Routine home care is provided by hospice in the patient’s place of residence. The care is delivered by a specially trained and compassionate staff of medical, spiritual and social work professionals and volunteers. Assistance with pain management, skilled nursing care, symptom management and activities of daily living are provided. The interdisciplinary hospice team coordinates care with the patient and family.
Most patients, with the assistance of the hospice team, are able to remain in their place of residence, whether it is a private home or nursing home duration of their illness. If the patient lives in a long-term care facility or nursing home, the care delivered is in addition to the normal nursing care provided by the facility and is covered by Medicare under a separate benefit. The care is coordinated by the interdisciplinary hospice team, nursing facility staff, the patient and the family.
Routine Hospice Care is the most common level of hospice care provided to patients with limited life expectancy.
Routine Hospice Care includes, but is not limited to, nursing and home health aide services, as well as counseling and social worker visits. Patients may receive Routine Hospice Care in their home or wherever they “call home”— a private residence, a hospice residential care facility, a nursing facility, an assisted living facility or an adult care home – when the care is related to the terminal diagnosis and included in the plan of care for the patient. Routine Hospice Home Care includes intermittent visits from all the members of the Interdisciplinary Team.
A patient will be placed at this level of care if they reside at home (or a long-term care facility) and the symptoms of their illness are controlled with medication and treatments.
A patient receiving Routine Hospice Care has access to the following services:
- Visiting nurses
- Chaplains/Spiritual Care
- Social Worker
- On – call services 24 hours, seven days a week when needed
- Nutritional assessments
- Home health aide
- Pain and symptom management
- Medical equipment, medications and supplies
The needs of the patient will determine the number of visits from hospice staff team members. These needs are identified and outlined in a plan of care developed by you, the patient and family, and the hospice team and physician(s). The care plan serves as a guideline to assist all those providing care and support to the patient. At this level of care the patient also has access to an on-call hospice nurse twenty-four hours a day.
Nurses, physicians, social workers, nurse assistants and volunteers will work together efficiently and effectively to manage the symptoms of the patient’s illness, whether they are physical or emotional. The Supportive Hospice Care team will strive to understand the patients’ goals for living in this phase of their lives.
Knowing when it is time to decide on hospice and choosing the right hospice care provider are two critical decisions. Supportive Hospice Care is here to help guide patients through the decision making process for end-of-life care.
Continuous Care For Hospice Patients
On occasion, a medical crisis can occur which requires close medical supervision. Supportive Hospice Care has the ability to provide continuous, around-the-clock licensed nursing care for a hospice patient so they can avoid hospitalization. Once the medical crisis is over, the patient can return to routine hospice care.
A patient can receive continuous nursing care if they have symptoms that are uncontrolled and choose to stay in their home.
Continuous Hospice Care is similar to inpatient care, except for the fact that the patient remains in their home instead of being admitted to an inpatient care facility.
Continuous care for hospice patients is offered only during periods of “crisis” to maintain a patient in their home. This advanced level of care is necessary when symptoms are not well controlled and the patient requires sustained nursing care to achieve symptom control.
When Is Continuous Care Considered?
If a patient develops physical or emotional symptoms that cannot be properly managed with routine hospice care, continuous care may be an option.
Continuous care provides an advanced level of care in the patient’s home environment. A hospice nurse or home health aide will be present in the patient’s home environment for up to 24 hours per day to administer medications, provide treatments, care and support until the symptoms are controlled.
What Type of Symptoms Require Continuous Care?
Some examples of symptoms that may require continuous care include unrelieved severe pain, severe nausea and vomiting, severe shortness of breath, anxiety or panic attacks or a breakdown in the primary caregiver support system. Continuous care is considered a short-term level of care and is generally reevaluated every 24 hours.
Supportive Hospice Care has extensive experience in providing crisis care for our patients. Our Hospice Nurses and Home Health Aides stay with the patient for extended periods of time, day or night, to provide advanced levels of care. Not every hospice patient will need continuous care, but it is comforting to know that it is available and can provide important peace of mind to patients and their loved ones.
General Inpatient Care
Some patients may have symptoms so severe that they cannot get adequate treatment at home or they may feel more comfortable getting treatment at an inpatient facility. For these patients, inpatient care may be an option. Some patients may already be living in a facility that offers inpatient level of care and can benefit from its services. Others would have to be admitted to an inpatient facility.
Symptoms requiring inpatient care are the same as those requiring continuous care (above), only the setting of care may be different. With inpatient care, nurses are available around the clock to administer medications, treatments, and emotional support to make the patient more comfortable. The inpatient hospice services can be provided in a:
- Hospital – A hospice company may lease a unit in the hospital to provide inpatient care. In this case, hospice trained staff would provide around the clock care. A company may also have a contract with a hospital which would allow hospital staff to provide 24 hour care with hospice staff supplementing care.
- Long term care facility – As with a hospital, a hospice company may lease a unit in a nursing home or contract with the nursing home to provide care.
As with continuous care, inpatient care is considered short term and would be discontinued once a patient’s symptoms were under control and they were comfortable. If the patient was admitted to an inpatient unit, they may then be discharged back home.
At times, a hospice patient may require inpatient care when their symptoms worsen or can no longer be managed successfully at home. When pain or symptoms cannot be controlled with routine hospice home care, the patient will require extra assistance or more advanced medical attention until the symptoms subside.
Supportive Hospice Care takes diligent actions to control these symptoms to make the patient comfortable and safe. In order to accomplish this, the patient may need to be temporarily placed in a hospice home, hospital or acute care facility. At this “inpatient” level of care, a real-time assessment of the patient’s condition and their symptom status will be evaluated and a proper course of action will be taken in order to regain symptom control. The hospice care team and the patient’s physician(s) work together to ensure the patient achieves and maintains a tolerable level of comfort. Once pain and symptom management have been achieved, the patient can return home and resume routine hospice home care.
Typically, Inpatient Hospice Care is performed for a brief period of time that is necessary to manage acute symptoms in a clinical setting with a 24-hour nurse on staff. It may be required for certain procedures that require a higher level of nursing care to manage pain or symptoms.
Supportive Hospice Care has special arrangement with local hospitals and other accredited facilities where patients are able to receive the necessary care when their needs cannot be provided for at home.
What Symptoms May Require General Inpatient Care?
Some examples of symptoms that may require general inpatient care include unrelieved severe pain, severe nausea and vomiting, severe shortness of breath, anxiety or panic attacks. General Inpatient Care is a short-term level of care where nurses are available around the clock to administer medications, implement treatments, and provide emotional support to make the patient more comfortable.
Where is General Inpatient Care Provided
There are three types of facilities that may offer inpatient hospice services:
- Hospice Home
- Hospital
- Long Term Care Facility
Since inpatient care is considered short term, once a patient’s symptoms were under control and they were comfortable, they would return home and back to a Routine Level of Care.
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