Dying With Dignity: A Look at the Advantages of the Medicare Hospice Benefit

Is hospice really a place sick people go and never come back? Once someone goes into hospice, does that mean the family never gets to see him or her again? Isnt hospice some sort of religious practice?The answers to these hospice myths are no, no and no. These are the facts::Hospice is not a place. Those who choose hospice services near the end of life do not go into hospice, but receive services where they live. This could be a private residence, assisted living community or nursing home. Some hospitals have hospice beds; however, the intention of hospice is to deliver hospice services to the patient wherever he/she calls home.Loved ones and relatives are not kept from participating in caring for the hospice patient. In fact, theyre a part of the team. Every patient has an interdisciplinary team that starts with the patient and family: patient, family caregiver, physician, nurse, social worker, chaplain, hospice aid, bereavement specialist, and volunteer. A plan of care is created that family and loved ones carry out at home to the extent they are willing and able.Hospice is not a last resort. When medical treatments can no longer cure a disease, hospice professionals can do many things to control pain, reduce anxiety, offer spiritual and emotional support, and improve quality of life for terminally ill people and their families.Hospice has no religious affiliation. Hospice provides chaplains and other spiritual counselors from all faiths and no faith. They respect all cultures and points of view and are there to lend support and discuss the patients and the familys feelings.Hospice is not just for cancer patients. Certainly cancer patients make up a large number of hospice patients. However, anyone who has a terminal illness, whether its heart disease, COPD, liver disease, kidney failure, stroke, ALS, Alzheimers disease, multiple sclerosis, AIDS or any life-limiting condition, is eligible for hospice care.Hospice care is not expensive. Hospice is usually less expensive than conventional care during the last six months of life. Hospice is an all-inclusive benefit covered by Medicare, Medicaid, Medi-Cal and most private insurance companies. Under Medicare there are no co-pays for physician visits, nursing care, medications, hospice equipment or medical supplies related to the patients primary illness.The patients personal doctor is not excluded. A patients personal physician can choose to be part of the hospice care team. Hospice doctors have extensive training in end-of-life care and will work closely with a patients personal physician to ensure the patient is as comfortable as possible.Hospice does not forego medications or treatments. On the contrary, hospice takes advantage of state-of-the-art medications and palliative treatments to relieve pain and symptoms to keep patients comfortable.Families are not shielded from the hospice patient. Hospice professionals believe that when family membersincluding childrenexperience the dying process in a caring environment, it helps to counteract the fear of their own mortality and the loss of their loved one.Hospice does not mean anyone has failed the patient. Hospice is a mode of medical therapy that may be more appropriate than curative procedures for people with terminal illness. Hospice focuses on symptom management, controlling pain and addressing spiritual, emotional and psychological comfort.Hospice is not about giving up; its about living in comfort and dignity for the time one has left.Hospice does not make death come sooner. The goal of hospice is neither to prolong life nor hasten death, but to make the quality of the patients life the best it can be in their final months, weeks and days. There are no studies that indicate that hospice can hasten death, but there have been studies showing that some patients live longer when receiving hospice services.Hospice is not the same as euthanasia. Death is a natural part of the cycle of life, and hospice neither prolongs life nor hastens death. The goal of hospice is to provide pain control, symptom management and spiritual and emotional support to help seriously ill people live in comfort and dignity until they die. Euthanasia (youth-en-asia) is purposeful mercy killing to end suffering. It is not provided by hospice.A hospice death is not the same as a physician-assisted death. In hospice, a patients terminal disease state is allowed to progress to its natural conclusion. In a physician-assisted death, a physician, at the request of the patient, provides the means for the patient to end life early.Morphine prescribed to a hospice patient does not cause premature death. Hospice physicians are specially trained in the use of morphine and administer only the dose necessary to alleviate a patients pain or help them breathe. When administered correctly, morphine helps terminally ill patients enjoy a better quality of life at the end of life.Hospice may withhold nutrition and/or hydration at some point in the dying process. There are many things to consider when it comes to nutrition and hydration for patients near the end of life. Since the natural progression of a patients disease interferes with the bodys ability to process foods and fluids, it is expected that terminally ill patients will begin to eat and drink less and less.A nasogastric tube (a feeding tube through the nose and throat and into the stomach) or gastrostomy tube (a feeding tube that goes through the abdominal wall and into the stomach) can be put in place to provide nutrients when a patient cannot eat. But these can be painful/uncomfortable medical procedures with potential complications, including infections, electrolyte and mineral imbalances, vomiting and diarrhea.Artificial nutrition and hydration do not usually help the hospice patient feel better, feel stronger or live longer. Most dying patients do not experience hunger. Those who do feel hunger are satisfied with small amounts offered upon request. Hospice physicians are specially trained to know when it is appropriate to intervene with artificial nutrition and hydration support.Contact us at VITAS to learn more.

