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FREQUENTLY ASKED QUESTIONS
What is a hospice?
What services does hospice provide?
Why is hospice care important?
Where is hospice care provided?
How is the family involved?
What if the patient lives alone?
Who pays for hospice?
What should I
look for in a hospice?
What about advance directives, proxies and DNR orders?
How
does hospice help after my loved one dies? What is a hospice?
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Hospice is a philosophy and specialized method of caring for people who are at the end of their lives. Hospice strives to meet each patient's unique physical, emotional social and spiritual needs, as well as the needs of the patient's family and close friends. Hospice keeps the patient as comfortable as possible by relieving pain and other distressing symptoms, and preparing for a death that follows the wishes and needs of the patient. Hospice reassures both patient and family by helping them to comprehend and manage the circumstances. This support assists patients and families through the process of facing, understanding and accepting death. |
Hospice
isnt a place. Its a philosophy and |
Many people think that hospice is a specific place, and it can be, but 90% of all hospice patients are cared for in their own homes. In fact, in many cases, it's hospice care that allows them to stay at home, surrounded by the people and things they love. Continuum Hospice Care also treats patients in hospitals, nursing homes and our hospice residences.
What services does Hospice provide?
Since everyone's needs are unique, hospice creates an individualized Plan of Care for each patient. Hospice's interdisciplinary teams physicians, nurses, social workers, counselors, special therapists, clergy and volunteers help our patients and their families with their physical, emotional, social and spiritual needs. A member of the interdisciplinary team is on call 24 hours a day.
In order to meet the many and varied needs of our patients, Continuum Hospice Care offers a lengthy list of distinct services and features that can minimize the stress associated with preparing for death and can maximize our patients' quality of life, including:
- Specially trained hospice physicians treat each patient for pain and other symptoms. Also, the patient's own doctor may consult with our physicians on the patient's disease and, when appropriate, other specialists may be brought in.
- For doctor appointments, we provide transportation to bring our patients to an in-patient unit exam room, so there is very little waiting.
- Nurses are the primary contact for patients. In addition to their medical duties, nurses order and coordinate all services, such as medication, home health aides, supplies, etc.
- A social worker is assigned to each patient and family for counseling and to help them cope. The social worker makes financial assessments and, when necessary, referrals for food stamps, housing, or other services. The social worker also helps the family with funeral arrangements in advance of death.
- In-patient Units (IPU) are available if patients have acute problems, or for caregiver respite (rest) when needed. For example, if the caregiver has to leave town for a few days, the patient stay may in the inpatient unit.
- Home health aides are available, when required, to help with chores of daily living such as meals, bathing, and wound dressing.
- For hospice patients who cannot stay in their homes, but do not require the acute care level of an IPU, The Zicklin Hospice Residence is available.
- Additional services such as nutrition, physical, and speech therapies are provided as needed.
- Volunteers visit for companionship or caregiver respite.
- Art and music therapy are offered in the IPUs and in homes when recommended or requested.
- Chaplains for any denomination provide spiritual support for patients and families.
- All necessary medical services are provided, including pharmacy / medication management, lab tests, radiology and medical supplies and durable medical supplies (hospital bed, wheelchair, etc.)
- Bereavement counseling, support groups, outside referrals if necessary, and quarterly memorial services are available for 13 months after the loved one's death.
- Most importantly, we regard the unique needs of each patient and their family and do our best to fulfill their individual wishes.
In addition, hospice's knowledgeable, caring support teams offer assistance but no pressure to patients who are dealing with troubling social, emotional or spiritual problems and issues. That may mean helping the patient communicate needs to family and friends, put financial matters in order, find spiritual support, or cope with the isolation or fear of dying.
Why is hospice care important?
Far too many people fear and experience death as a time of pain, anxiety and loneliness. Hospice alleviates fear and pain with comfort, knowledge and caring. Hospice focuses on quality of life, thereby turning the end of life into an important time of living, closure, and even growth.
Hospice also helps people attain their wishes for the end of their lives. For example, when interviewed, 75% of people say they want to die at home. Fifty percent of hospice patients are able to fulfill this wish, but only 25% of non-hospice patients end their days in their place of choice. Additionally, only 9% of hospice patients died in a hospital, while 75% of those without hospice care died in an institutional setting, with 15% in the emergency room and 35% in acute care.
Hospice care is so important because each of us has the right to die pain-free and with dignity, and our families should receive the necessary support to allow us to do so. No one should ever have to die alone, scared, and in pain.
Where is hospice care provided?
