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
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.