If his or her life expectancy is measured in months rather than years, the patient is almost certainly eligible for hospice. Although the general guideline is a six-month prognosis, each case is different. The important thing to remember is that quality of life with hospice assistance for both the patient and the caregiver is much better than without, so the earlier hospice care is initiated the better.

Some indications that a patient may be ready for hospice care include:

• Repeated visits to the emergency room or the hospital, from which the patient doesn’t recover at the normal rate
• Difficulties breathing, urinating, eating or sleeping, inability to comprehend simple instructions, or increased complaints about pain
• Increased need for assistance in performing routine activities
• Decreasing awareness of activities going on around them, or a desire to sleep more and converse less, but there are some other considerations that might also help you decide whether you should look into hospice eligibility.
• Are the caregivers feeling overwhelmed? Are they struggling to provide care for the patient that they really feel unqualified to provide?
• Is it important to the patient to stay at home, whether that’s a private residence or a long-term care facility
• Could the patient benefit from having services like skilled nursing, counseling and spiritual support come to them, rather than having to make office visits for all of these services?
• Is it important to either the patient or the family to have a say in the patient’s plan of care?

If you answered yes to any of the above questions, and you or your loved one has been diagnosed with a life-limiting illness, it is probably time to at least ask about hospice.

Hospice services are not provided by a single nurse or doctor. Rather, they are provided by a team of individuals that includes doctors, nurses, social workers, chaplains, bath aides, personal care attendants and counselors, all of whom contribute their expertise to the patient’s plan of care.  All members of the hospice team treat the patient in his or her own home, whether that’s a private residence or a long-term care facility.  Hospice nurses provide whatever medical care the patient needs, and teach the patient’s family how to provide care between visits.

But Catholic Community Hospice provides much more than simple nursing care.

• First, our nurses are certified in palliative care and pain management, meaning that they are specially trained in keeping patients comfortable.
• These same nurses serve not only as the patient’s and families’ advocate with the physician, but also with the entire hospice team. Counselors, chaplains, social workers and other professionals are available for home visits as needed. It’s as simple as asking the visiting nurse.
• Our nurses use laptop computers, and update each patient’s plan of care at each visit. That way the most current information is readily available when questions arise.
• A registered nurse is available 24 hours a day for consultation.

That is why Catholic Community Hospice nurses, unlike most other hospice nurses, are certified/specially trained in pain management and palliative care.

Catholic Community Hospice uses a variety of modalities for treatment of pain:

• Massage Therapy
• Touch Therapy
• Music Therapy
• Pet Therapy
• Guided Imagery
• Aroma Therapy
• Pain Medication
• Other Holistic Approaches

Perhaps one of the first and best indicators of the sort of care you will receive from a particular hospice is its nurse-to-patient ratio. Catholic Community Hospice has one of the lowest nurse-to-patient ratios in the metropolitan area. This allows them more time to care for the patient as well as the caregiver and to meet special needs as they arise.

Moreover, most of our nurses are experienced hospice professionals, taking personal pride and satisfaction in providing the very best of care to their special patients. As a result, our nursing team is very experienced in all aspects of hospice care, and our employee turnover rate is very low.

Pain management/palliative care expertise

 The nursing team of Catholic Community Hospice is certified or in training to be certified in both hospice and palliative care. That means they have received special training in how to keep their patients comfortable and able to enjoy as high a quality of life as possible.

Compatible philosophy

Catholic Community Hospice professionals respect the faith of their patients, whatever it may be, and help their patients work not only toward peace and reconciliation within that faith tradition, but also with those loved ones they’ll be leaving behind.

If you’re interested in more information on hospice, help is only a phone call away.  A doctor’s order is required for hospice services before care can begin.  We can help you coordinated with your doctor to retain a order for hospice care.

The following books might be particularly helpful to those considering hospice, and are widely available:

• Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying, by Maggie Callanan and Patricia Kelley
• The Hospice Choice: In Pursuit of a Peaceful Death, by Marcia E.Lattanzi-Licht
• The Good Death: The New American Search to Reshape the End of Life, by Marilyn Webb
• The Handbook of Hospice Care, by Robert Buckingham
• The Hospice Handbook: A Complete Guide, by Larry Beresford
• Final Choices: To Live or to Die in an Age of Medical Technology, by George M. Burnell

There are also numerous Web sites providing information about hospice, to which links are provided below. Among the best is the Web site of the National Hospice and Palliative Care Association ( www.nhpco.org ), of which Catholic Community Hospice is a member.

Other useful sites include:

www.hospicenet.org
www.hospicefoundation.org
www.americanhospice.org
www.hospiceweb.com

• Worsening clinical signs – see below
• Worsening lab values
• Decreasing functional status
• Evidence of metastatic disease

Clinical signs

• Pain, nausea or vomiting
• Thrombosis or DIC
• Bone marrow involvement requiring transfusion
• Superior vena cava syndrome

Disease stage

• Stage IV (any T, any N, M1) at presentation
• Progression of any earlier stage of disease to metastatic with either of the following:
  • Patient continues to decline in spite of definitive therap
  • Patient refuses further treatment

Performance status

Karnofsky score 50% or less
Karnofsky score 70% or higher, if patient has progressive disease, declines therapy, or does not qualify for therapy

• Ability to speak is limited to 6 words or fewer
• Ambulatory ability is lost
• Cannot sit up without assistance
• Loss of ability to smile
• Cannot hold up head

Patient should show all of the following characteristics:

• Inability to ambulate independently
• Unable to dress without assistance
• Unable to bathe properly
• Incontinence of urine and stool
• Unable to speak or communicate meaningfully

• Progression of disease documented by symptoms or test results
• Decline in Karnofsky score
• Weight loss supported by decreasing albumin or cholesterol
• Dependence with 2 or more of the following:
  • Feeding
  • Ambulation
  • Continence
  • Transfers
  • Bathing and dressing
  • Dysphagia leading to inadequate nutritional intake or recurrent aspiration
  • Increasing emergency visits, hospitalizations, or MD follow-ups related to their primary medical diagnosis
  • A score of 6 or 7 in the Functional Assessment Staging Test (FAST) for dementia
  • Progressive stage 3-4 pressure ulcers in spite of care