Hospice care is delivered wherever the patient is: at home, in a nursing home, or in the hospital. About 95% of our patients are able to stay in the familiar surroundings of their homes, cared for by family and friends. Hospice interdisciplinary teams empower the caregivers with information, instruction or practical assistance, as well as medical and nursing care, emotional support, counseling. And, if necessary, a home care aide is available to give the primary caregiver a brief respite and assistance for a couple of hours.
In addition to many nursing homes and hospitals located throughout New York City, Continuum Hospice Care cares for patients in our own units and residences:
Jacob Perlow Hospice
The Mollie and Jack Zicklin Jewish Hospice Residence
Click here for a list of New York City facilities that Continuum Hospice Care serves
Patients may be transferred from home or a nursing home to an inpatient unit for acute care, or when the primary caregiver needs a longer respite. When the crisis has passed, the patient may return home.
How is the family involved?
Since hospice emphasizes keeping our patients at home with loved ones, family support is vital. And, in the spirit of hospice, family is defined as the patient's family of choice, that is, the people most beloved by the patient, regardless of blood relation or marriage.
On a practical level, the Interdisciplinary Hospice Team can instruct and encourage the family in performing caregiving tasks. The family's involvement not only helps the patient feel loved and cared for, it is often fundamental to the patient's ability to stay in his or her home. Further, at such a difficult time, participating in daily caregiving tasks can help the family feel empowered, rather than helpless.
The knowledge that their loved one is getting the best possible care helps family members tremendously. With emotional support and counseling, hospice helps family members understand and manage what is happening. After their loved one's death, hospice stays involved with the family, providing bereavement services for up to 13 months.
What if the patient lives alone?
If a patient lives alone, we will do all we can to help keep the person at home, as long as they can stay there safely. Hospice can assist patients in planning alternatives, if necessary.
Continuum Hospice Care offers The Mollie and Jack Zicklin Jewish Hospice Residence which is an excellent choice for people who cannot remain in their homes.
Our hospice residences care for people in the final stage of life, without regard to faith, race, disease, sexual orientation or ethnic background. Each residence features a home-like environment, specially trained staff and an open visiting policy that includes overnight stays, children and pets.
Who pays for hospice?
There are so many worries when facing the end of life, it is a relief to know that you don't have to worry about paying for hospice. Hospice is available for everyone who needs it, regardless of financial status.
Covered by most private insurers, hospice is a Medicare entitlement. To qualify as Medicare-certified, a hospice must provide:
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For people without private insurance, eligibility for the Medicare Hospice Benefit is simple, with only 3 key requirements:
- The patient's doctor and the hospice medical director certify that the patient's life expectancy is 6 months or less, if the disease runs it normal course;
- The patient chooses hospice care;
- The patient enrolls in a Medicare-approved hospice program. (Continuum Hospice Care is Medicare certified.)
Hospice care also extends to the patient's loved ones, helping them cope with the many problems associated with the end of a loved one's life. The patient's Plan of Care encompasses the family, and services include instructions on caring for the patient; emotional support and, if needed, respite (rest); assistance and companionship from trained volunteers; and bereavement support for both adults and children.
If uninsured and ineligible for Medicare, the costs of hospice will be covered, usually through charitable donations. No one is ever turned away because of inability to pay. (To contribute to Continuum Hospice Care, please click here.)
What about advance directives, proxies and DNR orders?
Made when a person is lucid and mentally competent, advance directives are written instructions that will dictate the course of medical care when that person is no longer able to speak for him- or herself. In the context of hospice, advance directives communicate the patient's wishes about medical treatment if he or she becomes too sick or unable to make these decisions. Advance directives include but are not limited to naming a health care proxy, a consent to a do-not-resuscitate (DNR) order, and a living will .
In New York, it is highly recommended that every person of legal age appoint a Health Care Proxy. Your health care proxy should be someone you trust - for example, a family member or close friend - to make health care decisions for you if you lose the ability to make decisions yourself. Hospitals, doctors and other health care providers must follow your agent's decisions as if they were your own. More information about health proxy assignations may be found at http://www.health.state.ny.us/nysdoh/hospital/healthcareproxy/about.htm .
A Do-Not-Resuscitate (DNR) Order instructs the medical staff not to try to revive you if your breathing or heartbeat stops. This means that doctors, nurses and other health care practitioners will not initiate such emergency procedures as mouth-to-mouth resuscitation, external chest compression, electric shock, insertion of a tube to open your airway, injection of medication into your heart or open chest. In New York, your Health Care Proxy or agent, family member or others close to you can decide about DNR and other treatments if you become unable to do so. A DNR order is not required for hospice eligibility.
Additional Questions
If you have questions about hospice that were not answered here, please call 212.420.3370, or email us at hospicecare@chpnet.org
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