When to use hospice

HOTC When to Use Hospice Graphic

When treatment focus shifts to comfort care and you determine that the patient’s life expectancy is six months or less, it is time for a hospice referral. Hospice care is not just for those patients who are close to death. In fact, the more time a patient can receive hospice care, the more benefit they and their family will receive.

Two physicians must agree that the patient has a prognosis of six months or less. One of those physicians can be the hospice medical director. A good starting point is to ask yourself if you would be surprised if the patient lived for another year. If you would be surprised, then contacting hospice should be the next step.

Hospice is for patients of all ages and is appropriate for a variety of life-limiting illnesses, including, but not limited to, the following conditions:

  • Alzheimer’s Disease and other forms of dementia
  • Heart Disease
  • Lung Disease
  • Cancer
  • Liver or kidney failure
  • Neurological disorders, such as Parkinson’s disease or ALS.
  • Comorbidities

For more detailed guidelines related to specific diseases, view our criteria for hospice appropriateness or contact our office for more information.

General indicators for hospice care include:

  • Increased or uncontrolled pain
  • Progressive weight loss
  • Decline in ability to perform activities of daily living
  • Frequent infections, emergency room visits or hospitalizations
  • Progressive decline despite curative interventions
  • Increased weakness or fatigue
  • Withdrawal, confusion or inability to get out of bed
  • Poor nutritional status

Hospice staff is available to provide an assessment and informational visit, free of charge and with no obligations, for patients who are considering hospice care. We are also available as a resource for you if you need help in determining if hospice is the right choice for your patient and if it is the right time. Please call our office at 763-531-2424 and we will gladly assist you.

How do I start the conversation about end of life care?

Talking about end-of-life care, particularly hospice, does not mean that you are giving up on the patient or that there is nothing that can be done. Hospice is aggressive symptom management and comfort care. It is a matter of reframing hope considering the patient’s goals of care. It can be comforting to the patient to know there is another source of support and help available to them.

HOTC How to Start the Conversation Graphic

Consider talking with patients about hospice as giving the patient choice. By talking about it, you are helping them make the best decision for themselves and their family. Your relationship with the patient is very important and they trust you. Talking about hospice with them helps them to know that it could be a good choice for them and that you are willing to walk this journey with them.

It is never too early to discuss end-of-life wishes. The discussion about hospice could be part of developing an advance directive. The conversation may be a natural follow-up when specific events occur:

  • The diagnosis of a terminal illness is made.
  • The patient has had many exacerbations of their illness
  • There have been frequent emergency room visits or hospitalizations.
  • The patient is tired and discouraged because of the treatment of the illness.
  • The patient asks about hospice care.

Starting the conversation with a discussion about the patient’s goals of care and what is important to them at this time may provide an easy transition to a discussion about end-of-life care, including hospice.