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.