Questions to Ask When Choosing a Hospice Provider

Facing the realities of a terminal illness is one of the most emotionally challenging experiences for any family. In these moments, finding compassionate, professional support is essential. Hospice care in Denver offers a vital service that focuses on comfort, dignity, and quality of life for individuals with life-limiting conditions.This guide is designed to help families in the Denver area better understand what hospice is, how it works, and how to access local, high-quality services. Whether you're just beginning to explore options or planning ahead, this resource will help you make informed, compassionate decisions. What Is Hospice?Hospice care is specialized care designed for individuals who are facing the final stages of a serious illness. The goal is not to cure, but to provide comfort, pain management, and emotional and spiritual support to both the patient and their family. Hospice can be provided in various settingsincluding the home, an assisted living facility, or a dedicated hospice center.Key services often include:Symptom and pain managementEmotional and psychological supportSpiritual counselingSupport for family caregiversCoordination of medical supplies and medications Who Is Eligible for Hospice?Hospice is available to patients who have been diagnosed with a terminal illness and have a life expectancy of six months or less, as certified by a physician. Most patients have conditions such as cancer, heart failure, advanced Alzheimers disease, or chronic respiratory illness.Eligibility is not limited by age, and services are typically covered by Medicare, Medicaid, or private insurance plans. Why Hospice MattersHospice is not just about end-of-life careits about living with dignity, being surrounded by support, and ensuring each moment counts. For families, hospice also provides much-needed relief and guidance during an incredibly difficult time.Benefits include:Enhanced comfort for the patient through expert symptom controlReduced hospital visits and medical interventionsEmotional closure and improved family copingAccess to grief support and bereavement services Hospice in Denver: Local ConsiderationsDenver is home to a broad network of hospice providers, each offering a range of services suited to different needs. The citys vibrant healthcare community ensures residents have access to experienced professionals and resources focused on compassionate, end-of-life care.To explore hospice services available in Denver, you can visit the following trusted directories:  Denver Home Health Directory  Denver Hospice Care Providers What to Look for in a Denver Hospice ProviderChoosing a hospice provider is a personal decision that should reflect your familys values and preferences. While all hospice programs must meet certain federal standards, individual providers may differ in their philosophy, staffing, and additional services.Here are key questions to ask:What types of professionals are on the care team (nurses, social workers, chaplains)?Is support available 24/7?Are bereavement services offered to family members?How is pain and symptom management handled?Can care be provided at home or in a preferred setting?Denvers diverse provider landscape means you can find a hospice service that aligns with your loved ones specific needs and wishes. Hospice vs. Palliative Care: Whats the Difference?While both hospice and palliative care focus on comfort, there are key differences. Palliative care can be provided at any stage of a serious illness and may be given alongside curative treatments. Hospice, on the other hand, begins when curative treatments have stopped and the focus shifts fully to comfort and quality of life.If you're uncertain which type of care is most appropriate, speaking with a healthcare provider or social worker can help guide your decision. Final Thoughts Hospice care in Denver is more than a serviceits a compassionate philosophy of care that respects the individuals journey, values dignity, and provides vital support during lifes final chapter. Choosing hospice is never easy, but it can be a powerful step toward peace and comfort for both the patient and their loved ones.

