What to expect from hospice care

If you or a loved one are nearing the end of life, hospice care can provide much-needed relief from pain and other symptoms. Hospice care is tailored to meet the individual needs of each patient and may include a combination of services such as:

• Pain management
• Symptom control
• Emotional and spiritual support
• Nursing care
• Medical equipment and supplies
• Social work services
• Bereavement counseling

Hospice care can be provided wherever the patient considers home. This can be in the patient's home, a relatives' home, a nursing home, an assisted living, a hospice facility, or a setting of the patient's and/or family's choice. The hospice team works diligently with all patients to ensure their needs are met, and they remain comfortable during this time.

How to pay for hospice care

In the United States, Medicare, Medicaid, The Veteran's Health Administration, and Private Insurance cover hospice care in most cases.

Medicare provides hospice coverage for Medicare recipients with terminal illnesses and a life expectancy of six months or less. Medicaid also covers hospice care for recipients who have hospice coverage and are considered hospice-eligible under their criteria.

The Department of Veterans Affairs works with hospice companies to ensure that veterans receive care; you may also be able to receive hospice care through the VA if you are a veteran or the spouse or caregiver of a veteran. To learn more about eligibility and how to apply for the hospice through the VA, visit their website or call 1-877-222-8387.

Private insurance companies and policies vary, but many will cover hospice care. 

We accept Medicare, Medicaid, and Private Insurance. We welcome VA hospice benefits and provide care for indigent patients. A patient's ability or inability to pay for health insurance should never be a factor in receiving compassionate, comforting, and dignified end-of-life care. Once a patient is certified as eligible for our services, there is zero out-of-pocket financial responsibility. The patient and the family will never receive a HOPE Healthcare and Hospice bill. 

How to choose a hospice program

When deciding on which hospice program is best for a loved one, it is essential to consider the following:

• Philosophy: What's the approach to care?
• Staff: Are they compassionate and knowledgeable?
• Services: What is included in the plan of care?
• Is the agency locally owned and operated: Or are they part of a corporate conglomerate in another state?
• Referral process: How easy is referring a loved one to the hospice?
• Is the Medical Director Hospice and Palliative Care Certified? Ask if the medical director is Hospice and Palliative Care Certified. Is the medical director trained to prevent and ease suffering for people with serious illnesses or who need end-of-life care, are they certified to improve a patient's quality of life by managing pain and other distressing symptoms of a serious illness?
• Are the nurses and support staff available after hours on weekdays and weekends? Are RNs available 24/7?

Symptom Management With Hospice Care

Transitioning to end-of-life can be difficult. HOPE strives to provide patients with comfortable care enabling them to have moments of peace as they experience their last seasons on earth.  

 HOPE has extensive experience in symptom management and understands the importance of identifying early signs of discomfort and treating them appropriately and swiftly.  A patient's final stage of life should be spent in comfort, surrounded by those most special, making meaningful memories. 

Physical Pain

Many patients can communicate their pain level to the hospice team; however, some patients won’t out of fear of appearing “not strong enough” or not wanting to "worry" their family and loved ones. Some patients are non-verbal and simply cannot, such as patients with Dementia; these individuals are unable to communicate.

Below are some signs and symptoms that loved ones and caregivers can be cognizant of, which may indicate pain is present.

• An increased breathing rate
• An increase in the patient’s systolic blood pressure from their baseline
• Becoming more aggressive and easily angered
• Crying
• Eyes closed tightly or blinking rapidly
• Guarding certain areas of the body when turning or resisting care
• Holding arm or leg muscles tightly or a rigid body posture
• Increased confusion/cognitive decline
• Moaning, calling out, sighing, and asking for help
• Rocking, fidgeting, or pacing

Managing Pain

Medication is the most utilized form of hospice pain management. Hospice care medications include the use of opioids for pain control. Opioids attach to “opioid receptors” in the brain, blocking the pain sensation. Opioids are reserved for moderate to severe pain and shortness of breath. Morphine is a preferred hospice medication for pain relief; however, every patient is different, and what works for one patient may not work for another. 

Some of the most often-used opioids are:

• Hydrocodone
• Hydromorphone (Dilaudid)
  
• Morphine
• Oxycodone

Misconceptions About Morphine and Other Opioids in Hospice Care Pain Management

Families occasionally express concern about opioids, including addiction. Symptom management is prioritized when a patient is terminal and provides the most effective pain relief.

