Although hospice service touches millions of lives each year—whether as a patient, a family member, or a caregiver— it’s a topic that many of many of us are uncomfortable talking about… And when we do talk about it, misconceptions abound. Compounded by a lack of easily-accessible resources for patients and their families, these problems can make one of the most challenging times of people’s lives even harder.
Oncologist and Palliative Care Expert Dr. Adil Akhtar is working to fix this. By illuminating the issues surrounding hospice service and correcting the misconceptions that may keep people from seeking it out in the first place, he’s changing the conversation around end-of-life-care.
Patients, in Dr. Akhtar’s view, go to hospice not to die— but to live and enjoy their remaining life, while letting the hospice team take care of their medical problems. And although the individual plan of care is tailored to each hospice patient, the overarching goal of that care is always the same: to improve the quality of life for both the patient and their family.
As the Chief of the Palliative & End of Life Care Division of Michigan Health Professionals, as well as the Director of Inpatient Clinical Operations at Karmanos-McLaren Oakland Cancer Center in Michigan, Dr. Akhtar offers a profoundly patient-focused perspective on hospice care. “Hospice service provides care for the whole patient: physically, emotionally and spiritually,” he explains. “It is a multidisciplinary team approach that takes place around the clock.”
The physician-led team collaborates with primary care physician, who has known the patient over the long term. Crucially, the patient’s family and caretakers must be engaged as well, as they form an integral part of the team.
And while family members are part of the patient’s care team, they also receive care themselves, supported with equal professionalism and compassion throughout all stages of the process. That care continues even after a patient’s passing, through on-going grief counseling and support.
“In my opinion,” Dr. Akhtar says, “hospice care is often not given the consideration and importance it deserves. No one wants their loved ones to spend their last moments in discomfort and distress. Hospice service not only helps to mitigate any unnecessary suffering, it ensures a greater quality of life for our loved ones.”
1. What Exactly Does the Hospice Care Team Do?
It takes a uniquely passionate, empathetic, and dedicated person to care for hospice patients. The interdisciplinary hospice team handles all facets of care, including:
- Manages the patient’s pain and other symptoms
- Supports and assists the patient and family members through the emotional, psychosocial, and spiritual aspects of dying
- Provides medications and medical supplies and equipment
- Instructs the family on how to care for the patient
- Provides grief support and counseling
- Makes short-term inpatient care available when pain or other symptoms become too difficult to manage
- Delivers special services like speech and physical therapy when needed
- Provides grief support and counseling to surviving family and friends
2. Where Does Hospice Care Take Place?
Although the majority of hospice care is usually provided in the patient’s home (including nursing homes and residential facilities, in addition to private residences), end-of-life care may also be provided in free-standing hospice facilities and hospitals.
3. What Kinds of Care Are Available to Medicare Recipients?
Hospice benefits are covered by Medicare. These benefits afford patients four different levels of care:
- Routine Hospice Care (RHC) is the most common level of hospice care. With this type of care, an individual has elected to receive hospice care at their residence.
- General Inpatient Care (GIP) is provided for pain control or other acute symptom management that cannot feasibly be provided in any other setting. GIP begins when other efforts to manage symptoms are not sufficient. GIP can be provided in a Medicare certified hospital, hospice in-patient facility, or nursing facility that has a registered nursing available 24 hours a day to provide direct patient care.
- Continuous Home Care (CHC) is care provided for between 8 and 24 hours a day to manage pain and other acute medical symptoms. CHC services must be predominately nursing care, supplemented with caregiver and hospice aide services and are intended to maintain the terminally ill patient at home during a pain or symptom crisis.
- Inpatient Respite Care (IRC) is available to provide temporary relief to the patient’s primary caregiver. Respite care can be provided in a hospital,hospice facility, or a long-term care facility that has sufficient 24-hour nursing personnel present.