FAQ:  What is Hospice?

What is hospice?

Hospice is specialty medical care provided for people at the end of life. It is designed for comfort rather than a cure with an emphasis on quality of life. It provides comprehensive and compassionate care for patients and their families.

Is hospice care just about medicine for pain?

Hospice care is about relief of suffering.  Pain is one form of suffering, however pain can be addressed by approaches other than just medications.  While medications can be crucial for some patients, it’s not the only way to address pain.  Pain may be physical, emotional or spiritual, and each requires a different therapeutic approach.

Who can receive hospice care?

Any patient who is diagnosed with a terminal illness is eligible for the hospice palliative care. All U.S. citizens age 65 and older are entitled to Medicare coverage for hospice at the end of life

What does hospice care cost?

Hospice is a covered benefit under most insurance plans. For Medicare patients, there are no out-of-pocket costs. Even the cost of related medications, supplies and equipment is covered.

How is hospice paid for?

Hospice is covered by most major insurers including, Medicare, Medicaid, Blue Cross, Blue Shield, HMO, and other private insurers. This includes medical equipment and illness-related medications. There is usually no cost to patients.

When is the right time to ask about hospice?

Now is the best time to learn more about hospice and ask questions about what to expect from our hospice services.  Although end-of-life care may be difficult to discuss, it is best for family members to share their wishes long before it becomes a concern.  This can greatly reduce stress when the time for hospice is needed.  By having these discussions in advance, both you and your family are not forced into uncomfortable situations or decisions you’re not ready to make.  Instead, people should be able to make an educated decision that includes the advice and input of family members and loved ones.

Who can refer to hospice?

Doctors can refer but so can families or even patients. A representative from our hospice can come to the patient and then contact the physician involved, if there is one, for more information about the appropriateness of hospice in one’s care.

How does hospice care differ from other types of health care?

Hospice is the only medical specialty that focuses on the end-of-life care. Unlike most home health care providers, hospice recognizes that the patient will not get well and provides comfort and support, rather than a cure. Hospice of New Mexico care is provided by a team of interdisciplinary care givers. These professionals and specially trained volunteers attend to a wide range of physical, emotional, and spiritual needs. Hospice care focuses on the entire family, and educates loved ones about caring for the patient. Hospice care does not end when the patient dies. Bereavement services are provided for family members for up to 13 months after the patient’s death.

How does hospice care begin?

Typically, hospice care starts as soon as a formal request or a “referral” is made. Anyone can make a referral to hospice but admission requires the agreement of two doctors that an individual is appropriate.  A hospice representative will make an effort to visit the patient within 48 hours of that referral, providing the visit meets the needs and schedule of the patient and family/primary caregiver.  Usually, hospice care is ready to begin within a day or two of the referral, if not the same day.

Can a hospice patient who shows signs of recovery be returned to regular medical care?

Certainly! If the patient’s condition improves and the disease seems to be in remission, patients can be discharged from hospice and return to aggressive therapy or go on about their daily life. If the discharged patient should later need to return to hospice care, Medicare and most private insurance will allow additional coverage for this purpose.

What if I change my mind?

Hospice is a choice, so a patient may choose to leave at any time. If a patient chooses to discontinue hospice, we work with their physician to make sure that there are no gaps in care as they transition out of hospice.

How long can a patient receive hospice care?

The patient may receive hospice care indefinitely if the patient’s condition remains appropriate for care.

How does the hospice work to keep the patient comfortable?

Many patients may have pain and other serious symptoms as illness progresses.  Our hospice staff receives special training to care for all types of physical and emotional symptoms that cause pain, discomfort and distress.  Keeping the patient comfortable and pain-free is an important part of hospice care. Hospice staff works with the patient’s physician to make sure that medication, therapies, and procedures are designed to achieve the goals outlined in the patient’s care plan.  The care plan is reviewed frequently to make sure any changes and new goals are in the plan.

Can I be cared for by hospice if I reside in a nursing facility or other type of long-term care facility?

Our hospice services can be provided to a terminally ill person wherever they live.  This means a patient living in a nursing facility or long-term care facility, apartment or home, can receive specialized visits from hospice nurses, home health aides, chaplains, social workers and volunteers, in addition to other care and services provided by the nursing facility.

How difficult is caring for a dying loved one at home?

Caring for a dying loved one at home can be quite difficult but hospice can help you and your family figure out how to find the care support you need. In addition to nursing care, hospice offers social workers who can help families and patients navigate these difficult times.

What if our physician doesn't know about hospice?

