When Is It Time for Hospice or Palliative Care?

The achievements of modern medicine have extended both the length and quality of our lifespans. For many people, however, advancing age brings a growing constellation of health conditions, which are met with a battery of treatments and medications to help keep them at bay.

Treatment can take on a momentum of its own, with a medical team responding to fight off every new condition, symptom, and decline in health. There always seems to be something that can be tried—and loved ones often encourage ongoing treatment because they want to preserve every possible hour together.

But there may come a point when one’s remaining days are better spent seeking comfort rather than treatment and making the most of precious time with family and friends.

How do patients and families know when the time for hospice has arrived?

There is no one absolute answer; it’s a very individualized, personal decision. But one place to start is to consider the medical facts and options available. When treatment will no longer lead to a cure and improved health, it may be time to consider hospice or palliative care.

Hospice services are generally provided when a patient has a life expectancy of six months or less. None of us know when our end is near, but there are some common signs of the end of life to look for.

For example, a rapid downturn in health or lack of improvement despite active medical treatment is one clear sign. This may include obvious major physical symptoms like uncontrolled pain, nausea, or vomiting, or incontinence.

Other indicators include:

  • frequent hospitalization or emergency room visits,
  • recurring infections;
  • declining appetite with reduced food and fluid intake;
  • changes in body temperature;
  • spending more time sleeping;
  • rapid breathing or chest congestion; and
  • restlessness or repetitive motions

Perhaps a less obvious but important signal is a change in mental and emotional states. A patient may withdraw from family or exhibit a loss of interest or awareness of surrounding activities. He or she may make comments or requests that seem out of character, or lose touch with reality, experiencing visions or hallucinations. Another sign is making apologies or farewells.

Entering hospice can be a time to focus on relationships, goodbyes, and the aspects of life that mean the most to the patient, rather than pursuing a continual quest to maintain health. This can bring great peace of mind, increasing the quality of life and maximizing lifespan.

Hospice emphasizes comfort care that helps patients make the most of their days. It provides some control and freedom from unwanted tests, treatments, or medications. It allows a patient the peace of spending their remaining days at home or in an environment that they choose, surrounded by people and things that they love.

The hospice team is dedicated to helping patients and families discover meaning in these important moments and to live them to the fullest. According to the National Institute on Aging, research shows that when a person enrolls in hospice care they are more likely to have increased family satisfaction and better symptom and pain management.

The hospice approach also recognizes that emotional and spiritual pain are as real and as important as physical pain; counselors and clergy are part of the hospice team to provide comfort. Seeking guidance from a pastor or spiritual adviser can be helpful in making the decision to begin hospice care.

Many people wait until the final days or weeks of life to consider hospice. However, choosing hospice earlier can mean a longer period of peaceful comfort care and meaningful time spent with loved ones. An honest conversation with the medical care team can help patients and families assess the likely progression of declining health and the value of continued treatment. Patients should always feel free to ask questions and initiate that conversation with their physician.

When Can Palliative Care Help?

Palliative care offers similar care and services for patients with a long-term illness that is not immediately life-threatening. These conditions may include cancer, AIDS, dementia, or other illnesses for which the course of the disease or treatment can deeply limit the ability to function.

Palliative care aims to relieve the symptoms and provide support for the emotional upheaval of dealing with such conditions. If nausea, pain, lack of energy or mobility, inability to concentrate, or depression have become disabling, it may be time to consider palliative care.

This option may be covered by Medicare Part B, Veteran’s Administration insurance, or private health care plans. Consultations to consider the need for palliative care are usually covered.

Evolving Needs

At Wings of Hope, we offer customized, comprehensive hospice and palliative care services. We can provide the specific services that an individual patient needs—from nutritional support and pain management to special services like massage and pet therapy—and tailor them as needed along life’s journey. While medical treatments are suspended, physical, occupational, and speech therapy may be provided to help patients get the most out of their days.

Ideally, patients and families can make the decision to begin hospice care while patients still have the strength and awareness to take advantage of its benefits. From that perspective, it’s helpful to have a frank discussion about hospice and palliative care well before end-stage illness sets in. It can and should be part of advance directive planning. For patients who do not have advance directives in place, the hospice team can discuss this and help document wishes for end-of-life care.

The hospice philosophy aims to allow patients some choice and control over the final chapter of their lives. It lets them devote their energy and time to the people and things that mean the most. The choice of whether and when to begin hospice or palliative care is always entirely up to the patient and his or her family. And there are no hard and fast rules that determine the perfect time.

It is a decision that depends on a constellation of medical, spiritual, and emotional factors, as well as one’s personal life philosophy. It’s a choice that can bring pain relief and peace of mind. If you or a loved one are nearing the point where hospice may be helpful and you’re questioning the timing or what hospice would mean for you, feel free to contact us using the following form.

We are here to help and would be happy to discuss specific situations or needs.

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