By Faith Protsman, MD, Regional Medical Director, VITAS HealthcareTwo recent studies highlight how sepsis impact often extends well beyond the acute event that led to a patients hospitalization. The studies emphasize two particular points that should inform physicians and clinicians as they consider referring these patients to specialized care: Medicare patient data gathered between 2012-2017 shows that sepsis patients face considerably poorer health outcomes following hospital discharge when compared to non-sepsis patients, including elevated risk for death and increased use of advanced healthcare services. Sepsis survivors exhibit strong indicators of persistent inflammation and immunosuppression for up to a year after hospital discharge, increasing their risk of readmission or death. Both studies indicate a significantly elevated risk of death among sepsis patients after they have been discharged and ostensibly cured. Of course, sepsis patientsparticularly those of the Medicare cohort, who are largely of advanced agerarely leave the hospital in better condition than they entered.The Yende study, in particular, shows that neuroendocrine and inflammatory responses to sepsis can continue long after the patient survives a septic episode. For patients with advanced or chronic diseasesas was the case with nearly 78% of participants in the studythese biomarkers are associated with decline.Post-sepsis Discharge: A Critical JunctureIn many cases, these individuals life expectancies upon discharge will be less than six months. This is a critical juncture: While comfort-focused hospice care could provide an ideal source of support for the eligible patient, their family, and their caregiver(s), most sepsis patients are simply sent home without even a discussion about palliative end-of-life care and its benefits.Frankly, such an oversight is a disservice to everyone involved. The sepsis patient is left with physical and/or cognitive dysfunction, often without significant options for symptom management. Their partner or family will either need to assume caregiving duties or turn to costly private services. And the physician and hospital staff will likely see the patient again following another acute event, a readmission that impacts performance scores, strains resources, and unnecessarily fills beds.By no means do I intend to lay the blame for these unfortunate circumstances on physicians. Timely hospice referrals require ongoing education about end-of-life care, and open, ongoing communication between hospice providers and referral sources.More Help: How to Talk About Hospice Care >Those of us in hospice are working hard to bridge the gap, but even as our healthcare system transitions to a value-based model, the mentality of fee-for-service still permeates our nations acute-care facilities, and many hospitalists see a discharge home as a success.Hospice: A New Way Of Judging SuccessIn hospice, we judge our successes on the patients quality of life and the fulfillment of their goals and wishes near lifes end. Usually, that means going home with 24/7 support from an interdisciplinary hospice team. Whether home is a traditional residence, an assisted living facility, or nursing home, the hospice team will assist caregivers (and/or facility staff) with direct clinical care and education, integrative services, bereavement support, and delivery of medication, equipment, and supplies.In other cases, improving quality of life means remaining in a general inpatient setting with hospice support, taking the burden off hospital staff until the patient is able to transition home or until the patient dies. Hospice offers complex modalities in any setting, so patients who would otherwise be confined to an ICU can usually return home to be among loved ones.With support from hospice, a sepsis patient and their family are more likely to report higher satisfaction of care and greater quality of life. The patients emotional and spiritual needs can be met alongside their physical needs, thanks to care from chaplains, social workers, music and massage therapists, and other integrative specialists. Finally, the patient is more likely to die at home, surrounded by loved ones, rather than in the hospital.Because sepsis is most common in patients with advanced or chronic diseases that indicate hospice eligibility, acute incidences of sepsis should always trigger a hospice eligibility assessment. We owe it to our patients, their loved ones, and our colleagues in healthcare, all of whom can benefit from the support that timely end-of-life care offers. 

By Dr. Lauren Loftis, Regional Medical Director, VITAS HealthcarePain and discomfort can be under-recognized and under-treated in patients with serious illness. At the end of life, 81% of patients cite being pain free as an important factor in dying a good death. 