Hospice Care: Quality at the End of Life

Kimberlie Miller, LCSW
Marcus Daly Hospice Services
1200 Westwood Drive
Hamilton, MT 59840

Hospice Care: Quality at the End of Life
The decision to stop curative treatments and enter hospice care is not easy. If the topic arises during the course of your treatment, or that of a loved one, understand that choosing hospice does not mean you are "giving up hope". In fact, utilizing hospice support can offer participants and their family a lifeline by streamlining care, providing relief from symptoms that are interfering with quality of life, and supplying trained professionals that come right to your home.

The word "hospice" is a medieval term that describes a brief resting place on a long and difficult journey. It can conjure up an image of a place such as a "hospice house", but usually hospice services are provided in someone's residence, an assisted living home or skilled nursing facility. Ravalli County is fortunate because Marcus Daly Memorial Hospital also has a 6 bed hospice center which is available to our hospice patients either for respite use or residential stays.

Hospice is a service that is covered under Medicare and Medicaid as well as most private insurance programs. The goals of hospice are not to cure a terminal illness, prolong life or hasten death but to provide end of live comfort care by alleviating pain and discomfort while maintaining dignity. Hospice services can be accessed when a physician attests that in their opinion, the patient is suffering from a terminal condition which will end their life in six months or less (there are a number of specific diagnoses which meet these criteria). The Hospice Medicare/Medicaid Benefit covers the following services when they are related to the terminal illness.

Physician services - Patients are able to see their primary care physician for specific issues that are not related to their terminal diagnosis. The goal of hospice, however, is to decrease the need for regular physician visits so that the patient can remain at home and receive the bulk of their care from the hospice care team.

Nursing - Access to nurses specializing in hospice care 24 hours/day, 7 days/week including weekends and holidays. This availability alleviates the need for emergency department visits for any after hour crises. Nurses provide assessment, routine medical care, case management and education with care and compassion.

Bath aide - Assistance for in-home personal hygiene is another important benefit under Hospice services. Adding the skills of a professional health aide to provide consistent and safe bathing allows hospice patients to maintain their cleanliness with dignity and respect. A bath aide can free up family members from this additional task that can become challenging and emotionally charged. Caregivers consistently praise our bath aide for providing professional and skilled care as well as education for family.

Social Work and Chaplain - Addressing the emotional challenges that come with declining health and impending loss are primary concerns for Social Work and Chaplaincy when working with hospice families. We provide emotional and spiritual support as well as a link to multiple community resources.

This arm of the Hospice Care Team continues to follow families with support up to one year following the patient's death. Grief and bereavement needs are provided through individual and group counseling. Ongoing mailings and periodic phone calls also allow for long term care for family members after the hospice patient has passed away.

Volunteers - MDMH Hospice is blessed to have over 75 volunteers that provide services to patients and their families through a number of activities, both direct and indirect. These volunteers go through extensive training as well as a background check. Volunteers can offer families support by providing breaks for caregivers, running errands, completing household chores, giving massages and many other beneficial services. Volunteers often have the ability to spend consistent time with patients and in addition to bringing support and companionship, they provide an important connection back to the Hospice Care Team. This added insight to our staff members is instrumental in continuity of care.

Medication - Medications that are related to a terminal condition (or their symptoms) are covered under the Hospice Medicare/Medicaid benefit. This includes medication for pain management, anxiety, and other comfort related issues. Releasing the financial burden for these medications can provide peace of mind and reduce the stress of managing refills during this difficult time.

Therapies - If patients may benefit from physical, occupational or speech therapy for comfort related issues, the Hospice Care Plan will include these services. Many times these services are provided for assistance with equipment or caregiver training to ensure patients and family members are safe when moving the patient from one position to another.

Hospice Center/Inpatient care- The MDMH hospice center is a 6 bed facility connected to the hospital where an individual may stay short term for respite care, may be admitted for symptom control as a general inpatient until their condition is stabilized or may become a resident continuously. The facility accommodates multiple friends and family members with extra space for overnighting with the patient, a fully equipped kitchen with dining room for comfort and ease of meal preparation, as well as a living room with a fireplace and lovely courtyard for outdoor reflection or enjoyment.

The Medicare/Medicaid hospice benefit provides payment for respite services for patients who reside in their homes with a non-paid primary caregiver. Those patients may come to the hospice center for 5 consecutive days every 30 days to allow caregivers to have a break from the taxing effects of constant caregiving so they can rejuvenate while knowing their family member/friend is being provided with 24 hour professional care in a comfortable, relaxing atmosphere that is quiet and peaceful.

Some families choose to have their loved one become a resident of the hospice center. When patients are residents at MDMH hospice center (they live there continuously), there is a daily room and board charge comparable to a skilled nursing facility that the family then becomes responsible for paying.

Hospice Team approach - Hospice care through MDMH provides a patient and family-centered approach that includes a complete team of clinical professionals, caregivers and trained volunteers working together to develop a Plan of Care. Our goal is to enhance the quality of life and provide support for the individual and family while respecting their wishes during the terminal phase of the illness and the bereavement period.

If anyone has additional questions or wonder when is the "right time" to consider hospice services, please feel free to contact Kimberlie Miller, LCSW, Marcus Daly Memorial Hospital's Hospice Social Worker. Marcus Daly Memorial Hospital is working together to build a healthy community.