Hospice has been covered by Medicare since 1982. Health-care providers have to certify that a patient is terminally ill, with six months or less to live, which can be difficult to predict, according to both Diane Meier, director of the Center to Advance Palliative Care and professor of geriatrics and palliative medicine at Mount Sinai Hospital in New York, and Thomas Michael Gill, professor of medicine, epidemiology and investigative medicine at Yale University. People can leave hospice at any time, because their condition stabilizes, for example, or they want to pursue curative treatments again. Hospice care can also be extended beyond six months.
“Many people are fearful that if they choose hospice, they won’t be able to return to mainstream medicine should they improve or new treatments become available but that’s not true,” Meier says. “Hospice is not a one-way street.” Some evidence suggests that hospice patients live just as long as or even longer than similarly ill patients who are not in hospice. If you have not discussed hospice with a doctor, for yourself or a loved one, two signs suggest when it might be time to raise the topic, Meier says. The first is when someone is having increasing difficulty with self-care, struggling with tasks such as walking, getting out of a chair, bathing, dressing and using the toilet. Hospice care is designed to help with all of those activities. The second is the presence of symptoms such as severe pain, shortness of breath, hopelessness, depression and profound fatigue. In hospice, “most of them can be improved or eliminated,” Meier says.
People with terminal illnesses and their doctors should be having ongoing discussions about goals and priorities, Gill says, ideally long before hospice is broached. “Often, patients will say, ‘I’m more interested in the quality rather than the quantity of my remaining life,'” he says, and that can help inform future discussions about end-of-life care. “It’s challenging to have honest discussions with patients and families about death and the dying process,” Gill says. “But leaving the conversation until the very end makes it more difficult.” From: ConsumerReports.org
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