Most physicians know about hospice but not all of them have experience with hospice. If your physician wants more information, our physicians are available to talk to them and discuss their concerns. In addition, there are resources such as the National Council of Hospice Professionals Physician Section, National Hospice Helpline (1-800-658-8898) and the National Hospice and Palliative Care Organization.

Where are the services provided?

Hospice of New Mexico takes care of people wherever they live – in their own homes, the homes of friends, in assisted living apartments or nursing homes.

What are the hours of services?

Hospice care is available 24 hours a day, 365 days a year by just calling 505-872-2300

Who will be helping us?

Hospice of New Mexico uses an interdisciplinary team approach to providing care. We use the word “interdisciplinary” to indicate that each of us brings a different expertise, yet we all focus together on the issues that matter to you.

An interdisciplinary team consists of:

  • A patient and family
  • The patient’s attending physician
  • The hospice medical director
  • An RN case manager
  • A hospice aide
  • A licensed social worker
  • A pastoral counselor
  • Therapy and treatment specialists
  • Hospice-trained volunteers

Members of your team work together to develop a plan of care that addresses your individual circumstances. The care plan is adjusted as the patient’s symptoms and the needs of family members and other caregivers change. As patient and family, you are in charge of your own plan of care. Our role is to advise and assist.

All members of the hospice team focus on one goal: to bring comfort to those facing a life-limiting illness. They have special expertise in addressing physical, emotional and spiritual needs.

What kind of help will we receive?

A physician may recommend hospice, but only the patient, or the patient’s representative, may choose hospice care. The hospice team will work closely with the patient and the family to develop an individual Plan of Care.

This Plan of Care may include:

  • Physician and nursing care
  • Personal Care hospice aides
  • Social workers
  • Chaplains
  • Equipment and supplies
  • Medications to reduce distressing symptoms of terminal disease
  • Follow-up care for families after a loss
  • Volunteers (companions, errands, caregiver relief)
How is Hospice and Palliative Care different from other care?

The emphasis of hospice care is on quality of life and on maximizing comfort as the illness takes its natural course. Hospice and Palliative care focus on relieving and preventing the suffering of patients; delivered by a team of professionals. It is designed to address the physical, emotional, spiritual, social, and psychological issues that accompany end of life. We focus on controlling distressing symptoms and address other concerns the patient or family may have.

What if it just gets too hard for the family to look after the patient?

No family is completely prepared for the challenge of caring for a sick family member. To support the family, the hospice team may take a variety of steps including:

  • Changing the Plan of Care so that team members visit the home more often
  • Adding volunteers who can sit with the patient while family members take personal time
  • Recommending “respite care,” a brief period in which the patient resides in a nursing home
  • Helping the patient choose a permanent nursing home residence. Patients who choose to live in a nursing home may have to pay for the room and board “out of pocket.” A hospice social worker will help the patient and family understand all costs before any move is made.
What if a patient lives alone?

Many patients live alone through choice or through circumstance. We will develop a Plan of Care with the patient that supports his or her needs. It will include a plan for how to meet the patient’s needs as additional help is required.

Is hospice affiliated with any religious organization?

No. Hospice of New Mexico honors all religious beliefs and those with no affiliation. We focus on comfort and quality of life however you define that.

FAQ:  What are some common Hospice myths?

Are all hospices the same?

All hospices are not the same. Here are some questions you might ask when you are comparing hospice providers.

  • Is your medical director board certified in hospice and palliative medicine?
  • Will I have the same nurse and hospice aide while on service?
  • Are nurses available to visit me if I have an emergency in the middle of the night?
  • Will you accept patients who do not have a full time primary caregiver?
  • Will you follow my wishes, as long as they are not illegal, whatever they may be?
  • Will you accept patients who don’t sign a Do-Not-Resuscitate form?
  • What if I don’t die within six months or even 12 months? Will you still take care of me?
  • How much time is spent with patients on each visit?
Does choosing hospice mean giving up hope?

Choosing hospice does not mean that you are giving up hope. It means that you have opted to focus on quality of life and for treatments that will help manage various medical symptoms. Hospice allows you to feel comfortable and provides support in order for you to have control over your life.

Does hospice do anything to make death come sooner?

Hospice neither hastens nor postpones dying. Just as doctors and midwives lend support and expertise during the time of child birth, hospice provides its presence and specialized knowledge during the dying process with the primary focus of comfort and support for the patient and their loved ones.

How do I know when the time is right for hospice?

If you or a loved one is living with terminal illness and are not seeking a cure, hospice may be the right choice for you. Generally, hospice is appropriate for persons who are in the last six months of life.  There is never a charge for a hospice assessment, call us at 505-872-2300 to schedule an RN home visit.

