Receiving a terminal diagnosis is devastating news for patients and families. While the initial reaction may be to continue pursuing aggressive treatments, there comes a time when these interventions are no longer beneficial or desired. Hospice care offers comprehensive comfort care and support for those facing the end of life, allowing them to spend their remaining days surrounded by loved ones in the setting of their choice. So when is the right time to transition from active treatment to hospice services? Consider the following indicators that hospice may be appropriate.
Diagnosis of a Terminal Illness
A tеrminal diagnosis indicatеs that a disеasе is еxpеctеd to rеsult in dеath within 6 months or lеss if it follows its normal coursе. Whilе prognosis can bе difficult to prеdict еxactly, cеrtain disеasеs likе mеtastatic cancеr, еnd-stagе hеart failurе, еnd-stagе dеmеntia, and еnd-stagе lung or livеr disеasе havе rеasonably wеll-dеfinеd trajеctoriеs. Patiеnts who rеcеivе a tеrminal prognosis may fееl dеspondеnt or insist on continuing aggrеssivе trеatmеnt. Howеvеr, curativе trеatmеnt is not thе goal of hospicе carе. Instеad, thе focus is on comfort, quality of lifе, and holistic support for thе patiеnt and family. Bringing up hospicе soon aftеr diagnosis givеs thе patiеnt timе to undеrstand and accеpt what liеs ahеad.
Difficult to Manage Symptoms
Patients with advanced illness often experience severe and complex symptoms that are challenging for providers to control. Examples include shortness of breath, pain, nausea, anxiety, agitation, and more. If these symptoms persist in spite of maximal medical management, it signals that the disease is progressing. Hospice staff specialize in symptom control, customizing a plan of care to provide the best possible comfort. With access to specialized treatments like nerve blocks for pain, patients can often achieve better symptom control under hospice care.
Uncontrolled Pain from Underlying Cancer
Living with cancer comes with side effects and pain, which typically gets worse as the disease advances. If pain becomes excruciating and unresponsive to high dose opioid and adjuvant medications, it diminishes quality of life significantly. Hospice can provide better pain management through specialized techniques like nerve blocks, anesthetic pumps, neurolytic blocks, and sedation. With the aggressive pain control options available through hospice, patients can be made more comfortable.
Frequent Hospitalizations
For those with advanced illness, hospitalizations are often triggered by issues like pain exacerbations, infections, dehydration, falls, and complications of further cancer spread. If someone requires hospitalization for similar issues more than 2-3 times within 6 months, it can signal that their body is under extreme stress from progressive disease. Frequent hospitalizations also take a toll on mental, emotional and financial wellbeing. Hospice care allows patients to remain home with close medical supervision and access to medications, equipment, and visits from hospice staff. This reduces the likelihood of repeating hospitalizations.
Dependence on Others for Activities of Daily Living
Bathing, dressing, eating, mobility – when illness strips away a person’s independence, it can be emotionally shattering. Daily activities once taken for granted become impossible chores without help from others. Qualifying for hospice generally requires needing assistance with at least two activities of daily living (bathing, dressing, feeding, mobility, toileting). With the support of hospice staff, family caregivers don’t have to go it alone when caring for these needs. The specialized medical and personal care can help ease the burden.
Progressive Confusion or Restlessness
Metastatic cancer, liver failure, kidney failure – many advanced diseases cause toxins to accumulate in the body. This can lead to worsening confusion, restlessness, and even delirium. When a patient’s mentation fades in spite of medical efforts, it indicates deterioration. Hospice provides medications and around-the-clock oversight to help control these symptoms more effectively. Patients don’t have to distressingly cling to consciousness alone but can slip away peacefully guided by hospice support.
Increasing Weakness and Fatigue
As the body systems shut down, people describe advanced illness fatigue as unlike any tiredness they’ve experienced before. Simple tasks become impossible. The desire to move or participate in activities diminishes. When fatigue and weakness progress to spending most of the day sleeping/dozing, it often indicates a transition to actively dying. Hospice helps by bringing supportive care into the home while the patient sleeps more peacefully and family keep vigil at the bedside.
Decreasing Appetite and Excessive Weight Loss
Late-stage illness often involves metabolic changes and loss of appetite. As the body begins shutting down, patients describe food tasting different or feeling forced to eat. Despite family’s urging to maintain strength and weight, the patient experiences little hunger and cannot manage more than small bites. This signals that the body is entering a catabolic state. Continuing nutrition needs should be evaluated. However, appetite loss alone does not mandate artificial nutrition, which can actually increase discomfort near death. Hospice nurses help families understand this natural decrease in intake as the end draws near.
The services of hospice aim to enhance comfort, meaning, and dignity during life’s final chapter rather than achieve cure. This requires a mental recalibration for patients and families accustomed to “battling” disease. By focusing on quality rather than quantity of life, hospice care values the whole person. While saying goodbye to loved ones is painful, sharing intimate moments together through the end of life journey brings a chance for closure. Hospice offers the gift of helping patients to live fully all the way through their final days. If the indicators above resonate with your family’s situation, now may be the time to learn more about hospice services in your area.
Why Hospice?
Hospice is a treatment modality. Meaning just like you would take medications to treat something, the treatment received by patients while on hospice provides a benefit. While some patients and families are looking for help to off load daily tasks and focus on getting day to day activities done, others benefit from hospice by using it as a treatment modality. The frequent check ins, the increased medical scrutiny (frequent nursing visits and close physician oversight), the increased emotional support, the increased spiritual support, and the increased medication monitoring allows patients to live better as well as live longer.
Admission to hospice earlier in the disease process allows patients to focus on quality of life, live more comfortably, and live longer. How? Patients live longer by being better managed, being more closely watched and having all of their needs met. Living life and living longer is more than just taking pills, it’s about love, caring and support. This is the core of what hospice provides.
At Lenity Light Hospice we strive for excellence by providing compassionate care at all the time. This philosophy stems from our roots of pursuing clinical and nonclinical excellence while prioritizing our customer/patient service. Visit us at our website for more information about hospice and visit our hospice blog for more great articles!
