I have a friend who had a stroke a few months ago. He seems to be stable with one side of his body paralyzed and he can’t swallow. he can talk but seems to halucinate about a lot of things.
He has a feeding tube and recurring bowl infections from this. I found out today he has been moved to hospice. His family doesn’t ask many questions and is really not able to relay any inteligible information about his condition.
Hospice is usually the end-of-the road. No care designed to “fix” medical problems, just care to make a patient comfortable. When a person is very ill, Hospice workers usually get involved days to weeks before the person is actually moved to the facility. They are trained to evaluate when a person is close to the end, and is becoming too much work to stay at home.
Both these statements are true. Nothing is a forgone conclusion, but hospice is usually brought on board when a Dr. feels that the individual has less than 6 months to live. However, I’ve seen several people who have been under hospice care for several years.
Hospice isn’t a place. It’s an attitude or approach to patient management. Yes, some are inpatient facilities which provide the support the patient needs. But hospice care is also done at home by family coached or assisted by drop-in professionals.
The more physically / mentally disabled the patient, the more likely the process will be, or become, inpatient.
Though the term isn’t often used, in a sense most (all?) Alzheimer’s facilities are in effect hospice. They’re tending to the patients’ basic physical needs while letting the underlying disease take its course. In the case of Alzheimer’s there’s no choice but let it take its course since there are no effective treatments. Yet.
Although in some cases they can get involved months or even years before the end.
Ideally, hospice should be involved sooner rather than later, it’s just that in the US the usual practice is do enroll them very, very near the end.
Not everyone winds up in a “facility”. When my mother was in hospice we were able to keep her at home and that is where she died. It looks like my dad is going to be able to die in his own bed, too. A lot depends not only on the individual’s particular condition and problems but also what the family can or can’t handle.
Thanks for asking this question, because I wish I would have had a clearer view of what hospice is six months ago, before my 89-year old mother’s health started a quick decline. She had “hospice” care at home for about three months, and then moved into a “hospice” nursing home for her last six weeks. In both cases, the workers were wonderfully kind and supportive, but when this all started I didn’t really know what hospice meant. What others have said fits in with my experiences.
Deb has had a very few patients with terminal diagnoses whom she nursed for years. As noted, however, a several month prediction is more appropriate. This gives the staff and family time to work out any issues, (including the proper medication for best quality of life and pain control, funeral preparation, visits from distant friends and family, and a host of other things).
An extremely frustrating situation for the hospice staff is to have the doctor/hospital spend weeks or months fighting “death” and when they recognize that they have “lost,” sending the patient home with 24 or 72 hours to live. There is very little that hospice can provide in the way of preparation–for either the family or the patient–on such short notice; the patient is often not even conscious or responsive.
JohnGalt’s story sounds troubling from the perspective that the FIRST thing Deb and/or the social worker do when they show up, (well, the second; the first is taking the medical history), is to explain just what they are offering and why. (Of course, in such a situation, the persons with direct contact with hospice may not be able or comfortable conveying that discussion to other family members.)
Deb’s company provides hospital-like “hospice houses” for the treatment of situations where the patient may need 24 hour nursing care, but the general goal is to allow people to die at home and patients in the hospice houses tend to make up a tiny fraction of the patient census at any time.
I found out this morning that they have removed his feeding tube and once the family pays their last respects they will remove his IV water line. I guess that means about 72 hours or less. I was a little surprised at this as he is awake, alert and talking.
my brother was in hospice for about 4 months. One thing I learned was that hospice also handles all the doctor bills and insurance claims. That’s nice, it takes the pressure off the patient and family. He stayed at home for a while but he died in a nursing home after a short time there.