Hospice Care Guided by Grace, Compassion, and Caring Hearts

Hospice care is a specialized medical support program for individuals whose focus of care is shifting from curative to palliative. There are specific criteria and guidelines to ensure that individuals are appropriate for admission to a hospice program. Once certified for hospice care, the individual served and their loved ones are provided with a circle of support that includes medical management with a focus on comfort care, counseling services, advanced care planning, and spiritual support.

While often used interchangeably, there are a few distinctions between palliative care and hospice. Palliative care in general refers to the goal of care being focused on the quality of life for patients with serious life limiting illnesses. Palliative care can be provided at any stage of the disease, during times of concurrent curative treatments. Hospice care is a type of palliative care, but is a specific program designed for end-of-life care. The focus shifts away from acute hospital care, aggressive treatments, and life-saving measures, and individuals are then guided through the transition to comfort measures, pain management, and emotional support for both the individual served and their loved ones during the end-stage of their illness.

Individuals can qualify for hospice when they are certified, typically by two physicians, to have a prognosis of six months or less.

If an individual on service lives beyond six months, they can continue to receive hospice care as long as their healthcare team agrees they remain eligible based on their condition, and with approval and recertification for services by a hospice physician.

Hospice coverage is provided by Medicare, Medicaid, and most private insurance plans.

Hospice care can be provided in various settings, including the home or long-term care settings such as Independent Living Facilities, Assisted Living Facilities, and long-term care nursing facilities. Hospice care may be provided in an inpatient setting for short periods during times of crisis or to provide a benefit called Respite for caregiver relief.

Yes, hospice provides necessary medical equipment and supplies related to the individual’s condition, such as wheelchairs, hospital beds, oxygen, medical supplies and medications.

Medications prescribed by our hospice medical team can be obtained through pharmacies that partner with Nineveh Hospice. Routine and emergency delivery is offered to decrease the burden on the individual and their support system, and to allow loved ones to remain at the bedside.

While hospice does not cover the cost of a nursing home, we can provide hospice services within nursing homes or other facilities that the patient may reside.

The frequency and duration of nurse visits depend on the patient’s needs. Initially, visits may be more frequent and typically last between 30 minutes to a few hours.

The hospice team is a group of “disciplines” including physicians, nurses, social workers, chaplains, home health aides and trained volunteers, all working together to support your loved one and family.

We encourage individuals and their loved ones to accept all the available disciplines for the full circle of support, however you have the right to request that specific disciplines do not visit, and we will respect your preferences. At minimum, a nurse and a physician must be involved to manage your medical care plan and the nurse must visit at least every 2 weeks.

Volunteers at Nineveh Hospice can assist with companionship, light housekeeping, running errands, or providing respite care for family members. Ask a member of our team for information on available volunteer services.

While many often think hospice provides 24 hours a day, 7 days a week custodial care, or full-time care at home or at a facility, this is rarely the case. Although hospice provides a lot of support, most of the day-to-day care for the individual on hospice is provided by family and friends. However, a person from a hospice care team is available by phone 24/7.

Typically, hospice staff will not stay overnight unless an individual is facing significant difficulties with pain and symptom management that warrants a short period of a benefit called Continuous Care. If after several hours of Continuous Care the individual’s symptoms are felt to be uncontrolled despite all efforts, then a short-term inpatient stay may be warranted for pain and symptom management. If a loved-one is challenged with caregiver fatigue, a benefit called Respite may be available for short-term inpatient care, usually provided at a nursing facility (not more than 5-days at a time) for caregiver relief. Your hospice care team will work with you to ensure that a loved one is available for day-to-day caregiving needs as that is not a service that is provided under the hospice benefit and often prompts additional advanced care planning discussions which the medical social worker can help you navigate.

The hospice program offers 24/7 on-call support. If you have urgent concerns after hours, we are here to take your call. Under certain conditions where there is a symptom management crisis or after several attempts at managing symptoms with on-call support, a clinician will be dispatched to assist in-person for timely and personalized support.

