At what point does a person go to hospice care?

Question

My father's stomach cancer has metastasized into his brain, and all over his abdomen. Doctor had sent him home telling us there is not much they can do at this point, and they will admit him to hospice care when he started to feel pain. He feels some pain, but not bad now. How do we know to admit him to the hospice care? What should we watch out for?

Answer 1

When I read your story I was reminded of what I wondered about a few years ago when my Dad and family was going through the same thing. My Dad had stomach cancer that spread. First off, he can stay at home as long as possible unless he needs medical care like hydrating or transfusions. Even when my Dad had intense pain he was still at home being managed with specialists. He only went into the hospital when he was anemic and dehydrated since eating was getting harder and harder to do. What I would suggest is a pain specialist. Most doctors are not trained well on pain management and there is no reason in this day and age that anyone should have an inordinate amount of pain during the last stage of their cancer with all of the new drugs available. From someone who had to make the call, you will know instinctively when the time is right. It was one of the hardest things I have had to ever do. A good hospice care will come to your home and go over options and expectations. Such as a DNR order (do not rescutitate), what the family needs, any questions and a contact number day or night that gives you direct access to assistance if you need it. We kept him at home as long as possible but realised that his care was a 24 hour medical necessity that we could not provide. This is from a large family and a Mom who was a nurse for over 40 years. We rotated shifts and did everything we could. Once hospice care becomes necessary, while you will struggle with guilty feelings in hindsight it also helped the family because we were no longer responsible for such whole caregiving and instead of "keeping busy" it gave us a chance to just be his family. The greatest gift was realising that a good hospice is not just for the patient but for the whole family and your needs will be met even after his death. I will keep you all in our prayers and I wish you an abundance of strength and love. God Bless, Katherine

Answer 2

First of all i am very sorry to hear about your father. My grandfather also died to Cancer 14 years ago and we used Hospice for him. Since then me and my family have been having a hospice benifit party for Hospice. This past March we donated $5,000. Over the last 13 years we have raised $75,000. I also am a volenteer for Hospice so i know a lot about it.
Hospice is avalible for only Terminaly ill patients and useually with-in the last 12-6 mo. of their life. They have so many uses, Hospice is a great program. They do a lot with pain managment and also making sure that the family and patient are ready for everything. They help with grief councilling to arrangments of the funeral and burial. The best part is they are always there when you need it. Someone will come by everyday and stay for as long as you need. If you need someone there 24hrs a day they are there for that.
Medicare and Medi-cade (not sure what u have for health plans) does pick up a portion of Hospice. There is also a way where if you have none of the plans that cover Hospice they are very willing to help your family out financialy.
Hospice is a program that is very close to my heart and i know that once you decide to have Hospice it will make a big differance in you and your fathers life (and Family) I do hope this helps some in your time of need. God Bless you and your family!!!

Answer 3

Hospice is a very good organization over all. I've worked in the medical field for a good part of 10+ years. You can call and talk with the hospice intake worker and they will give you a very good idea as to what their particular organization can provide for you and your family as well as what the goals are in hospice care. They have a very good infastructure such as volunteers and social workers to boot. The purpose of hospice is to help a person have control over their death. What I have observed over the years is that the family doesn't completely understand that the entire purpose for hospice is so that the patient can be in the comfort of their home and recieve end of life care. Many family members misunderstand and think hospice is there to provide alternate care like visiting nurses. Although they do perform some of the same functions. It is completely different. It is not rehabilitative care. Please enlighten the members of your family because ppl tend to get upset when Uncle Bob is not revived. I think you should go ahead and admit him to hospice. The earlier they are involved, the easier it is on the family and the better relationship you can build with your hospice provider.

Answer 4

I'm sorry to hear about your father. We went through this with my grandfather a couple of years ago so I know what you are going through and about to go through.

Hospice will put him on drugs that help control the pain, but also impact his other abilities. They can make him halucinate and impair his ability to function..in short...dope him up. So my guess is that if the pain is bearable, they are probably trying to delay giving these drugs because of their impact.

At first, the dosages that they give him will not have serious impact to him. As the pain increases and increased dosages of the drugs are needed, the patient becomes less able to function. They can't drive for instance. They halucinate. Their waking and sleeping hours get confused.

My grandfather would get up in the middle of the night and walk around. My grandmother got little sleep because she was always chasing him and trying to bring him back to bed. In his diminished state of being due to the drugs, she was afraid he would walk out of the house and get lost or fall down stairs. Conversations begin to make little sense.

Hospice did a great job of preparing us for the different stages and telling us what came next. The people that helped with my grandfather from hospice even were nice enough to attend his wake. They were good people.

If you want to have any serious talks with your father...about how much your appreciated him....financial talks....whatever...you should do so earlier in the process rather than later. Because of the drugs, I feel like I lost my grandfather a few weeks before he died. He wasn't able to communicate after a certain point and make sense.

Sorry for your situation. Good luck.

Answer 5

Generally, Hospice care is for patients that you and your doctor feel are so gravely ill, that they can no longer take care of themselves, and they may be nearing their death.

Sit down and not only talk with your doctor for his honest opinion from a medical stand point, but also sit down with your family members to see if all of you are on the same page.

