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Posted: April 26, 2008

Turning to Hospice

Asking the Right Questions to Select Care Providers at Life's End

When a family member is dying, how can their loved ones provide the care and comfort needed?

Increasingly, Americans are turning to hospice for help. In fact, an estimated one-third of all deaths in the United States take place in hospice care. Hospice is a term that describes programs involving a team of individuals who work together to provide optimal supportive care for terminally ill individuals and their families. It begins when curative treatment has stopped and death is anticipated within six months.

Most hospice care is provided at home but it may be provided in a skilled-care facility or other residential settings.

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The newsletter Mayo Clinic Women's HealthSource recently presented an overview of hospice care, including these questions to help evaluate available programs:

– What services are offered to the patient? Services should include management of symptoms, including pain, insomnia, shortness of breath, depression, constipation, agitation and nausea.

– What services are offered to family members? Spiritual and emotional support should be part of the services offered to patients and families. Trained volunteers may support families by providing companionship or even running errands.

– What types of bereavement services are available? Guidance and support may be offered for a year after the death has occurred.

– Who makes up the hospice care team? How are they trained and screened? Team members could include doctors, nurses, home health aides, therapists, spiritual caregivers, social workers, volunteers and bereavement counselors.

– How involved is the doctor? Often, the hospice medical director oversees care in conjunction with the patient's primary physician.

– How will the individual's pain and symptoms be managed? Effective methods exist to control even strong levels of pain. A goal of hospice is to ensure the patient's comfort without over-sedation.

– If circumstances change, can service be provided in different settings? Does the hospital have a contract with local nursing homes? Is residential hospice available?

–Is the program reviewed and licensed by the state? Is it certified some other way? Is the hospice Medicare certified?

–What costs are covered by insurance? Medicare, Medicaid and most private insurers cover hospice care.

Doctors, nurses and social workers are good sources of information on local hospice programs. The National Hospice and Palliative Care Organization offers information, including a provider directory, on its website.

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