When you begin hospice care, medication and other treatments to cure or control your serious illness are often discontinued. For example, if you are receiving chemotherapy that is meant to treat or cure your cancer, that must end before you can enter hospice care. However, a person in hospice can continue to take medications to treat other conditions or symptoms, for example, high blood pressure. Medication planning and medication discontinuation is a collaborative discussion. Certain medications may be considered unrelated to the terminal condition or non-formulary, meaning not covered under the hospice benefit. You will be informed if that is the case during the full medication review with your nurse and physician.

Typically, the motto is “Call Hospice First,” however there are emergency situations where it may be more appropriate to call 911. It is not required for the individual under the hospice program to be a DNR (Do Not Resuscitate). In these cases, or when facing any other imminent threat, you should call 911 first and then call the hospice agency. For the management of your hospice benefit, it is important to coordinate with the hospice agency as often you will have to formally terminate services in order to resume insurance coverage for acute or inpatient hospital care should you decide to call 911 for emergency medical services.

If hospitalization is necessary, our team will assist with the transfer and coordinate care with the hospital staff. A termination of services may be required in order for your hospital coverage to resume depending on the type of care received in the hospital and whether or not the hospital will allow the hospice agency to continue to provide hospice services while in their facility. Generally, most hospitals prefer to use their own internal hospice agency, and a transfer of service may be required should the individual wish to continue hospice or comfort care while in the hospital.

Infections are treated as a matter of pain and symptom management, though if aggressive IV antibiotic therapy is required for life-sustaining measures, the hospice team and the physician will collaborate to help you determine if a termination of hospice care is the best option so that the individual can receive acute or hospital care for more curative measures. If this situation occurs, the hospice team will be available to evaluate for recertification and resumption of hospice services once acute life-saving or curative treatments have been discontinued.

Generally, blood draws are not considered a comfort measure under hospice services, however there may be exceptions based on individual circumstances. Individuals may continue to use their home blood glucose or coagulation monitoring devices per their wishes.

This will depend on your primary doctor and your wishes at the time of hospice election. The hospice Medical Director often take a more primary role in the management of an individual’s care during the time they are on hospice services, however, many primary care physicians wish to manage care plan orders, including medication management, and others wish to remain informed and involved but will defer to the hospice physicians to take the lead. At time of admission, a team member will ask for your preference in Hospice Attending Physician. If you would elect for your primary physician to manage your hospice care, we will call for approval/acceptance. Either way, the hospice physician team is available for your 24/7 medical management needs as needed and will review your plan of treatment at least every two weeks with the hospice care team.

Most people with advanced dementia cannot communicate clearly, which means they may not be able to share their concerns with their caregivers. Caregivers may find it difficult to provide adequate care at the end of life because of this and other concerns. Hospice care can help with this situation. Hospice — whether used at home or in a medical facility — can provide caregivers and the person with dementia the support they may need near the end of life. Studies show that family members of people with dementia who received hospice report better quality of care and having more of their needs met at the end of life.

You can choose to discontinue hospice care at any time. Our team is here to guide you through the process and discuss your options. You should always contact your hospice team to initiate this process in order to prevent issues with your insurance benefit coverage.

Nineveh Hospice prioritizes comfort and will evaluate interventions on a case-by-case basis, however, depending on the stage of the dying process, IV fluids become more detrimental and cause undesirable fluid build-up which can lead to pain and shortness of breath, and we often recommend avoiding supplemental IV fluids at this time. Due to the structure of the hospice program, nurses are not available to facilitate IV medications and monitoring to the degree that is often necessary for these to be provided safely and generally oral and topical medications are preferred.

At the time of death, the Nineveh Hospice team will provide compassionate support to the family and assist with necessary arrangements. We aim to guide you through this process with care and dignity.