Introduction

The information that has been compiled for your consideration throughout these FAQs has been adapted from materials originally created by the NHPCO – the National Hospice and Palliative Care Organization. The growth of the hospice movement over the past three decades has been the result of a public that has become somewhat better informed about end of live alternatives and services that are available.

Even though more and more individuals are becoming more acquainted with hospice care, there remain many misconceptions. For example recent surveys indicate that 75% of adults in the United States do not realize that hospice care actually can be provided in a patient's home. In addition, 90% of those surveyed also did not understand that hospice care actually can be fully covered through the Medicare program. Despite these misperceptions about hospice generally, these surveys also demonstrate that most Americans strongly want the various end of life services that are offered through hospice programs.

Are there some specific questions that you should ask when considering a hospice program for yourself or a loved one?

The fundamental fact about hospice is that it embraces the philosophy that dying truly is a natural part of life. The hospice philosophy is that death is natural. Hospice is not designed to either hasten or postpone the end of life.

• With this in mind, there are some specific questions that you will want to ask as you do consider the propriety of hospice care for yourself or for someone you love:
• What specific services are provided through the hospice program you are considering?
• What kind of support is available to the family or the caregiver through hospice? Does this include respite care?
• What roles does the attending physician in the hospice program?
• What role does the volunteer play in the hospice program?
• What services are available through hospice to keep a patient as comfortable and as pain free as possible?
• Are services provided after normal working hours hours? How are these after hours services accessed?
• How can short term in patient case be accessed through the hospice program?
• Is it possible to bring hospice services into a nursing home or long-term care facility setting?

How can you pay for hospice care?

The vast majority of people who access hospice care are over the age of 65. Therefore, these individuals are able to pay for hospice care and services through the Medicare program. The Medicare Hospice Benefit covers nearly all aspects of hospice care, leaving very little in the way of out of pocket expenses. Because of the broad coverage offered through the Medicare program, the costs associated with hospice for most patients is nonexistent.

Beyond Medicare for patients that qualify, most private health insurance programs and Medicaid in 45 states (including the State of Texas) covers hospice services.
On a final note, Katy Hospice never turns away a patient because of an inability to pay.

Where does hospice care take place? Where do I have to be to access hospice care?

As mentioned previously, most individuals actually have significant misperceptions about where and how they can access hospice care for themselves and their families. The fact is that in the majority of cases, a patient in a hospice program is cared for in his or her own home or in the home of a family member of another loved one. In addition, hospice services can also be provided in nursing homes, assisted living centers, and hospitals. In short, hospice care can be provided wherever a patient happens to reside.

How does hospice provide services to patients and families?

Hospice care is founded upon a family centered approach to providing comprehensive end of life services. This includes, at a minimum, a team of dedicated doctors, nurses, social workers, counselors and trained hospice volunteers. The team works collaboratively to focus on the needs of a patient at the end of life as well as with family members and other loved ones. The team's efforts are directed at providing physical, psychological and spiritual support and services. The primary goal of hospice care is keep a patient comfortable, pain free and as lucid as possible under the circumstances. In addition, the objective is to keep loved ones as close to patients until the end of life process comes to a natural conclusion.

What types of specific services are provided to hospice patients as a general rule?

The following list describes those services that are available to hospice patients on Medicare. This listing of services is similar to the services that are provided to hospice patients that receive services through a private health insurance plan or through Medicaid. (As mentioned, because Katy Hospice does not turn away a patient because of an inability to pay, these are the services that generally are available to all patients regardless of their inability to pay.)

• Comprehensive physician services that provide for the medical direction of the patient’s care
• Regular home visits made by registered nurses and licensed vocational nurses
• Home health aides and homemakers for a variety of support services including such dressing, bathing and related assistance
• Social work and counseling services
• Medical equipment such as hospital beds and related items
• Medical supplies that are related to the particular hospice diagnosis as well as for symptom control and pain relief
• Medications for symptom control and pain relief
• Volunteer support to assist patients and loved ones on a number of levels
• Physical therapy, speech therapy, occupational therapy, and nutrition
  counseling as is appropriate for patient care and comfort

Does the patient have a roll in deciding what services will be provided through hospice?