Hospice Care for Pancreatic Cancer: Providing Comfort in End-Stage DiseaseUnderstanding Pancreatic Cancer ProgressionPancreatic cancer is often diagnosed at an advanced stage due to its subtle symptoms and aggressive nature. Unfortunately, this often leads to a terminal prognosis. The median survival rate for patients with metastatic pancreatic cancer is approximately 3 to 6 months from diagnosis, with overall 5-year survival rates remaining below 10% (Siegel et al., 2024). These statistics highlight the critical need for timely conversations about end-of-life care options, including hospice.The Role of Hospice in Pancreatic Cancer CareHospice care can be introduced when curative treatments are no longer effective, and the goal shifts to comfort and quality of life. For patients with advanced pancreatic cancer, hospice focuses on managing symptoms such as severe pain, digestive issues, and weight loss, which are common as the disease progresses. Hospice teams offer:Pain and Symptom Management: Specialized care to control debilitating pain, nausea, and other distressing symptoms.Emotional and Spiritual Support: Counseling for patients and families to help navigate the emotional complexities of end-of-life care.Coordination of Care: A multidisciplinary team works with medical providers to ensure seamless transitions and comprehensive care.In-Home Support: Care is delivered in the patients home or a familiar setting, allowing them to remain where they feel most comfortable.Impact of Hospice on Quality of LifeStudies show that patients with advanced cancer, including pancreatic cancer, who receive hospice care experience better symptom control and a more dignified end-of-life experience. A report from the National Hospice and Palliative Care Organization found that 85% of families reported high satisfaction with hospice services in the final days of life (NHPCO, 2023).When to Refer to Hospice for Pancreatic CancerEarly hospice referral can significantly improve the quality of life for patients with terminal pancreatic cancer. Medical professionals should consider hospice when patients:Experience uncontrolled pain despite aggressive management.Have lost the ability to perform daily activities.Face recurrent hospitalizations due to disease complications.Hospice care for pancreatic cancer is not about giving upits about prioritizing the comfort and dignity of your patients. To refer a patient or learn more about how we can support your team, contact our hospice team today. Our care coordinators are ready to assist in providing compassionate, expert care for your pancreatic cancer patients.ReferencesNational Hospice and Palliative Care Organization (NHPCO). (2023). Family satisfaction with end-of-life care.Siegel, R. L., Miller, K. D., Fuchs, H. E., & Jemal, A. (2024). Cancer statistics, 2024. CA: A Cancer Journal for Clinicians, 74(1), 7-33.

As a hospice care provider, we understand the complexities and challenges of managing end-stage heart conditions. These advanced stages of heart disease can significantly impact the quality of life, making it essential to consider supportive care options that prioritize comfort and dignity.Common End-Stage Heart ConditionsCongestive Heart Failure (CHF): Advanced CHF often includes symptoms such as persistent fluid retention, severe fatigue, and difficulty breathing, even at rest.Coronary Artery Disease (CAD): When CAD progresses to frequent angina (chest pain) and limitations in daily activity, the condition may be nearing its final stages.Valvular Heart Disease: Severe valve dysfunction leading to heart failure or recurrent infections may indicate the need for advanced care.Cardiomyopathy: End-stage cardiomyopathy can result in arrhythmias, significant heart enlargement, and a decline in heart function.Pulmonary Hypertension: As pulmonary hypertension worsens, it can lead to right-sided heart failure and a marked decline in physical capabilities.Signs It May Be Time for Hospice CareFrequent hospitalizations or emergency room visits for heart-related symptoms.Progressively worsening symptoms, such as shortness of breath, fatigue, or swelling, despite maximum medical therapy.Dependency on assistive devices like oxygen or a ventricular assist device (VAD).Decline in physical function, including the inability to perform daily activities.Presence of co-existing illnesses or significant weight loss (cachexia).According to the Centers for Medicare & Medicaid Services (CMS), patients with heart disease qualify for hospice care if their life expectancy is six months or less, as certified by a physician (CMS, 2022).How Hospice Care HelpsSymptom Management: Hospice provides expert care to alleviate symptoms such as pain, dyspnea, and fatigue.Emotional and Spiritual Support: Patients and families receive guidance and support to navigate the emotional challenges of end-stage heart conditions.Care Coordination: Hospice teams work closely with cardiologists, primary care providers, and family members to ensure continuity of care.Respite Care for Families: Caregiving can be overwhelming; hospice provides temporary relief to family members.Why Hospice is a Win for End-Stage Heart ConditionsQuality Over Quantity: Hospice shifts the focus to quality of life, helping patients find comfort and peace in their remaining days.Reduced Hospitalizations: Studies show that hospice care reduces hospital admissions and emergency department visits for patients with heart failure (Gelfman et al., 2021).Patient and Family Satisfaction: Families often report higher satisfaction with care when hospice is involved, as it addresses physical, emotional, and spiritual needs.Cost-Effective Care: Hospice care can reduce healthcare costs by avoiding unnecessary treatments and hospital stays (Connor, 2021).Statistics to ConsiderNearly 6.2 million adults in the U.S. live with heart failure, and approximately 50% of these individuals will not survive more than five years after diagnosis (American Heart Association, 2021).Hospice care reduces healthcare costs by an average of $9,000 per patient during the last 30 days of life (National Hospice and Palliative Care Organization, 2022).Next StepsIf you or a loved one is living with an advanced heart condition, consider how hospice care can help maintain dignity, comfort, and peace during this challenging time. Our team is here to provide expert care and guidance every step of the way.Contact us today to learn more about hospice services for patients with end-stage heart conditions. Let us help you make the most of every moment. Contact us for details.ReferencesAmerican Heart Association. (2021). Heart disease and stroke statistics2021 update. https://www.heart.orgCenters for Medicare & Medicaid Services. (2022). Hospice care eligibility. https://www.cms.govConnor, S. R. (2021). Hospice cost savings in the U.S.: Evidence and implications. Journal of Palliative Medicine, 24(5), 698-703.Gelfman, L. P., Kavalieratos, D., Teuteberg, W. G., & Lala, A. (2021). Hospice and palliative care for heart failure patients: Evidence and future directions. Journal of Cardiac Failure, 27(7), 888-897.