastoral care
• Medical equipment, supplies and medications related to patient care
• Occupational, physical and speech therapy
• Trained volunteers

We also provide support groups and programs to help you and your family cope with the effects of a life-shortening illness and loss.

Trained counselors facilitate ongoing programs for both children and adults, such as:

• Support groups, including programs for coping with cancer, terminal illness, spousal, non-spousal and children’s bereavement
• Educational seminars related to caregiving and the grieving process
• Memorial services to honor loved ones
• Seasonal and holiday forums and gatherings

It can be difficult to determine if hospice care might be the best choice for a patient. Those with specific diagnoses can utilize the following guidelines to decide if hospice care is right for them.

SEPSIS
Hospice-eligible but not previously identified

1. Cancer, solid tumor and hematologic
2. Advanced cardiac disease
3. Advanced lung disease
4. Dementia
5. Eligibility at hospital discharge

OR: 

Pre-hospital functional ability

1. Physical impairment
   1. 1 of 6 ADLs or 1 of 5 IADLs
2. Cognitive status
   1. Any degree of dementia

ALZHEIMER'S DISEASE AND OTHER DEMENTIAS
Consider hospice if patient meets both:

1. Dependent in 3/6 ADLs
2. One of these complications:
   1. Pneumonia
   2. Recurrent UTI
   3. Sepsis
   4. Weight loss 10%
   5. Two Stage 3 or 4 pressure ulcers
   6. Hip fracture
   7. Swallowing difficulty
   8. Feeding tube decision
   9. Delirium

LUNG DISEASE
Consider hospice if patient meets both:

1. Dyspnea at rest and/or minimal exertion while on oxygen therapy
2. One of these progressions:
   1. Frequent ED visits and/or hospitalizations
   2. Cor pulmonale

CANCER
Consider hospice if patient meets both:

1. Spends 50% of time in bed or chair during waking hours
2. No longer pursuing chemotherapy and/or immunotherapy

HEART DISEASE
Consider hospice if patient meets all:

1. NYHA Class III or IV (fatigue, angina, or dyspnea at rest and/or with minimal exertion)
2. Multiple ED visits and hospitalizations
3. Not a surgical candidate

LIVER DISEASE 
Consider hospice if patient meets both:

1. NR > 1.5 and serum albumin < 2.5 g/dL
2. One of these complications:
   1. Recurrent ascites
   2. Spontaneous bacterial peritonitis (SBP)
   3. Hepatic encephalopathy
   4. Variceal bleed
   5. Weight loss 10%
   6. HRS

The hospice talk is difficult but necessary, and timeliness matters. Although these conversations are tough on all parties, studies show that patients want to discuss end-of-life care with their physician, and the majority think physicians should introduce the topic.

It’s best to begin discussing end-of-life options with the patient early on – even at the time of the initial diagnosis, if possible. Early discussions on this topic provide the opportunity to elicit the patient’s overall thoughts about end-of-life care. Talking about end-of-life care early and candidly makes the idea easier to digest and ultimately enables the patient to make an informed choice.

“We can’t predict exactly what kind of medical treatment you may need at the end of your life, should your disease progress to a terminal stage. I need to know your thoughts about what type of medical care you would like to receive in that situation. How do you want to spend your last days, weeks, and months?”

Additional probing questions may be necessary to clarify the patient’s end-of-life wishes. Don’t be afraid to go a bit deeper with them.

“You said that you don’t want to suffer. What type of suffering do you want to avoid?”

“You said that you don’t want to be a burden to your family. What would you consider to be a burden?”

While you can elicit the patient’s general thoughts about end-of-life care in these initial discussions, the first conversation should not be the last. Your patients’ preferences may change over time, and they may not. Discussing hypothetical scenarios early on is an effective way to initiate end-of-life conversations, but necessary decisions must be made as the situation arises. That’s why maintaining open communication is key to allowing physicians, patients, and families to respond to changing medical and psychosocial needs.

The preferences of terminally ill patients trend toward less aggressive care as their illnesses progress. Most patients believe that, at some point, life-prolonging interventions should be limited. We can support this important notion by asking:

“Are there any treatments that you might not want to receive? Are there any circumstances in which you believe life-prolonging treatment would not be desirable?“

A supportive physician-patient relationship provides a crucial foundation for end-of-life care. Patients and families speak more openly and are more trusting when they feel their doctor’s empathy and compassion.

There is a natural tendency to downplay bad news – even the seriousness of a patient’s condition. When no viable therapeutic options remain, it’s critical to acknowledge this with directness and compassion. There must be no chance for misinterpretation.

When terminal patients are not fully aware of their prognosis, they tend to overestimate their survival, influencing their preferences regarding medical treatment.

“The treatments that helped you in the past are no longer working, and your condition is getting worse. Most people at this stage of the disease can expect to live another 6-12 months. But that is the average patient, and I cannot predict precisely how you will fare. I certainly hope that you will do better than average, but it is also possible that you may do worse.“

Patients and families may need repeated explanations to comprehend fully. As with all medical discussions, use straightforward language and avoid technical wording. During times of high anxiety, concentration and comprehension may be limited. It may be helpful to ask:

“I want to be sure that I have clearly explained your medical situation. Can you give me your understanding of what is ahead for you?“

It’s important to remember that although physicians attend the experience of death many times, a family goes through it only once with a loved one. Patients and families need time to reflect, to feel confident they are making the best choices. During this challenging time, patients and families may harbor seemingly irrational hopes for an improbable reversal. Supportive, unpressured end-of-life conversations increase the likelihood that sensible and humane decisions are ultimately made.

Once a patient and family acknowledge that death is approaching, the physician’s role is to facilitate an open discussion about desired medical care and remaining life goals.

“As your doctor, I want to ensure we never do anything that either can’t help you or you wouldn’t want. So, I need to know what things are most important to you, given your illness. How do you want to spend your remaining time?“

As death nears, most patients share similar goals: maximize time with family and friends, avoid hospitalization and unnecessary procedures, maintain functionality, and minimize pain. Earlier discussions about general desires need to be revisited, as the immediacy of a worsening illness may modify one’s feelings and thoughts.

“A few months ago, we spoke about what kind of care you would want if you became very ill, and you said you wanted to be admitted to hospice care. We’re now facing that situation. I want to know if your thoughts are the same or if they have changed in any way.“

Providing quality end-of-life care requires understanding how patients and families experience the dying process and a sensitive communication style. With these skills, physicians can conduct thoughtful discussions in which most decisions evolve comfortably.

Caring for a dying patient is not easy, but it can be a meaningful and gratifying experience for the physician. To help someone die in comfort, in peace, and with dignity is to give one final gift of life.

To view resources that can help clinicians and patients with advance care planning, please click here.