Many Americans die in facilities such as hospitals or nursing homes receiving care that is not consistent with their wishes. To make sure that doesn’t happen, older people need to know what their end-of-life care options are and state their preferences to their caregivers in advance. For example, if an older person wants to die at home, receiving end-of-life care for pain and other symptoms, and makes this known to healthcare providers and family, it is less likely he or she will die in a hospital receiving unwanted treatments.
Caregivers have several factors to consider when choosing end-of-life care, including the older person’s desire to pursue life-extending or curative treatments, how long he or she has left to live, and the preferred setting for care.
Doctors can provide treatment to seriously ill patients in the hopes of a cure for as long as possible. These patients may also receive medical care for their symptoms, or palliative care, along with curative treatment.
A palliative care consultation team is a multidisciplinary team that works with the patient, family, and the patient’s other doctors to provide medical, social, emotional, and practical support. The team is made of palliative care specialist doctors and nurses, and includes others such as social workers, nutritionists, and chaplains.
Palliative care can be provided in hospitals, nursing homes, outpatient palliative care clinics and certain other specialized clinics, or at home. Medicare, Medicaid, and insurance policies may cover palliative care. Veterans may be eligible for palliative care through the Department of Veterans Affairs. Private health insurance might pay for some services. Health insurance providers can answer questions about what they will cover. Check to see if insurance will cover your particular situation.
In palliative care, you do not have to give up treatment that might cure a serious illness. Palliative care can be provided along with curative treatment and may begin at the time of diagnosis. Over time, if the doctor or the palliative care team believes ongoing treatment is no longer helping, there are two possibilities. Palliative care could transition to hospice care if the doctor believes the person is likely to die within 6 months (see What does the hospice 6-month requirement mean?). Or, the palliative care team could continue to help with increasing emphasis on comfort care.
Increasingly, people are choosing hospice care at the end of life. Hospice can be provided in any setting—home, nursing home, assisted living facility, or inpatient hospital.
At some point, it may not be possible to cure a serious illness, or a patient may choose not to undergo certain treatments. Hospice is designed for this situation. The patient beginning hospice care understands that his or her illness is not responding to medical attempts to cure it or to slow the disease’s progress.
Like palliative care, hospice provides comprehensive comfort care as well as support for the family, but, in hospice, attempts to cure the person’s illness are stopped. Hospice is provided for a person with a terminal illness whose doctor believes he or she has 6 months or less to live if the illness runs its natural course.
Hospice is an approach to care, so it is not tied to a specific place. It can be offered in two types of settings—at home or in a facility such as a nursing home, hospital, or even in a separate hospice center.
Hospice care brings together a team of people with special skills—among them nurses, doctors, social workers, spiritual advisors, and trained volunteers. Everyone works together with the person who is dying, the caregiver, and/or the family to provide the medical, emotional, and spiritual support needed.
A member of the hospice team visits regularly, and someone is always available by phone—24 hours a day, 7 days a week. Hospice may be covered by Medicare and other insurance companies; check to see if insurance will cover your particular situation.
It is important to remember that stopping treatment aimed at curing an illness does not mean discontinuing all treatment. A good example is an older person with cancer. If the doctor determines that the cancer is not responding to chemotherapy and the patient chooses to enter into hospice care, then the chemotherapy will stop. Other medical care may continue as long as it is helpful. For example, if the person has high blood pressure, he or she will still get medicine for that.
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Although hospice provides a lot of support, the day-to-day care of a person dying at home is provided by family and friends. The hospice team coaches family members on how to care for the dying person and even provides respite care when caregivers need a break. Respite care can be for as short as a few hours or for as long as several weeks.
Families of people who received care through a hospice program are more satisfied with end-of-life care than are those of people who did not have hospice services. Also, hospice recipients are more likely to have their pain controlled and less likely to undergo tests or be given medicines they don’t need, compared with people who don’t use hospice care.
For More Information About Hospice and Palliative Care
Content reviewed: May 17, 2017