Hospice provides countless services for terminally ill patients in the home. What if the patient’s “home,” however, is a nursing home, assisted living residence, or inpatient hospice facility?
Don’t worry — hospice meets patients right where they are, no matter what they consider home. One major goal is keeping patients comfortable without the need for emergency room visits or hospitalizations. But in many cases, it’s impossible to care for a patient in the home, like those in memory care units or those who need around-the-clock monitoring. It can be upsetting to uproot a loved one from their known environment and routines.
“As hospice has expanded over the years, so has its use in the locations the patient calls home, such as group homes, assisted-living facilities and nursing homes,” writes Ellen Ness with Mayo Clinic Health Services.
Starting the Conversation for Hospice
Danette Kammeyer, the Community Manager for an independent living residence in Ft. Wayne, Indiana, says that introducing hospice to families takes sensitivity and wisdom. Because she manages a residence for independent living, she’s not directly involved in a resident’s medical care or status. However, Danette says they often share their medical updates with her because of their close-knit community. With hospitalizations or declining health, families will often turn to her for advice or resources.
When appropriate, Danette will introduce the idea of hospice: “Families are often surprised or in shock [at first], but I tell them hospice is for the living. It helps them stay in the place they call home, surrounded by the things they love and the ones who love them.”
Patients, families, and their doctors determine if it’s time for hospice and they meet these qualifications: 1) They have a six month or less life expectancy. 2) They are not receiving active curative treatments for their disease. Many families don’t know where to start, but nursing facilities, inpatient centers, and even hospitals recommend hospice companies with whom they are familiar or contracted with, like Heart to Heart Hospice. Families and patients, then, are free to interview and choose any hospice company they prefer.
While Medicare does not typically cover the cost of long-term housing or room and board at a facility, the services are vast and valuable to patients, families, and the residential staff. Medicare does provide a benefit for short-term respite care (up to five days at a time) for contracted inpatient hospice for contracted inpatient hospice beds.
Hospice’s Role in Residential Facilities
In nursing homes or assisted living, think of hospice as adding to the team, not changing teams by taking over every aspect of patient care. Nursing homes provide medication administration, meals, routine daily care, and staff support. Many offer activities and programs for residents. Nursing homes often have attending physicians and nurses to assess and treat patient’s immediate needs or health changes. Aides and other staff provide support.
When it’s time, hospice offers additional services and staff who specialize in end-of-life care and further enhance a resident’s quality of life while on hospice, including:
- Regular nurse visits for specialized hospice care, like pain management, comfort measures (for breathing, eating, etc.), medical equipment needs, and more.
- Education and coordination with nursing home staff and other medical providers to provide continuity of care.
- An on-call line for 24/7 hospice support and determination if a visit is needed.
- Extra emotional, mental, and spiritual support from a social worker, chaplain, aides, and volunteers to provide additional resources, presence, and compassion relating to end-of-life issues.
- In concert with the facility and based on the patient’s care plan, hospice offers support for bathing or other activities of daily living.
- Assistance with healthcare documents, a patient’s final wishes, funeral planning, bereavement care, and grief resources for families after death.
Benefits of Hospice in Residential Care
Nursing home staff and assisted living managers recognize the advantages of hospice for their residents as well, including Farrah Elwood, Director of Nursing of an assisted living facility in Ft. Wayne, Indiana, and Jordan Pidek, Assistant Administrator in Flint, Michigan.
Jordan said he’s looking for hospice providers who really emphasize patient quality of life. Farrah consistently sees how hospice helps keep residents in the community, which provides security for many patients and relieves other stressors like the need for enhanced care measures. Patients look forward to the extra visits from chaplains, social workers, or volunteers that offer companionship and a compassionate presence.
Danette, Farrah, and Jordan frequently meet Community Education Representatives from hospice companies, and their preferred partnerships are with providers who:
- Don’t take up a lot of time on initial visit or push for other resident referrals, but differentiate their services from other providers.
- Communicate quickly and coordinate well with the assisted living staff, RNs, CNAs so there are no gaps or confusion in their care plan.
- Provide consistency of hospice staff to build rapport and trust, such as the same RN visiting the same patient.
- Help educate families and staff; address misconceptions about hospice.
- Provide medical equipment (like beds), delivered quickly.
- Lead activities or partner with the facility, such as recognition for veterans, pet or music therapy visits, social gatherings, special programs (like a visiting physical therapist addressing balance and safety issues), and more.
- Are on time and consistent with visits, as residents often look forward to the extra support services and companionship.
With hospice, patients in nursing facilities gain comfort and peace of mind with personalized care during their final months of life. See if your loved one needs the additional services hospice provides today.