Hospice was originally envisioned to be
a noninstitutional benefit that would
provide end-of-life support for patients and their families. Because hospice
care was primarily designed to be administered in an in-home setting, many people
may not be aware that patients in acute
care facilities can also receive the benefits
of hospice.
Patients who are too frail to go home or
who enter an acute care facility when the
end of life seems imminent can qualify for
hospice services. Medicare provides coverage for hospice, including the cost of the
hospital stay and limited medications.
Hospice not only offers hospice-trained
nursing staff but services for the patient’s
emotional needs, including scheduled visits from case managers, social workers and
bereavement counselors, who extend their
services to the entire family.
“Sometimes, it’s not best to transfer the
patient to a long-term care facility, and it
may not be feasible to send them home.
That’s when extending their stay in an
acute care facility like a hospital might be
the best decision for the patient and his or
her family,” says Dr. Raj Menon, medical
director with Hospice Care of the West and
staff physician with Coastal Communities
Hospital.
Smart Business spoke with Menon about
the benefits of hospice, and when patients
are eligible for in-patient hospice care.
What is general in-patient hospice care?
Traditionally, when a terminally ill patient
was hospitalized and death was imminent,
that patient was discharged, returning
home or to a nursing home or freestanding
hospice unit for end-of-life care.
With in-patient hospice care, we are able
to keep the patient in the acute care environment and extend the hospice continuum of care for 48 to 72 hours until either
death occurs or the patient has a change of
condition that permits his or her transfer to
a long-term care facility.
When is in-patient hospice care appropriate?
If the patient is too frail, either physically or emotionally, to permit transfer to another location, or if the patient doesn’t have
the immediate support of caregivers who
can provide 24-hour care at home, it often
makes sense to keep the patient in the
acute care facility.
Frequently, the patient is initially admitted into emergency and then into the intensive care unit, where he or she is fully evaluated and the prognosis becomes clear. It
isn’t uncommon to see a patient in the end
stages of cancer develop other medical
conditions, like infections, that require hospitalization for treatment. Often, the perception is that patients don’t receive any
treatment for their conditions once they
enter hospice. In this case, we can still
aggressively treat the infection because the
treatment will provide comfort to the
patient and we can do that more effectively using an in-patient setting.
What are the care advantages of in-patient
hospice treatment?
Hospital-based in-patient hospice units
can be part of the comprehensive care of
cancer and other end-stage diseases. The
unit provides continuity of care within the
same care setting. Environmental and psychological adjustments will be minimized
for patients and their families, and the transition of care is smoother from the perspective of health care workers. Not only is
the communication and transfer of medical
information easier when the patient stays
in the same facility, but the same physician
can follow the case, assisted by a hospice-trained nursing staff that is on duty 24
hours a day. Additionally, the medical
director for the hospice can also assume
management of the case.
Patients receive fluids and antibiotics
intravenously if necessary, as well as tube
feedings, pain medications and mild rehabilitation to keep them comfortable. The
family will immediately receive palliative
care, including all of the counseling benefits that are part of the hospice program
and — should their loved one pass away —
they can continue to receive counseling for
a period of 13 months following death.
Are in-patient hospice programs readily
available?
Not all acute care facilities offer in-patient hospice treatment, but if the situation arises where this is the best solution
for a member of your family, you can
request transfer to a facility that offers the
service. You may also request a consultation with a hospice professional to determine where you can find the most convenient acute care facility that offers an in-patient program.
The community benefits having in-patient hospice care as an option because
the patient can be more at ease, and the
family is reassured that the end of life will
occur in a comfortable setting.
DR. RAJ MENON is medical director with Hospice Care of the
West and staff physician with Coastal Communities Hospital.
Reach him at (714) 556-6666.
