When is it Time for Hospice or Palliative Care?

When thinking about a patient, if you answer yes to any of these questions, hospice or AIM palliative care services may be appropriate for that patient.  The earlier a patient is referred to Hospice, the more benefit the patient and his or her family will receive from our services.

Please review the Hospice & AIM admission criteria and feel free to call Hospice if you have questions about a patient’s eligibility.

Have you diagnosed your patient with a serious, life-limiting illness? These include (but are not limited to):

• AIDS
• Alzheimer’s Disease
• Cancer
• Cardiopulmonary Disease
• Cerebral Vascular Accident/Stroke
• Liver Disease
• Neurological Conditions (Dementia, Parkinson’s, MS, ALS, Huntington’s Disease)
• Renal Disease

Has there been a recent change in your patient’s condition? Some examples might include:

• Progressive weight loss
• Several falls in the past six months
• Shortness of breath, even when resting
• Spending most of the day confined to bed or a chair

Has your patient’s needs for medical support increased?

• Is the patient calling or visiting your office more?
• Have you started or increased pain medication for the patient?
• Has the patient visited the ER or been hospitalized three or more times for the same symptoms in the past six months?

Is your patient starting to need more help to perform daily activities? These include:

• Bathing
• Dressing
• Eating
• Walking
• Getting out of bed

Does the patient have a prognosis of six months or less to live if the disease progression runs its normal course?

Your Role as a Primary Provider

Controlling your patient’s pain and managing other symptoms can demand a lot of your time. Hospice of St. Lawrence Valley (HSLV) is here to help you. We are not here to replace you.  Add in the attention your patient’s family members need from you, both for medical information and emotional support, and your time commitment can be daunting.

HSLV is here to help you provide extra support to your patient. When you refer your patient to hospice care, you may choose to maintain your role as attending physician, or you may choose to be the referring or consulting physician. If you prefer the HSLV medical director be the attending physician, you may still request to be updated regularly on your patient’s condition. We respect your established relationship of trust with your patient and we are happy to work alongside you to provide comfort and support to your patient and his or her loved ones.

As the attending or primary physician you will be asked to:

• Review your patient’s hospice medical care plan.
• Review and/or amend the hospice standing orders.
• Receive updated plans of care.
• Participate in telephone consultations with HSLV staff.

You will have an entire team of professionals caring for your patient. They are experienced in managing physical, social, emotional and spiritual pain. A telephone triage team will be available 24 hours a day, seven days a week to meet your patient’s emergency needs. You can rest easy knowing the triage team will expertly assess your patient’s symptoms and dispatch assistance as required.

We look forward to working with you in providing the comfort and compassion your terminally ill patient needs. Thank you for partnering with us.

Discussing Hospice with Your Patient

It is never easy to tell your patient that he or she is terminally ill. Here are suggestions for initiating the discussion of hospice care and offering your patient hope for a higher quality of life.

How to deliver difficult news

When you offer hospice care as part of your discussion, it is also an opportunity to give your patient hope for a higher quality of remaining life. Here are some suggestions for how to initiate the discussion of hospice care:

• Choose a private area where there will be no interruptions. As much as you may want to get this over quickly, you will show more care and concern if you have an unhurried presence.
• Sit down with your patient, family and caregivers. It is always best if the patient is not alone to receive this difficult news.
• Use plain, easy-to-understand language to offer an overview of the patient’s health situation, the diagnosis and its implications. Do not assume your patient or the caregivers will understand everything you say. Check with them as you discuss each aspect and make it easy for them to ask questions.
• Be prepared to repeat information several times if necessary. Allow time to recognize your patient’s and caregivers’ emotional reactions.
• Find out your patient’s, the family’s and caregivers’ specific concerns and address them.
• Without overwhelming the patient and family, provide options such as hospice or palliative care. Assure them that hospice care is not about giving up hope, it is about living, loving and making every day count.
• To the extent possible, offer a general estimate of your patient’s expected length of survival.

How to discuss hospice care and make timely referrals

Through my years as a hospice doctor, I have learned that dying does not have to be agonizing. When people are relatively comfortable and know that they are not going to be abandoned, they frequently find ways to strengthen bonds with people they love and to create moments of profound meaning in their final passage.

Ira Byock, M.D.

Physicians have many reasons why they delay talking about hospice with their patients and their patients’ families. You may share some of their reasons, too.

• Perception that a referral to hospice care is “giving up” on the patient
• Discomfort with dying and death
• A sense of personal failure for not being able to cure your patient or prolong life
• Lack of information about HSLV services
• Uncertainty about the appropriateness of a hospice referral

But there are convincing reasons to talk about hospice care with your patient before there is a medical crisis. Hospice care is most effective when provided over a period of several months. Research published recently in the New England Journal of Medicinefound that “With earlier referral to a hospice program, patients may receive care that results in better management of symptoms, leading to stabilization of their condition and prolonged survival.”