Katy Hospice is fully committed to including patients and family members in the decision making process. This includes having the patient and loved ones in the service selection process. Indeed, the right of a patient to decline certain services is also respected as appropriate.

Do volunteers play a role in hospice care?

Yes. Hospice trains volunteers to aid patients and families in a number of ways. For example, hospice volunteers are trained to provide primary caregivers relief by doing such things as helping with household chores. In addition, volunteers provide comfort, caring, conversation and companionship to patients and loved ones alike. Above all, volunteers are great listeners.

Who actually qualifies for hospice care? Is hospice only available to people who have cancer?

There is a fairly common misperception that hospice care is designed only for cancer patients. This is not the case. The fact is that hospice care is designed for any individual that has a life threatening or terminal illness. The definition that is used by funding sources of who qualifies for hospice care – including Medicare, private insurance and so forth – requires a prognosis of six months of less of life if the illness runs its predicted course. The patient and the family (or other loved ones) are considered together as a unit of care.

When should a decision be made about entering a hospice care program? Who should make that decision?

The fact is that a decision can be made at any time during the course of a life limiting illness to consider entering into a hospice program. Legally, the decision rests with the patient. However, friends and family members can be important resources when a patient is contemplating the possibility of entering into a hospice program. Finally, hospice staff members always are available to discuss a patient's options.

Should a person wait for a doctor to recommend the possibility of hospice, or should the patient raise the propriety of hospice first?

You do not have to wait for a doctor to recommend hospice. It is more than appropriate to discuss hospice and hospice care with your doctor, family members, friends, other health care professionals or clergy.

At Katy Hospice we have learned through experience that a physician will normally discuss hospice care when a patient or family member raised the issue. Interestingly, through our community education efforts, the typical family member starts to consider hospice when a doctor brings it up. The bottom line, it is important for doctors, patients and loved ones alike be better educated about hospice and when hospice care is available.

You need to understand that you do not a referral from your doctor to obtain information about hospice care from Katy Hospice or any other hospice program or hospice care provider. If you contact Katy Hospice, we will provide you the basic information that you need. We will also visit with your physician as desired or we can enroll you into the care of one of our own qualified physicians.

What if your doctor doesn't know about hospice care?

The fact is that most doctors today do know at least a little about hospice care. If your doctor would like more information about hospice care, he or she can contact our team at Katy Hospice. Our trained staff can provide educational assistance about hospice and hospice care to your doctor and his or her staff. In addition, more information is available from the Academy of Hospice Physicians, medical societies and state hospice associations. In addition, we have listed helpful Internet resources on our Resource Page at this website. In addition, more information can be obtained from the National Hospice Helpline by calling 800-658-8898.

Is it possible for a hospice patient who shows signs of recovery be returned to a regular and more traditional course of treatment?

Absolutely. If your condition improves or the disease or illness appears to be in remission, you can be discharged from hospice care at any time and returned to a more aggressive therapy. The fact is that at Katy Hospice our team experiences true elation when a patient is able to leave hospice care in favor of more aggressive treatments because of a health improvement. There are plenty of instances in which patients and loved ones have concluded that their health has improved because of the extra care and attention that is provided through the hospice care program.
If a person leaves hospice but later needs to return, the doors at Katy Hospice will be open. In addition, Medicare, Medicaid and most private insurance programs will provide coverage in such instances.

What is involved in the hospice admission process?

The first step in the admissions process at Katy Hospice involves education. In this regard, the team at Katy Hospice meets with the patient and family members to discuss their expectations and the situation that has led to an interest in hospice in the first instance.

The next step in the admissions process at Katy Hospice is contact between out staff and the patient's physician. The purpose of this contact is to determine whether the doctor believes that the time is appropriate for a patient to enter into hospice care. We also do have a medical staff that can assist you in this regard if you do not have a physician or if you want a second opinion.

As part of the admissions process, you will called upon to sign consent forms and other documents. These are similar to the types of forms that a patient will execute when he or she enters into a hospital.

