What you should know about hospice and end-of-life care
Q. I became aware of hospice when visiting the mother of one of my friends who was terminally ill. The care was compassionate and indispensable. Would you please write something about hospice so your readers will know the importance of this resource? A.N.
A hospice overview: Many think of hospice as a place that can be confusing. Typically, here in Southern California, hospice is not a place but a visiting service. It’s for those who are terminally ill, focusing on symptom management and comfort for the patient. The emphasis is on compassionate care rather than cure based on the belief that each person has the right to die pain-free and with dignity. To be eligible one must decline curative treatments for the terminal illness. A person can still receive care for problems that aren’t part of the terminal illness.
The most common place to receive hospice services is in the patient’s home. Services also occur in hospitals, nursing homes, large and small assisted living homes and other long-term-care facilities. Hospice is available to patients of any age, religion, race or illness. Medicare, Medicaid, most private insurance plans, HMOs and other managed care organizations cover hospice costs.
To be eligible for hospice one must be certified by a physician as having a life expectancy of six months or less after admission. If patients live longer, they can continue to receive services as long as a doctor again documents their eligibility. Patients are free to leave the hospice system at any time.
Hospice takes a team approach made up of individuals who provide expert medical care, pain management and emotional and spiritual support tailored to the patient’s needs and wishes. Support also is provided to the patient’s loved ones. The team includes a physician, nurses, aides, social workers, clergy or other counselors and trained volunteers. They provide comfort while managing symptoms and medications, visiting the patient about two or three times a week for a total of five to ten hours. It is not 24-hour care.
Personal services such as social visits, reading to the patient or limited shopping can be provided by valued hospice volunteers. The bulk of personal care, however, remains the responsibility of the patient and family. Depending on the patient’s needs and the availability of family to help, it may be necessary to hire in-home care or to move to a care facility in the community.
As of January 2022, there were more than 2,800 hospice agencies licensed to operate in California. Check the internet for ones in your community.
Caring House: Here is an example of an innovative home that welcomes hospice services for those who want to live their remaining time in a peaceful, comforting and supportive environment. It’s Caring House, the first non-medical home in Los Angeles County exclusively focusing on end-of-life care, located in Torrance. It opened seven years ago, but the planning began in 2002, when two of the co-founders, Ed and Patty Long, learned about a similar home in upstate New York and realized there was nothing like it in the South Bay.
Since then, nearly 500 residents have lived their final passage at Caring House. Their stay ranges from one day to many months with a 12-day average. Ages have ranged from the early 40s to age 102 with 89 percent over the age of 65.
The non-medical environment is key as is indicated in the language that is used. Patients are residents; Caring House is a home, not a facility, and hospital beds are resident beds. Additionally, staff does not wear uniforms and there are six bedrooms, not just beds. The air is fresh with waifs of freshly baked chocolate chip cookies.
The residents are well cared for by two caregivers per shift, 24/7. They are carefully selected and trained and well acquainted with all aspects of the end-of-life process.
Ritual is important. For example, when individuals become residents, their family selects a heart-shaped stone and the resident’s name goes on it. When that resident passes away, a family member or friend places the stone in a heart-shaped bowl, centered among many other stones with names of those who previously died. The stones are one way that residents are honored during their time at Caring House and honored when they are gone, notes Executive Director Kay Post. She adds, “the stones stay at Caring House so a part of the residents and their family is always there.”
Although Medicare and Medical cover hospice costs, they do not cover the cost for staying at Caring House. As a nonprofit organization, it is supported by the community which is a benefit for those who cannot afford the full cost of care.
Post notes, “I am always relieved when I am told that our residents pass in peace, holding someone’s hand at the end of their life, having their needs taken care of in a way that upholds the highest of human ideals.”
Thank you, A.N. for your good questions. We all should know about hospice services as well as the unique and compassionate environment of Caring House. Stay well and know kindness is everything.
Helen Dennis is a nationally recognized leader on issues of aging and the new retirement with academic, corporate and nonprofit experience. Contact Helen with your questions and comments at Helendenn@gmail.com. Visit Helen at HelenMdennis.com and follow her on facebook.com/SuccessfulAgingCommunity