This and other studies indicate that life can be prolonged by 20 to 69 days when palliative and hospice care is offered as soon as it is appropriate. Yet nationally, 50 percent of all patients die within one month of admission into hospice care and a full 20 percent die within the first week of care because referrals come too late in the life journey.

While HSLV is usually able to control the physical pain and suffering of late-referred patients, time limitations constrict the Hospice team’s efforts to provide adequate spiritual and emotional support. For the comfort of your patients and support of their caregivers, we want to encourage you to make your palliative and hospice care referrals as early as appropriate.

Some compelling reasons to introduce hospice care earlier to your patient include:

Pain Management Medical Care — Your patient’s pain management and comfort is HSLV’s primary concern. Our medical professionals stay abreast of the latest in pain management techniques. They are adept at teaching your patient’s family members or caregivers how to administer medication by a variety of means. Most of these pain management medical treatments can be provided in the patient’s home, but should more extensive care be required, HSLV will assist in locating a facility that will meet your patient’s and the family needs.

Emotional and Spiritual Support — Your patient’s hospice care team includes social worker’s and spiritual counselors who will help your patient and the family come to terms with the process of dying. The spiritual counselor will assist your patient in completing some of those important tasks associated with dying, such as saying final good-byes, mending broken relationships, and giving and seeking forgiveness.

Practical Support — The chores of daily living can be overwhelming to the caregiver. Your patient’s hospice team can relieve some of the burden by providing home health aides to assist in the grooming of the patient and to help with household tasks. HSLV volunteers also can perform many functions, including sitting by the bedside, to allow the caregiver an opportunity to take a break from continuous care.

Financial Relief — Most patients in hospice care access the Medicare hospice benefit. This benefit covers medications and equipment related to the terminal illness, visits by medical and nursing professionals, home health aides, short-term inpatient care and bereavement support for the family following your patient’s death. HSLV also accepts Medicaid and private insurance.  When financial resources are not available, no one is ever turned away from services thanks to the generosity of community donors who provide funds to defray the cost of care for uninsured patients.

Bereavement Care — The time after your patient dies can be very difficult for family members and friends. HSLV’s bereavement care staff will follow the family for a full 13 months after your patient’s death. In addition to monthly newsletters sent to the family, HSLV offers short-term, individual grief education and support.

Managing the Myths

There are several misconceptions about hospice care in the medical community. Here are factual responses to five of the most common myths.

As a medical professional, you dedicate your life to curing and healing. Yet there are times when you realize that it’s no longer beneficial to your patient to pursue aggressive curative treatment. That can be a very difficult moment for you. HSLV understands and is here to support you as well as your patient and your patient’s family and friends.

Myth #1: Physicians, nurses, case managers, discharge planners and social workers are held accountable if a patient outlives the six month prognosis.

Fact: It is not uncommon for many hospice patients to exceed their initial prognoses. In fact, a number of patients each year are discharged from Hospice care because they experience a significant level of improvement in their overall health.

It is the responsibility of the HSLV team members to monitor the patient to determine if the patient continues to meet the hospice guidelines for eligibility. Patients may continue with hospice care with no consequence to the referring healthcare professionals.

Myth #2: Patients die sooner with hospice care than without.

Fact: It is HSLV’s philosophy to neither speed up nor slow down the natural dying process. However, it is believed that patients may actually live longer once their pain and suffering are adequately managed. Published studies show that when palliative and hospice care are offered as early as appropriate, patients have prolonged their lives by 20 to 69 days because not only is the quality of their physical life improved through pain management and stabilization of symptoms, but also their emotional and spiritual needs are addressed. We encourage all medical professionals to discuss palliative and hospice care with patients diagnosed with a serious or life-limiting illness, disease or injury and their families or caregivers.

Myth #3: Hospice will only treat symptoms related to the terminal diagnosis.

Fact: HSLV specializes in palliative care. Our services provide care that gives comfort. In order to provide overall comfort, we believe that we must treat illnesses unrelated to the patient’s terminal illness if it will bring the individual relief or increased quality of life. Therefore, illnesses or injuries such as UTI’s, pneumonia or broken bones will receive appropriate attention.

Myth #4: Patients must sign a “Do Not Resuscitate (DNR)” form prior to admission to hospice care.

Fact: Although the majority of hospice patients choose to sign a DNR prior to entry into hospice, this is not a requirement for admission. If a patient or family makes the decision to sign a DNR, the document may be signed at any time. DNR status has no bearing on the care that a patient receives while enrolled in hospice services.

Myth #5: It is complicated to refer a patient to Hospice of St. Lawrence Valley.

Fact: Nothing could be easier! Simply follow these few simple steps:

1. Ask yourself, “Would I be surprised if this patient were still alive a year from now?” If the answer is yes, then talk with your patient about hospice. The Hospice and AIM criteria can help you and your patient make an informed decision.
2. Call Hospice of St. Lawrence Valley at 315-265-3105 or
3. Submit this short form and we will contact your office

That’s it! HSLV will take care of the rest!