Is My Patient Ready for Hospice?
Deciding when to refer a patient for hospice care is one of the most important decisions clinicians need to make when caring for a patient who is approaching the end of life. As we counsel patients who are dealing with advanced and progressive chronic illnesses, we are faced with difficult discussions regarding goals of care. The most important aspect of considering hospice is that the decision is made by you and your patient together; making sure that each of you has the same understanding of both your patient’s prognosis as well as your patient’s goals for the remainder of life. Sometimes this conversation is with the person who has been designated as the representative for a patient who cannot speak for himself or herself.
Keeping in mind that every patient has a unique combination of issues that may benefit from referral to hospice, here are some points about the hospice benefit that may help you when considering a referral to hospice:
- Are you ready to certify that your patient has a life expectancy of six months or less, assuming their illness or condition follows a typical course? Another way to ask this question is, “Would I be surprised if my patient died in the next six months?”
- Does your patient understand that hospice care is palliative-for comfort and symptom control-and not curative? And that you will still be their provider?
Hospice care is not just for cancer patients; frequent diagnoses include end stage heart disease and pulmonary disease. Dementia may be the most challenging situation when considering hospice, as prognosis can be very difficult to assess. You may find it helpful to discuss your patient’s condition with our Medical Director or Clinical Director.
Medicare has published clinical guidelines to determine if a patient meets requirements for the Medicare Hospice Benefit. The guidelines cover the typical diagnoses seen in hospice patients, and list a number of specific clinical details for each one. You can access the guidelines by clicking on this link www.medicare.gov
Finally, a very common statement that patients make is, “I wish I had made the decision to choose hospice sooner.”
Please call our Hospice Access Line at 410-822-2724 any time to discuss a patient. The phone is answered 365 days a year, 24/7.
Michael Tooke, MD
Robert Sanchez, MD
Associate Medical Director
Molly Kirsch, RN