1 Along with the physiological pain associated with a patients terminal illness, anxiety and depression may contribute to their total pain. Social, emotional, and spiritual dimensions of total pain increase the patients suffering beyond their physical discomfort.A holistic approach to targeting pain at the end of life enables physicians to provide relief and comfort care that improve the patients quality of life.To illustrate, a patient Ill call Bob Jones is a 65-year-old male with stage IV colon cancer and extensive metastases to the bone, liver, and brain. Mr. Jones wife is his caretaker, and he is estranged from his son who lives out of state. His son does not accept his terminal diagnosis. Despite surgery, chemotherapy, and radiation, Mr. Jones disease has progressed.As I meet Mr. Jones for an initial hospice encounter, I ask open-ended questions, especially what matters most to him at this point in his disease progression, to determine his goals of care. I learn he is a Vietnam Veteran with signs of undiagnosed PTSD. He is constipated and desires to return home and spend time with his wife. He wishes to go to Hawaii but fears that this can no longer happen. His son does not want him to take morphine.Looking at the Total Picture: Optimizing Patient ComfortAs physicians, when we ask about pain, we keep in mind that it is defined by the patient. Hospice clinicians manage pain based on the needs and expectations of the patient and family, not our own.Getting an accurate measure of the pain level is necessary for appropriate treatment. The patient may be reluctant to report pain for fear of being a complainer or a desire to avoid opioids. Asking open-ended questions may help you gauge pain more effectively: How severe is the pain? Where is the pain located? What are you taking for the pain? How is that working for you? How is the pain affecting your ability to function daily, such as bathing, dressing, and the ability to get up and walk? Is the pain impacting your ability to fall or stay asleep? How is the pain impacting your mood? Is the pain impacting your ability to socialize or spend time with the ones you love? Other indicators of pain and suffering can be viewed or discussed. Dryness of the eyes can lead to painful keratitis as well as infections. Patients on long-term oxygen therapy may have skin breaks around the nares, dryness, and episodes of epistaxis, which can be distressing. Patients who have been using noninvasive modes of ventilation may have pressure ulcers at the nasal bridge and cheeks. Pooling oral secretions and lack of oral care can lead to oral ulcers and dental issues.Signs of malnutrition include temporal wasting, supra, infra-clavicular wasting, scaphoid abdomen, and skin dryness. Loss of muscle mass can create an increased risk of skin breakdown. Dehydration signs include dryness of mucosal surfaces, loss of skin turgor, and dry skin. Abdominal fullness can point towards constipation or urinary retention, which can cause significant distress to the patient. Lastly, a hygiene assessment and well-being focused on maintaining the patient's dignity are essential.For Mr. Jones, our VITAS team contacted his son to discuss his hesitation to provide pain medication for his father. Using a calm and thoughtful approach, we explored where his beliefs came from and if they were simply based on a common misconception about the use of morphine in hospice patients.Mr. Jones had agreed to hospice services to get out of this place, meaning the hospital, and go home to sleep in his own bed, with his wife and dogs nearby, his stated goals for end of life. He received Continuous Care to help manage his symptoms at home. The VITAS hospice physician evaluated him at admission and after transport to his home. Clinicians profiled his medications, which we arranged to be delivered to the home along with a bedside commode, walker, oxygen, and briefs.Managing Both Physical and Nonphysical PainOnce in hospice, the interdisciplinary teama team manager, primary nurse, hospice aide, physician, chaplain, social worker, team physician, and volunteercollaborates to address the patients total pain beyond opioids alone. VITAS also has an in-house pharmacy team with Pharm Ds on call to assist with symptom management consultations, medication selection, and dose conversions.After Mr. Jones arrived home, the home health aide gave Mr. Jones the first true bath he had had in weeks. The team addressed his constipation. We consulted our VITAS social worker and chaplain to help him and his family. The VITAS Pharm D assisted with a methadone titration regimen and pharmacologic selection.With these interventions, Mr. Jones felt so much better he couldnt believe it and wished hed called us months ago. He was able to live at home for nearly six months after his hospitalization. His course of symptom management allowed him to make meaningful memories with his family. He also achieved resolution to his estrangement with his son, which was not only significant to him but also the rest of the family, even beyond Mr. Jones death.Focusing on Quality of Life With Compassionate CareA total pain approach to comfort care minimizes any medication side effectseven those not related to the terminal illnesswhile enhancing the patients: Functional ability Physical well-being Psychological well-being Spiritual well-being This includes empowering the patient to participate in decision-making, which helps them retain dignity and a sense of control.The emphasis of comfort care is to improve the patients quality of life in their remaining months, weeks, and days. The outcomes of the hospice interdisciplinary care teams efforts are evidentin the photos we receive and the kind words of family members and even patients themselves who entrusted their care to us. Like Mr. Jones, many tell us: We wish we knew about hospice sooner.Questions about total pain management? Ready to refer a patient? Contact your VITAS representative. 1Meier, Emily, et al. (2016). Defining a Good Death (Successful Dying): Literature Review and a Call for Research and Public Dialogue. American Journal of Geriatric Psychiatry. Retrieved Sept. 16, 2024