When your loved one has been diagnosed with a terminal illness or has suffered an adverse event such as a stroke, it can be very difficult for you and your family to cope with the resulting stress. Coming to terms with a major change in health is a process, whether it is for yourself or a loved one. But oftentimes decisions must be made about this person’s health care immediately before you have had time to think or process. If you are considering hospice in Phoenix as an option, talking to the social workers at Suncrest Home Health and Hospice can help. We can explain how hospice works, whether your loved one qualifies for hospice, and what to do to start the intake process.
Timeline for Hospice
The first and most important qualification to enter hospice in Phoenix is that the patient must have been referred by a physician who has deemed that they have six months or less to live.
Hospice is intended for terminally ill patients. It is not long-term care. For this reason, only those expected to live six months or less are accepted into hospice programs. Patients with diseases such as Parkinson’s, Alzheimer’s and emphysema respiratory diseases may live many years — even decades — with their illness. Sometimes is it possible to care for them at home, but other times it is better to place them in a nursing home. These same patients may eventually enter hospice when their disease progresses to the point that they are expected to live six months or less.
Patients and families often worry about this six-month requirement, however. What happens if the patient lives longer than six months? Will they be forced to leave hospice?
It is very rare for hospice patients to recover from their illness, or even to enter an extended remission. However, if this were to happen, they could be discharged from hospice. What happens more often when a patient lives longer than six months is that the patient is re-examined by a physician who makes a determination as to how long that patient is expected to live from that point. If it is six months or less, they are allowed to remain in hospice for another six months.
Agreement with Hospice Principles
Another key tenet of hospice is that no lifesaving medications will be given, and no lifesaving procedures will be done. The philosophy of hospice is to allow people to die comfortably, on their own terms, without intervention.
The concept of hospice originated with a British nurse who wanted to end the practice of making patients wait until they were in pain to receive another dose of medicine. Her goal was to keep patients comfortable in their last days, weeks, or months. Today, at our Phoenix hospice location, we still practice this philosophy, ensuring patients remain comfortable and pain-free.
At the same time, in keeping with the hospice philosophy of refraining from needlessly prolonging life, we do not give lifesaving drugs or treatments such as dialysis or chemotherapy. In order to enter hospice, the patient has to agree that they do not want such treatments.
Patients are, however, allowed drugs such as antidepressants, anti-anxiety medication, sleep aides, medicines to quell nausea and diarrhea, and medicines to help them breathe easier.
While hospices rarely require patients to have a do-not-resuscitate or do-not-intubate order, in the absence of such an order, we would not perform these procedures in hospice; instead, we would call 911.
Guidelines for Hospice Eligibility
While the final determination for hospice eligibility is made by a physician, it might help Phoenix family members to know what some of the guidelines are that help doctors make their determinations. Some of the most common illnesses in patients in hospice care include:
- Cancer
- Renal failure
- Dementia
- Heart disease
- HIV/AIDS
- Liver disease
- Pulmonary disease
- Neurological disease
- Stroke
- Coma
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Cancer
As unwelcome as a cancer diagnosis is, the truth is that some people beat cancer, or at least live many years with it. For this reason, cancer must be considered to be at an advanced stage to trigger hospice care eligibility. Criteria include diagnosis of a second disease along with cancer such as COPD, a steady and continued decline in health and wellness, weight loss, need for repeated blood transfusions, etc.
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Renal failure
Patients who have renal failure can live for many years on dialysis. However, as their disease progresses, their quality of life may begin to suffer more. Eventually, some patients on dialysis decide to end their lives by refusing dialysis treatments. Depending on their level of kidney function and other factors, patients can live without dialysis for a few days or a few weeks, and some of them choose to do this in hospice care in Phoenix.
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Dementia
On its own, dementia is not a disease; it is a condition that affects patients’ memories. At first, they may be forgetful or confused, but as the disease progresses, they become unable to complete the activities of daily living and eventually cannot swallow food or water. They may suffer from fevers, infections, bedsores, and other uncomfortable conditions. Once patients stop eating and drinking, they usually live a few days to a week.
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Heart disease
Heart disease encompasses many conditions, including congestive heart failure, coronary artery disease, and arrhythmia. Patients diagnosed with heart disease can live many years, especially if they take their medication and implement lifestyle changes. However, eventually, most patients lose their battle with heart disease. If patients are unable to move around without pain or other symptoms of heart attack or if they have another co-existing disease, these are often qualifiers for entering hospice care.
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HIV/AIDS
Since its discovery, HIV/AIDS has gone from an automatic death sentence to a manageable condition. Over the years, newly diagnosed cases have remained steady while deaths have fallen dramatically. Thus, the progression from HIV to full-blown AIDS and eventual death is often due to socioeconomic factors or behavioral choices. Some patients are simply diagnosed too late to benefit from treatment, while others may be lax about taking their medications or unable to afford them. Once AIDS is diagnosed, patients receiving proper health care can live another 10 years or more, while those who do not receive this care often live only two years.
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Liver disease
Liver disease can be the result of an infection such as hepatitis, an inherited condition, or an autoimmune disease. Another common liver disease is cirrhosis, which is the result of alcohol abuse. Some of these conditions can be treated successfully for a period of time, but eventually many liver disease patients will be able to live only with a transplant. Some patients are not good candidates for transplants and others refuse to undergo the procedure. When patients become jaundiced, retain fluid, suffer nausea and pain, or are unable to eat, they are usually eligible for hospice care.
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Pulmonary disease
Some pulmonary diseases such as asthma are easy to manage, while others such as lung cancer, COPD, or emphysema have more serious consequences. Many lung diseases can be treated for a period of time with drugs, surgery, or therapy, but some are eventually fatal. Signs of end-stage pulmonary disease, when hospice is appropriate, include fatigue, confusion, infections, and severe difficulty breathing.
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Neurological disease
There are many neurological diseases that are quite debilitating, yet patients can live for many years with them. These include ALS, Parkinson’s, Alzheimer’s, and strokes. ALS and Parkinson’s cause progressive paralysis, eventually preventing the patient from eating, drinking, and breathing. If your loved one has a neurological disease and has been declining, you may have them evaluated by a physician to see if they are eligible to enter hospice care.
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Coma
Comas are not diseases in themselves but can be the result of a disease, illness, or injury. People who are in a coma are unconscious and cannot eat or drink, so many of them are kept alive by artificial means. People assume that when you “pull the plug,” the patient dies immediately, but this is not always the case. They may live hours, days, or even longer than a week. These patients are often referred to hospice care.
The hospice nurses and other team members at Suncrest Home Health and Hospice of Phoenix hope this overview of eligibility for hospice care was helpful. Ultimately, most criteria have some degree of flexibility, and that is why the final determination is made by a physician.
We understand that having a loved one evaluated for hospice care is a difficult and upsetting time. The team at Suncrest is here to answer any and all of your questions about hospice care in Phoenix.
