When Do You Call Hospice?

Your elderly parent has been back and forth to the hospital and emergency room. They seem weaker and more dependent after each hospital stay. They are losing weight and needing more help at home. You are wondering about hospice care but reluctant to mention it. It feels to you like you are “giving up on them.” You feel even worse when her doctor says “but she is not dying.” What should you do?
Losing weight and increasing dependency in an elderly person are significant signs of decline. Weight loss can be caused by medications, depression or disease. Presumably these causes are investigated during the visits to the hospital. If treatment was not successful then their weight loss and functional decline become an indication that they are likely approaching the final months of life.
Below are some interesting facts to consider:
1) Ironically, research shows that all elderly patients lose weight while in the hospital. Elderly patients who have dementia lose both weight and their “thinking” also declines. Research shows that after discharge home they do not re-gain weight or re-gain cognitive function.
2) With all elderly patients at some point there will need to be a change in their goals for care. When recovery is no longer possible, undergoing treatments that no longer provide benefit will create suffering. It is an equally valid goal to have a peaceful and comfortable death. This is often readily embraced by the elderly patient who has suffered with decline.
3) Families are often shocked when a well-meaning nurse suggests hospice care for their parent. People think of hospice care as care for patients with cancer or other aggressive diseases. The fact is that more than 65% of the patients cared for by hospice have non-cancer diagnoses. The top four diagnoses are heart disease, debility, dementia and lung disease.
4) Patients who are losing weight and growing weaker can be admitted to hospice under the diagnosis of “debility.” Some of the criteria for “debility” include ten percent loss of weight within 6 months, hospital stays or emergency room visits, infections or trouble swallowing. Patients can be admitted to hospice with some and not all of the criteria.
5) If your parent’s doctor says “no” to hospice care, you still have legal rights. The Medicare Hospice Benefit is an entitlement under Medicare; you can read more about that on the Medicare website. You can call your local hospice and ask them to send a nurse who will evaluate your parent for hospice care. The hospice can then call your doctor to help him/her understand how they qualify.
6) One surprising fact about hospice is that there is now research to support that patients actually can live longer as a result of receiving hospice services. It is not uncommon for patients to improve and subsequently be discharged from hospice. Controlling a patient’s pain and meeting their emotional and spiritual needs can result in improvement.
Hospice has a good track record of meeting the needs of both patients and families. The National Hospice and Palliative Care Organization states that 75% of the families who used hospice for their loved one, rated the care as “excellent.” The involvement of hospice will reduce your guilt and anxiety and help your family to develop a plan that will assure comfort in those final months.

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