What happens if you don’t die within 6 months?

Hospice services may be provided beyond six months, with physician certification of continued eligibility. You can continue to get hospice care as long as the hospice medical director recertifies that you are terminally ill.

Is palliative care just about pharmaceutical pain relief?

If you or a loved one is living with terminal illness and are not seeking a cure, hospice may be the right choice for you. Generally, hospice is appropriate for persons who are in the last six months of life.  There is never a charge for a hospice assessment, call us at 505-872-2300 to schedule an RN home visit.

FAQ:  What is palliative care?

What is Palliative Care?

It is specialized medical care for people living with serious illness. It focuses on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.

Palliative care is often provided by a team of palliative care doctors, nurses, social workers and others who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.

Why have Palliative Care?

Palliative Care has been proven to benefit patients in many ways.  Studies of patients who have cancer and early Palliative Care involvement report:

  • Better understanding of their disease and prognosis
  • Better control over decision-making
  • Greater patient satisfaction with care plan and their providers
  • Improved QOL
  • Get treatments that are more aligned with their wishes
  • Less depression and anxiety
Who might need Palliative Care?

Any patient with chronic life limiting illness may benefit from palliative care.  Some but not all include patients with the following diseases:

  • Heart disease
  • Cancer
  • Stroke
  • Diabetes
  • Renal disease
  • Parkinson’s disease
  • Alzheimer’s disease
How do I know if Palliative Care is right for me?
Palliative care may be right for you if you are experiencing pain, stress and other symptoms due to a serious illness. Serious illnesses include but are not limited to: cancer, cardiac disease, respiratory disease, kidney failure, Alzheimer’s, AIDS, amyotrophic lateral sclerosis (ALS) and multiple sclerosis. Palliative care is appropriate at any stage of a serious illness and you can get it along with treatment meant to cure you.
What’s the difference between Hospice and Palliative Care?
Hospice is a type of Palliative Care. It is Palliative Care that is focused on those people who have a prognosis of 6 months or less. Non hospice Palliative Care differs in that it can occur alongside aggressive treatments.  For example, Palliative Care can occur while receiving curative treatments for cancer.
What’s the difference between Palliative Care and regular care?
Traditional medicine is focused on prevention, cure or treatment. Palliative Care is first focused on the comfort and wishes of the patient. In Palliative Care, the focus is on ensuring, that their physical, emotional and spiritual symptoms are addressed and that patients are informed as much as they want to be about their illness, including prognosis and treatment options. It adds that extra support that a patient with a chronic life limiting illness often needs.
Who else, besides the patient, can benefit?

Everyone involved! Patients as well as family caregivers are the special focus of palliative care. Your doctors and nurses benefit too, because they know they are meeting your needs by providing care and treatment that reduces your suffering and improves your quality of life.

FAQ:  Are there any guidelines for admission?  (for physicians)

Is my patient ready for hospice?

Some features are common in patients when they ready for hospice and help determine appropriateness but not all patients exhibit these findings:

  • Frequent hospital or emergency department visits
  • Decline in function – difficulties with walking or transfers, recently bedbound
  • Recurrent infections
  • Progressive weight loss
  • Declining mental function
  • Increasing dependence for most Activities of Daily Living
  • Multiple co-morbidities
Who should receive hospice care?

Patients with a condition that has created a life expectancy of 6 months or less if the disease were to run it’s natural course.

Patients who have chosen comfort care which focuses on relief of symptoms rather than curative care.

Patients who decline extreme life-saving or life-sustaining measures

Guidelines for common hospice diagnoses

Alzheimer’s Disease

  • Unable to walk without assistance
  • Urinary and fecal incontinence
  • Speech limited to a few words
  • Unable to dress without assistance
  • Complications: pneumonia, UTI, sepsis, pressure ulcers
  • Difficulty swallowing/eating
  • Weight loss

Amyotropic Lateral Sclerosis

  • Unable to walk,
  • needs assistance with ADLs
  • Barely intelligible speech
  • Difficulty swallowing
  • Weight loss
  • Significant dyspnea
  • Co-morbidities/complications: pneumonia, URI

Cancer

  • Metastases to multiple sites    
  • Weight loss
  • Patient/family chooses palliative care

Cardiac Disease

  • Optimally medically treatments in place or attempted, OR
  • Not a surgical candidate, OR
  • Pt declines surgical options
  • Pt has NHYA Class IV (symptoms of heart failure or angina at rest)