Watching a family member suffer is one of the hardest things you will have to experience. Make sure your father is comfortable and not in pain. Enjoy each day and moment you have with him. And remember that he most likely had a good life. Tell him each day how much you love him.

God bless you, your father, and your family.
My thoughts and prayers go out to you.

Answer 6

My mother died of brain cancer and we had hospice come to us. My father, brother and I were her primary caregivers and the hospice nurses and volunteers came to the house to give medicines or take care of her each day. It was really great to have her at home with us in her own room. It got hard near the end, but it was worth it. I don't know if you all have this option, but consider having hospice come to you.

You can also call the National Cancer Institute (if you are in the US) and they will give you all the info you need. They sent me free info in the mail and the person on the phone was really nice and helpful. You can call

1-800-4-CANCER

or got to http://www.cancer.gov/.

Here is a page that lists different hospice organizations. You'll have to see which one serves your area:

http://www.cancer.gov/cancertopics/factsheet/support/hospice

Good luck to you and your family. You'll be in my prayers. :)

Answer 7

Call the Hospice itself, and they will give you the admitting guidelines. Usually a terminal diagnosis with approx 6 months is what they require. It varies. Talk to a nurse there about your concerns. Hospice will control his pain, and make him comfortable. They do not treat the cancer. Best wishes to you and your family.

Answer 8

I can only imagine what you are feeling right now. My grandmother died of stomach cancer, but very quickly.

I've included an article I wrote recently about choosing hospice care. (I work at a senior care company called Gilbert Guide, and I urge you to read some of the info on our site)

First, plug this link into your browser. It will tell you all about hospice care, how to pay for it, etc.

http://www.gilbertguide.com/senior-care-101/senior-care-categories/palliative-hospice-care.php

And, here's the article:

How to Choose Hospice Care

Determining the appropriate hospice care you or a loved one requires at end-of-life may seem like a daunting task to take on during an already difficult time. In a recent blog describing hospice and palliative care, I’ve received many responses from readers who want to know how to choose a hospice program that is right for them. Many of these readers have shared their experiences with me on hospice care—some good, and others bad. Gilbert Guide lists hospice services that meet our strict standards and criteria in the following territories: San Francisco Bay Area and East Bay in California; Dallas-Fort Worth; New York City; with Pennsylvania and Los Angeles soon to follow. If we haven’t yet reviewed the long-term care facilities in your territory, which simplifies the searching process for you, I’ve compiled some tips from industry experts to help take the guesswork out of choosing a hospice.

One of the first things to remember when beginning your search for hospice care is to realize hospices are first and foremost a business, and while a well-intended business, they want yours. That said, it’s important to ask questions and get answers before committing to anything. Differences between hospices are often hard to determine as they tend to provide similar services. While memberships in state hospice organizations and The National Hospice and Palliative Care Organization (NHPCO) may sound impressive, these are available to any hospice. What does matter is that a hospice is Medicare certified, as Medicare provides the baseline requirements for quality care. To qualify for Medicare certification, hospices must offer 16 separate core and auxiliary services. Core services include bereavement counseling, nutritional services and doctor services. Continuous homecare, physical therapy, medication administration and household services are all examples of auxiliary services. Also important is whether a hospice will accept your insurance.

The Hospice Blog offers some great advice and tips that will help streamline the search process for you. First, find out who owns the hospice agency you are considering, and what the owner’s background is. Is the hospice service nonprofit, for profit or government operated? The type of ownership may influence the services a hospice patient receives. And talk to the administrator when contacting a hospice. Let’s face it, the administrator has the authority to say yes or no to anything the hospice office assistant or hospice employer has promised you. If you’ve found a hospice that meets your needs, make sure it is the home office, rather than a branch. Generally, the nurse who resides at the home office has access to the person in charge. Branch offices usually do not have employees who make financial or business decisions. Finally, before choosing a hospice, find out where the on-call nurse lives. If the nurse lives far away from the patient requiring hospice care, the response time will take longer.

Below are some resources that might be helpful in locating a hospice in your area:

Physicians and nurses

Friends who have had experience with hospice care

Clergy, social workers and counselors

Medical Internet sites

The Yellow Pages

NHPCO help line [phone]
After you’ve compiled a shortlist of hospices, it’s important to interview each one to determine if a particular hospice meets your needs. Compile a list of questions to ask the hospice administrator. Here are some questions to get you started.


How long has the hospice in existence?

What services does the hospice program provide?

How often will a nurse or other hospice staff visit?

Who owns the hospice?

Does the hospice have any accreditation?

What quality standards does the hospice meet?

How are home caregivers trained?
It is my sincere hope that this information will be useful in your search for quality hospice care in your area. Hospice is about affirming life. It exists to support people with an incurable illness and their families.

If I can be of further assistance to your and your father on this journey, please let me know.

Ami Icanberry
www.gilbertguide.com

Answer 9

You can call and talk to hospice and ask those questions. You might also be able to keep your father at home instead of placing him in a hospice center, they can come treat him at home. I'm so sorry to hear about your father and I pray for your's, your family's, and his peace and comfort.

Answer 10

hospice is practically there to help the person and family be at ease with death. Look up a local hospice or call your hospital and have them refer you to a hospice.