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Knowing what decisions to make in any type of healthcare can be extremely difficult, and sometimes, most of those difficulties come from not knowing how it all really works.

Our staff is highly knowledgeable in each of these subjects and we welcome any questions you may have at any time. In the meantime, this section will hopefully answer some of those hospice and healthcare questions you may have, whether you are in our program, or still in the process of making a decision regarding the best care for you or your loved ones.

Having knowledge or knowing where to ask for help to navigate your healthcare path is power, and the most proven way to make an informed decision.

WHAT IS HOSPICE?

Hospice is a philosophy of caring, centered on treating, alleviating, and managing the mental and physical pain and discomfort one may experience when living with a life-limiting illness.

The care is multidimensional with the focus being upon patients and families, rather than the illness. One of our main goals is to inspire and empower all towards restoring or maintaining quality of life, personal fulfillment, and dignity.

Through our holistic approach, combined the wide array of talents and abilities of your hospice team and contemporary science, we hope to open a pathway for you and your loved ones to continue or re-engage in living an excellent quality of life, and overcoming any self-imposed burden of feeling defeated by the possible limits of a diagnosis.

We will be present every step of the way to help you and your family in this journey.

Who Is Eligible for Hospice?

Hospice services are provided for people with life-limiting illnesses and certified prognosis of six months or less if the disease runs its normal course, and patient and family have agreed to palliative care in favor of curative treatments. Illnesses more familiarly cared for are cancer, heart disease, dementia, Alzheimer's, chronic lung ailments, kidney disease, and AIDS.

Where Does Hospice Take Place?

Hospice services can occur at home, assisted living facilities, skilled nursing facilities, hospice-licensed board and care facilities, and hospitals, on a short-term, inpatient basis.

The cost for living in an assisted living facility or board and care are usually out-of-pocket expenses. A skilled nursing facility can be funded through insurance, or it will be an out-of-pocket expense as well. Ask us about the latter.

How Long Can Someone Be On Hospice?

Admission onto hospice services is based on having a clinical diagnosis of having six months or less to live if the illness progresses at its normal course, and cannot be cured by life-saving treatments. Patients are, however, assessed at specific certification periods of time on service, and it is determined then whether or not a patient can remain on service.

Some patients will become well enough to navigate the world without the need for hospice, and because signing on to hospice is an agreement, not a contract based on an obligated duration of stay one must fulfill, one can end hospice services at any time. Patients ``graduating`` from hospice services is not unusual, and we will always be available if the need resurfaces.

Where Does Hospice Take Place?

There are four (4) levels of hospice care our team provides to patients:

1) Routine care - the most common type of hospice care provided in the home and/or healthcare facility.

2) Respite care - care process that is short-term relief for caregivers where patients are cared for in a nursing facility for up to five days.

3) Inpatient care - care process which is more intense than routine, designed to manage out-of-control pain and symptoms. This care takes place in a hospital or skilled nursing facility.

4) Continuous care - care/crisis intervention which takes place in the home or assisted living facility to manage uncontrollable pain and symptoms on a short-term basis. The nurse at the site will be there on a 24-hour or less basis until the pain or symptoms are under control.

An Advance Directive is a legal document which gives direction on how to carry out end-of-life wishes and actions when someone cannot communicate these wishes on their own behalf. The main goal of this document is helping guide you to carry out the fair and loving practice of gifting your loved one's final wishes in the manner they wished to have them carried out.

The importance of this document is to avoid any confusion or dispute regarding what actions to take when someone's health prompts a difficult decision needing to be made. Those decisions include resuscitation vs. CPR, being on life-sustaining machines or feeding tubes, burial vs. cremation, organ and body donations, to be placed in a nursing home vs. being home.

An advance directive should be done ahead of one's inability to make decisions to avoid confusion and conflict later on, and forms can be found on line. Make sure to fill these out in accordance to the state you live in. Our social worker can assist you through every technical and legal facet of this process.

The responsibility of making end-of-life choices and final plans can be emotional and difficult. Our social worker and staff will help support this process and eventual decision through listening and subsequently supplying a list of available agencies to facilitate the search.

The POLST or Physician Orders for Life-Sustaining Treatment document is a legally valid physician order form utilized by hospices to guide their actions and responses during emergent and end-of-life occurrences.

The POLST is divided into FOUR important sections, which after they are filled out, will be signed by our medical doctor as an official order. Our staff can and will discuss each section with you at your request.

1) CPR (Cardiopulmonary Resuscitation) or DNR (Do Not Resuscitate). This is the decision of the action to be taken when a patient has no pulse or is not breathing.

2) MEDICAL INTERVENTIONS: These are the 3 actions that can be taken when a patient is found with a pulse and/or is breathing: a) Comfort-Focused Treatment, which is maximizing comfort through relieving pain and discomfort with medications; b) Selective Treatment, which is an addition to comfort-focused treatment, i.e., IV antibiotics for infections, if patient cannot take medications by mouth, etc., c) Full Treatment, which is prolonging life through any means necessary.

3) ARTIFICIALLY ADMINISTERED NUTRITION: These are three processes used in the case patient cannot take in nutrition orally: a) No Artificial Means, which includes no feeding tubes; b) Trial Period, which is an artificial means for a fixed amount of time; c) Long-term, which is an artificial means for an extended-to-permanent amount of time.

4) INFORMATION AND SIGNATURES: This states the POLST has been discussed with our patient or legally recognized decision maker, and if there is an Advance Directive to coordinate with your POLST.

Hospice service with HolistiCare does not include housekeeping or in-home caregiving services. These services are not inclusive in the hospice package Medicare funds, and will mostly be out-of-pocket expenses.

However, situations like the need for extra physical help in the home and caregiver burnout occur more often than not. We can connect you with caregiving agencies, or discuss low-to-no cost Medicaid or Medi-Cal options, or discuss respite (rest) or permanent placement options.

We welcome this conversation sooner than later in your service tour, and add these words of encouragement that there is great bravery in asking for help in a situation like this, rather than becoming overwhelmed and unable to adequately provide care due to mental and physical shortcomings.

How Often Are Visits Made?

The frequency of hospice visits from staff depends on the severity of someone's illness and levels of their ancillary needs. All staff scheduling will be done between patient, caregivers, and staff during the initial visit, and at that time, days and frequencies should be coordinated.

Depending on the discipline, visits will either be weekly, bi-weekly or monthly. Nursing and Nursing Aide visits will usually be weekly, with frequencies to be worked out between staff and caregivers/patients, while all other disciplines will probably coordinate monthly visits, which can be 1-2 times or more per month, depending on need.

*Nursing visits are not daily and/or of a stationary personalized 24-hour, around-the-clock variety. Nurses are available for visits during regular and after office hours, and one will be sent to the home in the case of symptoms that cannot be brought under control.

What Happens When Someone Dies?

When someone dies, please call us, not 911. Whether the death occurs in the home or facility, the protocol is to call hospice, where one of our nurses will come to where the patient lives to confirm the passing. Once the confirmation is done, nurses or supportive care staff, who may visit for emotional support, will then make a call to the end-of-life service to receive the body at the length of time family and loved ones relay to the hospice staffer making the call. Someone can remain in the home as support until the deceased leaves the home.