Understanding the Basics
The Physician Orders for Life-Sustaining Treatment (POLST)
If you have a life limiting illness and your prognosis is less than five years, request that your physician talk to you about POLST. This is another important aspect of advance care planning.
Definitions of Life-Sustaining Interventions
An advance directive will ask you to declare the type of treatment that you want or don’t want. It’s important to know the types of life-prolonging or sustaining interventions that exist in order to make these decisions.
Hospice vs. Palliative care
Hospice care is a type of Palliative Care provided to those with incurable medical conditions indicating a probable life expectancy of less than six months. The patient is no longer a candidate for curative treatment or feels the burden is greater than the benefit.
Palliative Care is specialized medical treatment focused on providing relief from the symptoms and stressors associated with advanced illness. Services are provided at the same time as curative care and are integrated at all points in the disease trajectory regardless off prognosis.
Both Hospice & Palliative
The goal is to improve quality of life for both the patient and the family.
- All care is guided by the organization’s mission to honor the importance of choice, allowing patients to define for themselves the most dignified manner in which to live.
- Care is provided by an interdisciplinary team.
- The team meets with each patient and their loved ones to develop an individual care plan unique to the patient’s needs and healthcare requests.
Questions to Ask of Hospice Care
Does the hospice serve the area where the patient lives?
How long has the hospice been in operation?
Is the hospice certified by Medicare?
Does the hospice accept Medicaid?
What other insurance is accepted?
Is the hospice licensed by the state?
What services does the hospice provide?
- Phone calls to the family?
- Mailings on what to expect?
- Support groups?
- Retreats or activities for the family?
What, if any, hospice services does the hospice not provide?
Is participation in care by a family caregiver required for hospice enrollment?
What is expected from the family caregiver?
How can hospice supplement the family’s responsibilities?
To what degree are volunteer services available in the home?
What, if any, out-of-pocket charges can we anticipate? For what services?
How often does hospice staff make home visits? (E.g. once-a-day visits, every-other-day visits, or once-a-week visits?)
- Social worker
- Home health Aide
- Pastor or chaplain
Who provides on-call coverage during nights and weekends, the staff of the hospice?
Is a home health aide or certified nurse’s assistant on duty 24 hours a day if needed?
Is on-call coverage contracted out to other persons?
Does the hospice have contracts with local long-term-care facilities? If so, which one(s)?
Does the hospice have an inpatient facility? Does the hospice contract for this?
May I tour the facility?
Does the hospice provide funeral arrangement support?
What bereavement services are provided?
Eighty percent of hospice care is provided in the patient's home, family member's home and nursing homes.”
Hospice is a special concept of care designed to provide comfort and support to patients of all ages and their families when a life-limiting illness no longer responds to cure-oriented treatments. Hospice care neither prolongs life nor hastens death. Hospice staff and volunteers offer a specialized knowledge of medical care, including pain and symptom management. The goal of hospice is to improve the quality of a patient’s last days by offering comfort and dignity.
You may not control all the events that happen to you, but you can decide not to be reduced by them.
– Maya Angelou, Letter to my Daughter
Another option for support when someone has a life-limiting illness is palliative medicine. Palliative care is specialized care for people with a serious illness. It is focused on providing patients with relief of symptoms. It helps support the patient and caregivers with resources and coordination of advanced medical care needs. It is a team-based focus on improving the quality of life for the patients and their loved ones.
Patients receiving treatment for the following advanced illnesses are likely candidates for Palliative Care:
- Pulmonary Disease
- Cardiac Disease
- End Stage Renal Disease
- Other Advanced Illnesses as appropriate