01 Nov 7 of the Most Common Myths Associated with Hospice Care

Over the years, there have been many misconceptions about hospice care, about how hospice works and about patient eligibility. Here are seven of the most common myths about hospice care, coupled with the truths that dispel them.

Myth: Choosing hospice care means giving up hope.

People often assume that when a patient elects to receive hospice care, it is because he has lost hope and given up, but this is not the case. Many of those patients have new hopes—different hopes.

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Where once there was a hope to find a cure for the patient’s illness, there may now new hopes that include continuing to live with dignity, being pain-free and getting the most from spending time with family and friends. Often, patients’ hopes during this journey include remaining in their homes instead of enduring repeated trips to the Emergency Room or being admitted to the hospital. Other hopes for patients with a terminal illness might also include the accomplishment of goals, having wishes fulfilled, seeing an old friend or even traveling.

Because a good hospice care team designs a plan of care specifically for the individual patient, that plan of care can help to facilitate the patient’s goals, wishes and desires. As the patient’s journey changes, so might their hopes, goals and desires. Choosing hospice care certainly does not mean giving up hope. Clearly, it is often the doorway to redefining hope.

Myth: Hospice care is only available to patients with a terminal diagnosis of cancer.

In the 1970s when hospice care was first instituted, a majority of patients who received hospice services had a diagnosis of cancer. But hospice care can be appropriate for patients with a variety of clinical diagnoses. In 2016, only about 27% of Medicare beneficiaries who received hospice services had a primary diagnosis of cancer. Almost 19% percent had a diagnosis of cardiac disease. Eighteen percent were admitted to hospice services with a primary diagnosis of dementia, and 11% percent had a respiratory disease, such as Chronic Obstructive Pulmonary Disease (COPD). Just under 10% had a diagnosis of Cerebrovascular Accident (CVA) or stroke.◊

Myth: A patient can only receive hospice services if he is actively dying or if his death is imminent.

The process of dying from a terminal illness is exactly that—a process, and processes, by definition, take time. Disease and dying processes vary in duration from patient to patient and from diagnosis to diagnosis.

Between 2014 and 2016, almost 62% of patients who received hospice services did so for 1 to 60 days. Just over 18% received services for 61 to 180 days, and 10.7% received services for 181 to 365 days. Still another 9.4% of hospice patients remained on service for more than 365 days.◊

Hospice services can be more effective the earlier they are begun, meaning that a patient can benefit from an earlier intervention of hospice care. Early intervention gives doctors and nurses more time to assist in managing the patient’s symptoms and allows more time for social workers and chaplains to work with patients and their families.

In short, a patient may be eligible to receive hospice services long before he is actively dying, and the sooner he can begin receiving services, the better the opportunity is for him to experience the optimum benefits of hospice care—physically, spiritually, emotionally and psychologically.

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A patient’s family can also benefit when hospice care begins as early as possible. Because hospice care is both patient- and family-centered, starting hospice services early also affords more time for those involved to come to terms with the patient’s diagnosis, to be able to accept their new journey and to enjoy as much time together as possible.

Myth: Patients receiving hospice services die sooner than patients who do not elect to receive care.

Hospice services don’t hasten a patient’s death; nor do they prolong a patient’s life. Instead, clinical hospice care is focused on managing the patient’s symptoms, such as pain. Symptom management can improve a patient’s quality of life, which can have a very positive effect on the patient’s ability to live out his remaining days—whether few or many—with dignity and without pain.

Myth: If a patient elects to receive hospice care, only the symptoms related to his primary diagnosis will be treated.

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Hospice services are focused on “comfort care” aimed at providing pain control and symptom management. Because of this, when other medical needs or illnesses arise—such as an upper respiratory infection, a urinary tract infection, a sinus infection or other infections—those needs and illnesses will be treated in accordance with the hospice team’s goal of providing comfort and symptom management to the patient.

For example, if a hospice patient diagnosed with cancer develops a urinary tract infection while receiving services, his care team will address the infection and decide on an appropriate treatment plan. The patient won’t be left to suffer from the infection, even though it is unrelated to his primary cancer diagnosis.

Myth: When a patient elects hospice care, he must sign a “DO NOT RESUSCITATE” order.

A “DO NOT RESUSCITATE” order, also called a DNR, is a medical order written by a physician at the request of the patient. It instructs health care providers not to perform cardiopulmonary resuscitation, or CPR, should the patient stop breathing or in the event that his heart ceases to beat. And while it’s true that many patients who elect hospice care also choose to enact a DNR order, doing so is not a requirement for receiving hospice services. The presence or absence of a DNR order has no effect on the care and services a patient receives from a hospice provider.

Myth: In order to certify a patient as eligible to receive hospice services, a physician must be absolutely sure that the patient has only six months (or less) to live.

Medicare guidelines require that a patient must have a terminal illness in order to receive hospice services. But in the past, the language used in hospice legislation defined “terminal illness” differently than it does today. Legislation once dictated that a patient is eligible to receive hospice care as part of his Medicare benefit if he “has a medical prognosis that his life expectancy is six months or less if the illness runs its normal course.”*

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But today, thanks to more recent legislation, the revised definition of “terminal illness” allows for better support of the physician’s judgment. The revision of the definition further allows for a more individualized look at hospice appropriateness, stating that the “terminal illness of an individual who elects hospice shall be based on the physician’s or medical director’s clinical judgment regarding the normal course of the individual’s illness.”** Essentially, this means that the traditional language about life expectancy is no longer the standard, and today, legislation allows the physician to determine the patient’s need for hospice, with less of an emphasis on a specific life expectancy.

Do you have questions about hospice care? The staff at CarePlus Hospice will be happy to talk with you and help you understand hospice care and how it can benefit you or your loved one. Please call us at (972) 243-3033 today.

*per Section 1861 (dd)(3)(A) of the Social Security Act, www.cms.gov
** per Subtitle C, §322 of the Benefits Protection Act (BIPA) of 2000 amendment of §1814 (a)(7) of the Social Security Act, effective December 21, 2000, www.cms.gov

◊ Source: National Hospice and Palliative Care Organization, www.nhpco.org