Liver Disease

  • Helpatic encephalopathy
  • Recurrent variceal bleeding
  • INR > 1.5 and Albumin <2.5
  • And one of the following:
  1. Refractory ascites or pt noncompliance
  2. Spontaneous bacterial peritonitis
  3. Hepatorenal syndrome and urine sodium <10mEq/l

Pulmonary Disease

  • Dyspnea at rest – bed to chair existence
  • FEV1 <30% predicted helpful but not necessary
  • Progression of pulmonary disease – increased medical visits, infections
  • Also helpful but not required:
  1. Hypoxemia at rest on RA or Hypercapnia
  2. Right heart failure
  3. Unintentional wt loss
  4. Resting tachycardia >100/min

Acute Renal Failure

  • One of three below:
  • Pt is not seeking or continuing dialysis or transplant
  • Creatinine clearance <10cc/min or <15cc/min for diabetics
  • Creatinine >8.0 or > 6.0 for diabetics
  • Also helpful but not required:
  1. Mechanical ventilation
  2. Malignancy
  3. Chronic lung disease
  4. Advanced cardiac disease
  5. Advanced liver disease
  6. Sepsis
  7. Cachexia, Albumin <3.5

Chronic Renal Disease

  • One of three below:
  • Pt is not seeking or continuing dialysis or transplant
  • Creatinine clearance <10cc/min or <15cc/min for diabetics
  • Creatinine >8.0 or > 6.0 for diabetics
  • Also helpful but not required
  1. Uremia
  2. Oliguris (<400ccc/24h)
  3. Intractable hyperkalemia
  4. Uremic pericarditis
  5. Hepatorenal syndrome
  6. Intractable fluid overload

Stroke

  • Karnofsky Performance Scale or Palliative Performance of 40% or less
  • Inability to maintain hydration and caloric intake:
  1. Wt loss of 10% in the last 6 mo or >7.5% in the last 3 months
  2. Serum albumin <2.5
  3. Current history of pulmonary aspiration
What is covered?

Hospice care includes medications for pain and other symptoms caused by the condition for which they are on hospice, durable medical equipment (hospital bed, walker, commode, etc), and if needed, nutritional counseling, inpatient care for symptom management, respite care to relieve caregiving responsibilities of the loved ones.

Who pays for hospice?

Hospice is a benefit covered by Medicare, Medicaid and most private insurances.

Who is on the hospice care team?

Members of the Hospice of New Mexico Care team have one goal – to bring compassionate care and comfort to those facing a life-limiting illness and their loved ones. They each have special expertise in the management of physical, emotional and spiritual needs that arise during end-of-life care. 

Hospice medical director is a physician specializing in hospice care who collaborates with the patient’s attending physician and provides expert advice to the Hospice team. 

Hospice nurse provides symptom management expertise to improve the patient’s comfort. This includes empowering patients and caregivers with strategies for personal care, maintaining comfort, use of medications, and other needs as they arise.    

Hospice social worker provides emotional and anticipatory grief support along with assistance in identifying community resources for caregiving support, advanced directives and funeral home planning.   

Hospice pharmacist provides consultation to the Hospice Team regarding medication management.

Certified nursing assistant (CNA) provides scheduled visits to assist with the patient’s personal care and to instruct family members/caregivers on how to meet the patient’s day to day care needs. 

Hospice Volunteers are specially trained to support the needs of terminally ill individuals and their families. They offer companionship, compassionate presence, and practical household support (such as errands and light household chores). 

Chaplain offers in-depth listening to the hopes, fears and concerns of the patient and/or family using a non-denomination approach. 

Bereavement coordinators support families in their grief after the loss of their loved one through individual counseling, informational mailings, support groups and workshops

FAQ:  How can I become a volunteer?

What are good characteristics for a hospice volunteer?

Presence: Because words are so inadequate or incomplete, there are no words that can take a person’s pain or distress away. We say so much of what we mean through our nonverbal communication (65-90%). Perhaps the greatest gift that we give another person is to be with them, to stand with them in difficult times.

Ability to Listen/Empathy: Few of us have enough people who will listen to us in an open, non-critical way. In difficult times, there is a great need to talk about one’s experience, to review the details, to tell one’s story. Most people listen with the goal of giving answers or advice. The pure yet difficult gift of genuinely listening allows the person speaking to see and understand his experience in an expanded way. People feel understood and comforted when we try to empathize and enter into their world. When we try to understand what it might be like to be in the other person’s place, it can diminish his or her feelings of distress or isolation.

Life Experience/Maturity: We are the product of our own experiences and of our reactions to them. Our experiences, both positive and difficult, teach us about the world and other people. Maturity is the ability to integrate and use those experiences in a way that not only increases our understanding, but also enhances our personal power and our compassion.

