It's not just lay people who have misconceptions about hospice; plenty of doctors do, too. When dealing with end of life situations, some physicians jump into savior mode, rather than quality of life mode. To make the transition, it's necessary to understand exactly what hospice care involves – and what it doesn't. 

 

Hospice is prescribed after the patient's doctor and the hospice medical director certify that the patient has a terminal illness or condition with life expectancy of six months or less if the disease takes its natural course. The hospice team includes the nurse, social worker, spiritual care coordinator, home health aide, volunteer and naturally, the doctors – the attending physician and the hospice medical director. Hospice's primary goal is to improve the quality of life for dying patients through symptom management.

 

The Medicare Hospice Benefit includes non-curative medical and support services for patients, as well as counseling and bereavement services for families. To receive the Medicare benefit, a patient must choose to receive hospice care rather than curative treatments, and be enrolled in a Medicare-approved program. A patient or family member can contact a hospice program to get the process started. Once a qualified healthcare professional determines that a patient is appropriate for referral, then the selected hospice provider can seek a doctor's order. "Physicians usually like to hear from the family or the patient themselves about hospice," explained Anita Lane, GSW, medical social worker with Odyssey HealthCare in Lake Charles. "Some physicians don't want to refer a patient to hospice, because they don't always understand everything about hospice. "It's not their fault – they just haven't been taught."

 

Here are some of the most common myths about hospice care, and the truths about each.

 

False. In the March 2007 issue, the Journal of Pain and Symptom Management reported that hospice patients live on average 29 days longer than non-hospice patients. "Why do hospice patients live longer? Because they are comfortable," Lane opined. "Their symptoms are managed. All of their needs are being met – not just physical, but the psychosocial and spiritual. Patients actually have an increased desire to live, because their quality of life is better."

 

Under some circumstances, patients reach a point where hospice is no longer appropriate.

 

Sometimes, palliative care ceases because a patient decides to seek a second opinion or further treatment for the disease process. Other times, the patient might stabilize. "We've had patients that actually stabilize," reported Tammy LeBouef, RN, BSN, CHPN and patient care manager for Odyssey. "We watch them for a little bit longer to make sure that they are not just stabilizing and will take another dip. We have criteria that we have to meet for every disease process. And, when patients no longer meet that, we have to tell them that they are no longer appropriate for hospice." 

 

In some cases, patients might even improve after starting hospice. "Sometimes our patients get better – simply because they have so many people in there taking care of their needs," Lane reported. "Every once in a while, we get patients where all of their needs are met, and they are no longer appropriate for hospice."

 

False. Hospice patients can eat for as long as they are willing and able. "We don't starve our patients; we don't withhold food or fluids," LeBouef stressed. "What we do is we look at what's going on with the patient."

 

As people approach death, they often start refusing food and liquids – even clamping their mouths shut when offered something to eat or drink. "When patients get to the end of life, truly in the active phase of death, that is when you start looking at not giving them food or fluids," Leboeuf explained, "because they may choke or get fluid overload, and their bodies can't process what is being given to them anymore."

 

It is not the hospice staff that stops the feeding; it is the patient. "It's not a matter of us withholding the food; the body itself lets us know when it doesn't want it," LeBoeuf said. "At the end of life, patients lose their appetite. The body itself knows that it is shutting down. So, the patients will let us know." 

 

False. In fact, hospice provides the drugs related to the disease process and the patient's comfort, such as pain medication, anti-anxiety drugs, and anti-nausea and vomiting drugs. As a last resort, hospice uses morphine for symptom management. "We are not Dr. Kevorkian, by any means," LeBouef emphasized.

 

For in-home patients, hospice provides an "E-kit," or emergency kit, which the families can administer on nights or weekends. "What we look at is trying to simplify medications with the patient's attending physician," LeBouef explained. "Depending on their diagnoses, some medications are given for patients who are expected to live longer, and some of those drugs are not needed at end of life. Hospice is about symptom management – we are trying to not necessarily prolong their lives, but to give them quality of life until the natural death process takes place."

 

Many people do not realize that the hospice benefit also covers medical appliances and supplies, such as electric hospital beds, lifts, bedside toilets, shower chairs, wheelchairs, walkers, diapers, blue pads, wound care supplies, feeding tube supplements, bedpans, urinals, mouth swabs, oxygen – anything necessary for symptom management and patient care in the home. Additionally, hospice includes physician services, nursing care, counseling, home health aide services, social work services, spiritual care, volunteer assistance, bereavement services, and physical therapy, occupational therapy and speech/language pathology services. 

 

Definitely false. Patients do not get morphine until it becomes absolutely necessary to control pain or shortness of breath. "Morphine gets a bad rap," LeBoeuf said. "You give morphine at the last minute."

 

As patients approach death, many develop a high tolerance to the drug so that it becomes necessary to increase the dosage. "Morphine has no ceiling, meaning you can give as much as you need to relieve the symptom that you are working with, whether that's shortness of breath or pain," LeBouef explained. "We start with the smallest dose that we can, and we stay at that dose until the patient needs more to control that symptom. So, morphine is not something to fear. Our goal when we deal with our hospice patient is to control the symptom."

 

False. According to the National Hospice and Palliative Care Organization (NHPCO), cancer victims make up only about half of hospice patients. The remainder is made up of people who have COPD, congestive heart failure, liver disease, kidney disease – any kind of disease process that has reached end stage. Dementia and Alzheimer's patients can also qualify for hospice once they reach the point where they are not walking and cannot hold a lucid conversation. Another category is debility – a state of being weak, feeble or infirm without any particular cause. "When you put patients under debility, you help them with medications for symptom management or whatever you have to help them with," LeBoeuf explained.