When is the right time for hospice care?

In my 10 years as a hospice and palliative care physician, the most frequent question I?m asked is: “When is the right time for hospice care?”Patients ask, families ask, even other health care professionals ask. There is no one right-time. In fact, there are many opportunities to open discussions about patients? wishes and even more importantly how the supportive services of hospice can improve quality of life for those living with a serious illness. While each patient?s circumstances are unique, there are signs that may indicate that now is a good time to consider hospice care:u Are your doctor?s visits more frequent and increasingly more difficult to get to?u Is treatment becoming more of a burden than a benefit?u Have you noticed increased pain, nausea or breathing difficulties?u Have you started taking more medication for pain?u Have you had repeat trips to the emergency room or hospital?u Have you had significant, unexplained weight loss?u Have you started spending most of the day in a chair or bed?u Have you fallen several times in the last six months?u Is there a need for more help with bathing, dressing, walking or getting out of bed?u Are you confused or conflicted about the progression of your disease?If you answered “yes” to any of these, it is likely that you or your loved one may benefit from hospice services. Most important, when the goal of treatment begins to shift from curing the illness to providing comfort and focusing on quality of life, it is time to consider hospice.People facing serious illness are often overwhelmed by a multitude of physical, financial, emotional and spiritual concerns that the extra support of hospice services could alleviate. But sometimes a simple call to hospice is delayed because of the misconception that hospice services are for patients who only have a few days left.Research shows that patients on hospice care can live longer, and with better quality of life, than those without hospice. In fact, in the Nov. 13 issue of the Journal of the American Medical Association, a new study reinforced the benefits and value of hospice care – patients receiving hospice care had significantly lower rates of hospitalization, intensive care unit admission, and invasive procedures at the end of life.We hear time and again that patients and families feel relieved and incredibly supported once they have met with a hospice specialist. Knowing that they have a team to back them up, which includes a hospice-trained physician, nurse, hospice aide, social worker, chaplain and volunteer allows the family to focus on living, while the experts help them plan and manage their illness.The best way to assess if it is time for hospice is to talk with a professional. Starting the conversation with a hospice expert early in the diagnosis enables the patient and family to have additional time to understand their options and choose the path that will have the most impact on quality of life. You should also know that you have a choice when choosing a hospice provider and not all hospice providers offer the same quality of services. According to the December 2014 issue of Consumer Reports, there are six features to look for in selecting a good hospice:u Not-for-profit status and 20 or more years of experience.u Hospice-certified nurses and doctors on staff and available 24 hours per day.u Palliative-care consultants who can begin care if you?re not yet ready for hospice.u An inpatient unit, where patients can go if symptoms can?t be managed at home.u Ability to provide care in nursing homes and assisted living residences.u Medicare approval. That way, Medicare will cover services, including equipment and home health aides as needed, plus counseling and grief support for the patient and the family.At Care Dimensions we meet all six of the criteria above and practice a multi-disciplinary approach to providing medical, spiritual, practical and emotional support to patients with advanced illness who have a prognosis of