Families also express concern that using opioids will accelerate the patient’s death. Research shows the opposite: patients in hospice care generally live longer once their symptoms are well managed, compared to those who do not receive effective hospice pain and symptom management. The key to starting hospice care sooner rather than later, and to start low and go slow when beginning an opioid.

Medications used in hospice care are very safe for symptom control and, when increased slowly as needed, for pain relief. Pain management protocols for hospice care require close monitoring of all patients’ needs for the drug, including proper dosage and secure storage of the medication if the patient is living at home.

Initiating hospice care as early as possible after receiving a terminal diagnosis enables quicker management of pain and other symptoms – allowing the patient to enjoy a better quality of life for longer.

Anxiety (Emotional Pain and/or Spiritual Pain)

Hospice care respects patients’ ability to participate in care plans when possible and encourages honest and transparent conversations—enabling informed decision-making based on sensitive and open communication. However, the primary caregiver takes over these conversations when a patient begins to have cognitive decline or deterioration in psychology, causing anxiety, restlessness, agitation, and/or behavioral changes. We must understand the root cause of the issue to treat it properly. Anxiety looks and feels different for everyone, with potentially multiple sources causing the current state of stress. The hospice care team will perform regular evaluations to understand the patients and their perspectives and experiences properly.

 Anxiety can present as physical, behavioral/emotional, or cognitive symptoms. Signs of anxiety can include: 

• Avoidance of family/friends
• Behavioral changes (uncontrollable crying, agitation, yelling/screaming)
• Changes in vital signs (increased breathing, increased heart rate, chest pain)
• Difficulty focusing
• Irritability
• Muscle twitching/trembling
• Nausea
• Nervousness (churning or “butterflies” in the stomach)
• Restlessness
• Sleep disturbances (insomnia or difficulty falling asleep)
• Sweating
• Tenseness

Managing Anxiety

Some of the most often-used anxiety medications are:

• Ativan
  
• Haldol
• Xanax
  

Counseling and Support are also beneficial options.

Shortness of Breath (Dyspnea)

Struggling for air is a symptom of many serious medical conditions that can be deeply frightening. Dyspnea, the technical term for shortness of breath, often culminates in moments of crisis and fear – both from patients experiencing it and those who love them.

Signs of dyspnea include:

• Labored breathing
• Tightness in the chest
• Fighting for air
• Feeling smothered
• Increased respiration rate
• Discoloration of nail beds and/or lips

If any signs of dyspnea are present, you should call the hospice company; you most likely should not call 911 if the patient is a DNR, as this would create an unwanted emergency room and hospital stay.

Managing Dyspnea

Hospice care provides proven therapies to manage shortness of breath. Oxygen therapy is usually the first line of treatment, but other non-medical interventions may help, too.

• Administering Oxygen—If the cause of the dyspnea is a chronic illness such as COPD, medications for that illness might need to be re-evaluated.
• Morphine—is the most used medication to relieve breathlessness because it dilates blood vessels in the lungs, reduces respiration rate, and increases the depth of breathing—all of which can lower the patient’s anxiety level.
• Anti-Anxiety Medications—this can make a patient feel better but can worsen the dyspnea.
• Use of a fan to move air across the face—a portable fan can give patients a tool to self-manage symptoms.
• Breathing techniques—a hospice can teach a technique called diaphragmatic breathing.
• Pursed lip breathing—can help patients by slowing their breathing rate and opening their airways to exhale more fully.
• Relaxation techniques—this helps to have anxiety from escalating, which increases the sensation of shortness of breath.
• Changing posture—sitting upright in a chair or bed or elevating the head can relieve pressure on the diagram and lungs.
• Increasing humidity levels and lowering the temperature—can make breathing easier.
• Reducing irritants—smoke, pet dander, and dust should be avoided as best as possible.

Hospice Care in Acadiana, Louisiana

Serving Areas Including Lafayette, Opelousas, New Iberia, And More!

HOPE Healthcare and Hospice is available 24/7 for patients throughout Acadiana - Ville Platte Jennings, Church Point, Eunice, Breaux Bridge, Crowley, St. Martinville, Kaplan, and all the stops between. Our mission is to provide compassionate hospice care with dignity and respect for terminally ill patients and their families, regardless of if they reside in urban or rural areas.

We offer comprehensive services to patients and families from our knowledgeable, caring, and compassionate hospice team and staff members. We understand that each person’s end-of-life journey is unique and strive to ensure that every individual receives the highest quality of hospice care possible. If you or someone you know is facing a life-limiting illness, contact HOPE Healthcare and Hospice today to learn more.