Comfort: When we are in the midst of a difficult time, it is helpful to be around people who are comfortable with emotions and with their role as a helping person. Most of all, we appreciate people who are comfortable with themselves, who try to live with the reality of human and life limitations, and who are able to offer comfort to others.

Interpersonal Skills: There is a way of being with others that gives them the impression that they matter, and that you have nothing else to do at that moment. The better ways of responding to people in difficult times involve using our best communication skills to honor the person’s responses and abilities. Trust is an essential ingredient in relationships because it conveys belief in the person, and in his or her eventual ability to cope.

Caring/Concern: Like love, caring is a small word that attempts to convey a large experience. Caring involves warmth and acceptance of another person that is expressed in the relationship. There is a sense of kindness, gentleness, and concern for the well being of another that comforts and sustains us in difficult and good times. We offer and receive caring in personal relationships and in our larger human community, out of our understanding that what happens to another person matters.

Compassion: The ability to sit with and fully acknowledge the experience of a person in a painful time is a remarkable capacity that is born out of a personal

understanding of our own struggles and of the human condition. Compassion is the most profound level of human caring.

Patience: We all struggle to cope with difficult times in our own ways, and in our own time. And for everyone, difficult times seem too slow, or too long. Coping with major changes involves an ongoing series of adaptations, and is a process that takes significant energy and time. People know when we feel that they are not moving quickly enough. Relationships where there is a commitment to journey with a person through difficult times are both necessary and invaluable.

Sensitivity: In responding to others in times of their need, we often try to offer traditional wisdoms, or clichés that we have heard before. It is important not to say things that only comfort us, and might create distress for the other person. Sensitivity also means being aware of cues that will allow us to anticipate the needs of the person.

Courage: The strength to face our own difficulties and those of people we care about is not an inborn trait. We are not born brave; it is a quality we develop when we creatively enter into the full range of human experience. We choose to face our difficulties and to be present with others in theirs because we are asked to, because it is needed or required of us in the situation. Courage is an act of generosity of the spirit for ourselves and for those that we care about.

Taken from Lattanzi-Licht (1998) criteria list for hospice volunteers.

What is does the job description look life for a hospice volunteer?

Hospice of New Mexico

Volunteer Job Description

Organizational Relationship:

A member of the hospice volunteer program works under the direction of the volunteer manager in conjunction with the nurse, case manager and/or other disciplines, such as social worker, pastoral/counselor.

Purpose of Position:

Responsible for providing non-medical support services as needed to the home care patient and family member on a volunteer basis. The volunteer may also perform administrative duties in the office at times.

Basic Qualifications:

  • Must be 18 (eighteen) years of age or older. May perform administration duties at 14 (fourteen) years of age or older.
  • Has completed application, screening interview, volunteer orientation and training, health screen, and concluding interview.
  • Has realistic goals for his/her involvement in the hospice program.
  • Has evidenced his/her goals are compatible with the goals and needs of our hospice program.
  • Gives evidence of commitment to hospice.
  • Attends educational in-services when provided.
  • Verbalizes willingness to work as a member of a team.
  • Respects patient/family belief systems.
  • Agrees to follow rules of confidentiality.
  • Is reliable and punctual.

Performance Responsibilities:

  • Agrees to a minimum of an average of four (4) hours a month to fulfill the function assigned to, whether it is patient/family care, office support, or other duties requested and agreed to by volunteer and the volunteer coordinator.
  • Attends support meetings and continuing educational in-services when provided.
  • Provides needed services to patient/families (example: companionship, shopping, respite for caregiver, preparing light meals, occasional light housekeeping when appropriate and agreeable to volunteer.)
  • Maintains open communication with other team members (including the volunteer coordinator), reporting events or changes of concern to nurse case manager when necessary.
  • Uses listening skills effectively to provide emotional support to the patient/family.
  • Records accurate, timely and objective documentation on each volunteer activity.

Procedures for Correction

    • In the rare event that a concern arises regarding what may be deemed as inappropriate behavior by a volunteer, the following steps will be taken:

1. The Volunteer Coordinator will call the volunteer regarding

the issue and re-educate when appropriate.

2. In the event that the issue arises again, a second call will be

made to further address it.

3. If the issue continues beyond the second call the Volunteer

Coordinator will arrange a face to face meeting and the

volunteer will be dismissed from service with Hospice of

New Mexico.

Would you like to be a volunteer with Hospice of New Mexico?

Submit a volunteer application

Do you still have questions?

Contact us