American Medical Association Family Medical Guide - American Medical Association [309]
Hospice Programs
Hospice programs are palliative care programs that relieve the symptoms of a dying person, allowing him or her to die as comfortably as possible, surrounded by family and friends, in a secure, homelike environment. A doctor’s authorization is required to place a person in a hospice program. In most cases, a person is eligible for hospice when a doctor has determined that he or she is not expected to live longer than 6 months.
Various types of hospice programs offer different types of care—from basic emotional support to complex medical services. Most hospice programs are Medicare-certified and are licensed and regulated by the state in which they operate. Regardless of the level of care provided, trained professionals work closely with the dying person and his or her loved ones and are available to assist the family 24 hours a day. Some hospice programs may also provide grief counseling for family members after the person has died.
Medicare covers the full cost of Medicare-certified hospice care. Medicaid programs in many states, most private health insurance plans, and some health maintenance organizations and other managed care plans also cover the cost of hospice care. The dying person or his or her family may pay out-of-pocket expenses for hospice care if the person is not eligible for Medicare or Medicaid hospice benefits or if his or her health insurance plan does not cover the cost. Because most hospice programs provide care based on need rather than on a person’s ability to pay, cost is determined on a sliding scale. In some cases, hospice care may be available at no cost to people who have limited resources. Find out about a particular hospice program’s payment policies in advance.
Caring for a Terminally Ill Person at Home
In many cases, palliative care is best provided at home (rather than in a nursing facility or hospital). This is especially true if the caregiving is not excessively demanding or complicated. For people who may require complex care, the family may still want to care for the person at home during the last few weeks of his or her life. In general, hospitals are better equipped to treat people who are acutely ill than people who are terminally ill. At home, a terminally ill person can remain more independent, participate in family life, and avoid feelings of loneliness and isolation.
If a family member plans to care for a terminally ill relative at home, regular visits from the doctor, along with support from other family members and friends, are essential. The family should consider using the services of visiting nurses if they are available in their community. Many hospitals offer palliative services that provide support for people who are caring for a terminally ill person at home.
Controlling Pain
Pain is the most feared symptom associated with terminal illness. Continuous pain over a long period can wear a person down emotionally and physically and undermine his or her ability to cope. Pain control, which is the responsibility of a person’s doctor and caregivers, enhances the quality of the person’s life during the terminal phase of an illness.
Although some families express concern that a terminally ill person will become addicted to pain medication, drug addiction is not a realistic concern in the last few weeks of a person’s life. Cutting back on pain medication can result in inadequate pain relief and needless suffering. Keeping a terminally ill person as pain-free as possible should be the major goal.
Doctors often prescribe long-acting morphine to control the pain of a terminal illness such as cancer. If pain recurs between doses, the doctor may also prescribe a shorter-acting form of the drug or another pain reliever to use between doses of the longer-acting medication. If pain medication is prescribed on an as-needed basis, the medication should be given as soon as the person becomes uncomfortable. It is important to give pain medication on a regular basis to ensure continuous pain relief. Once pain begins