More than 1.8 million patients in the U.S. receive hospice care, which provides specialized support through skilled nursing care, counseling, advance care planning, and more to enhance comfort and quality of life for those facing life-limiting conditions.
Although the decision to engage these services ultimately rests with patients and their families, it almost always begins with the guidance of a trusted provider, such as a physician, nurse, social worker, or discharge planner. When health care providers thoroughly understand the role and benefits of hospice, they can empower their patients with accurate information and aid in a seamless transition to this valuable form of care, delivered wherever the patient calls home.
Challenges in Recommending a Hospice Transition
Health care providers may be reluctant to refer patients to hospice care for a variety of reasons. For example, one study found that physicians treating patients with late-stage dementia were often late to refer patients to hospice due to:
- Difficulty predicting life expectancy and a lack of knowledge of patient eligibility guidelines.
- Personal experience with severe disease in the family and a desire to maintain life-sustaining treatment.
- Fear of an angry response from the patient or their family.
Broaching this topic can be difficult, especially when many patients have negative preconceptions about hospice, often seeing it as akin to giving up. When providers understand the true philosophy behind hospice care and the finer details of how hospice benefits patients, they can address patients’ and loved ones’ concerns and help them make an informed decision.
The Power of Proactive Referrals
A common myth is that hospice care is appropriate only when a patient is in their last stages of an illness. In 2022, those enrolled in hospice spent 92.1 days, on average, receiving this care. However, half of hospice patients were enrolled in hospice care for 17 days or fewer, and one in 10 patients was enrolled for a mere one or two days.
These short periods in hospice care could be why many people equate hospice with nearness of death. In reality, hospice can help patients for many months as they navigate the challenges of life-limiting illness. Encouraging patients and their loved ones to consider hospice care earlier can deliver benefits such as:
- Better long-term pain management and comfort.
- No more visits to the ER, with rare exceptions.
- More robust support for emotional and spiritual needs related to terminal illness.
- Decreased caregiver burnout.
- More time spent at home with loved ones.
Recognizing When It’s Time for Hospice Care
Patients are eligible for hospice care when they have a life expectancy of six months or less and choose to discontinue curative treatments. Making this determination can be difficult for physicians, but even if a patient outlives their prognosis, they can benefit considerably from a long stint in hospice care and choose to discontinue care if their health improves or other treatment options become available.
Physicians should look for clinical indicators that it may be time to recommend ending curative treatments and focusing on comfort care. Some common signs include:
- Frequent hospitalizations or ER visits in recent months.
- A decline in functional status, necessitating help with activities of daily living (ADLs).
- Unintentional weight loss.
Ultimately, doctors must make an informed recommendation regarding a hospice transition based on the patient’s medical history, current health status, available treatment options, and prognosis.
Broaching the Topic of Hospice
Bringing up the topic of hospice with patients and their families can feel difficult, but the right combination of compassion and directness can help you have a productive conversation. Consider these tips to help.
Assess understanding.
Before you delve into the reasons they may benefit from hospice care, start by asking the patient (and any loved ones or caregivers present) what they understand about their prognosis and about hospice care. Assessing their understanding can help you more effectively meet the patient where they are. This can be a helpful opportunity to identify and address misconceptions.
Use positive language.
End-of-life care is a heavy topic, but you can help patients focus on the positive aspects of hospice through your language. Shift the narrative from "giving up" to refocusing on comfort and quality of life. Consider using phrases like, "I want to make sure you have the right type of support to match your goals."
Address fears directly.
Familiarize yourself with common hangups around hospice care so you can address these concerns directly. For example, many patients don’t realize that hospice can be revoked at any time if their condition improves or they choose to seek curative care again. Letting them know the decision to engage hospice isn’t irreversible may alleviate their fears and encourage them to make the hospice transition earlier so they can benefit from this care longer.
Involve others.
The decision to engage hospice is rarely undertaken alone. Be sure to consult with family caregivers and any loved ones involved in a patient’s care and address their concerns. One study documented what many physicians have found firsthand: Family caregivers generally lacked knowledge or misunderstood hospice care. So taking the time to explain their loved one’s prognosis and the ways hospice might support them can be beneficial.
If a patient or family is struggling with the decision to start hospice, suggest involving a social worker or chaplain to help them navigate the emotional weight of the decision.
WesleyLife Is Your Partner in Hospice Transition
When you refer a patient to hospice, you want to feel fully confident that they will receive the best care with no interruptions. WesleyLife works directly with referring providers to handle the heavy lifting of the hospice transition and ensure patients start receiving care as soon as possible. When external factors allow, we strive to admit patients to hospice within just two hours of referral. Even when factoring in logistics like family preferences, 77% of our hospice clients begin receiving services within 48 hours of referral.
We don’t just take care to make the transition smooth and expedient. Once in our care, your patients and their loved ones will receive excellent care from our dedicated interdisciplinary team, offering comprehensive support for physical, emotional, and spiritual needs — all in the comfort of their own home.
WesleyLife is known for excellence in providing competent, compassionate end-of-life care. Learn more or refer a patient here.