In addition, you will be asked to sign what is known as a hospice election form. This document states that you understand that the care that you will receive through hospice is considered palliative. (This means that you will be receiving care through hospice that is designed to relieve pain and control symptoms as opposed to being curative care.) The form will also outline the services that will be available to you. In addition, if you are a Medicare patient, there will be additional forms to sign relating to Medicare benefits.

We do have a trained professional meet with the patient and his or her family to explain all of the forms that will need to be signed. The entire paperwork process usually takes about an hour. We are more than happy to meet with a patient and his or her family at any location that is more comfortable to the patient and his or her loved ones.

Will you have to obtain any special equipment or make any changes at your home before hospice care can begin?

At Katy Hospice, our team of professionals will make an assessment of what your particular needs are during the admissions process. We will make recommendations to you when it comes to equipment and assist you in making arrangements to obtain any equipment that is deemed necessary for your care. In many instances, the equipment that you might need when you enter hospice care will be minimal. Over time, as your disease or illness becomes worse, you may need more equipment. When all is said and done, Katy Hospice will assist you in any way possible to make home hospice care as convenient, safe, secure and as comfortable as possible.

How many family members or other loved ones does it take to care properly for a patient at home?

The fact is there is no set number of family members or other loved ones that can assist with in home hospice patient care. The reality is a patient actually does not need any family members or other loved ones to assist with their care. Each and every day, the team at Katy Hospice cares for patients who do not have any other caregiver. At Katy Hospice we develop a comprehensive care plan that addresses the amount of actual care giving that will be necessary and appropriate in a particular patient's set of circumstances. In addition, hospice staff are always available to answer medical questions. Moreover, staff and volunteers are always available to provide support on a variety of different levels to the hospice patient.

Must someone be with the hospice patient all of the time?

As a general rule, during the earlier weeks of a patient's care, it normally is not necessary for a patient to have someone with them all of the time. When a patient gets closer to his or her end of life experiences it normally is recommended that someone be with the patient all of the time. One of the biggest fears of a patient in the final stages of life is that of dying alone.

Is it difficult to care for a dying loved one at home?

The reality is that it can be rather hard at times to care for a loved one during the end of life. Understanding this fact, the Katy Hospice staff is available around the clock both to consult with family members and to make night visits as necessary and desired.

As an aside, the Medicare Hospice Benefit provides a primary caregiver up to five days of respite care for every benefit period. Katy Hospice maintains contracts with nursing homes and other types of facilities to assist in allowing the primary caregiver the opportunity for respite care.

Does hospice do anything to speed up the dying process?

No. Hospice takes no steps to either slow down or to speed up the dying process. Hospice care is designed to provide comfort, peace, dignity and companionship during the end of life process.

How does hospice go about providing pain management?

Hospice takes an interdisciplinary team approach to pain management. At Katy Hospice, we understand that physical, emotional and spiritual pain all need to be addressed through compassionate care.

Our professional team of doctors and nurses are up to date on the current and most reliable medications, modalities and devices that can be utilized for pain and symptom relief.

What is the success rate of Katy Hospice in dealing with a patient's pain?

The success rate in dealing with and managing pain is very high. Indeed, most of our patients can be kept pain free and comfortable during the end of life journey.

Will these medications prevent a patient from being able to talk or to understand what is going on?

Normally the medications that we use will not have these negative effects. We strive not only to keep a patient pain free but also alert. We understand the desire of patients and loved ones to be able to communicate during the end of life journey.

Is Katy Hospice associated with a religious organization?

No. Katy Hospice, and the hospice movement generally, is not associated with any religion. We take an ecumenical, spiritual approach to out care giving that is based on the belief system of the patient. At Katy Hospice we honor all belief systems – or lack of belief systems.

If the patient is not covered through Medicare program. Medicaid or through private health insurance, will Katy Hospice provide care?

Katy Hospice will provide care to any patient regardless of their ability to pay.

Does Katy Hospice provide assistance to the family and other loved ones after a patient dies?

Absolutely. Katy Hospice provides ongoing support and contact for family and other loved ones for at least a full year after the passing of a loved one who was in hospice care.