Is it Time for Hospice? 3 Questions to Ask Yourself

Hospice care at the optimal moment gives patients the gift of time. They can come to terms with their diagnosis, spend time reminiscing, say goodbyes, get their affairs in order and focus on quality of life at the end of life.

Optimally timed hospice care also relieves healthcare professionals, caregivers and families of the crises, stress and challenges of increasingly challenging symptoms and situations as a patient declines.

Is it time to consider hospice? Answering these questions can help:

1. Is the patient facing one of these life-limiting diseases or conditions?

The most common disease and conditions associated with hospice care, according to the National Hospice and Palliative Care Organization, are:

• Cancer (28%)
• Cardiac and circulatory diseases (19%)
• Dementia/Alzheimer’s (17%)
• Respiratory diseases (11%)
• Stroke (9%)

Other conditions include end-stage liver and kidney disease, amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) and other degenerative neurological diseases.

Clinicians: Check disease-specific guidelines for hospice eligibility

2. Is the patient or loved one showing these signs of decline?

The following factors are good indicators that it’s time for hospice:

• A doctor has certified the patient has six months or less to live if the condition/disease follows its normal course
• Curative treatments (medications, chemotherapy, rehab, etc.) are no longer effective or create side effects that prolong suffering, discomfort and pain
• The patient has decided to stop testing, hospitalizations and treatments in favor of palliative care
• The patient is increasingly unable to perform the activities of daily living (personal hygiene, dressing, eating, maintaining continence, transferring)
• Over 4–6 months, the patient has experienced any of these:
• Loss of 10% or more of body weight
• More than 3 hospitalizations or emergency room visits
• Presence of other co-morbid conditions
• Declining physical activity
• Declining mental alertness/cognition

3. Have you taken the patient’s wishes into consideration?

A patient’s preferences for end-of-life treatment will be spelled out and easy to follow if they have an advanced care plan (ACP). This includes a living will, durable power of attorney for healthcare, or (in some states) a Five Wishes document. If the patient has made it clear that certain procedures or interventions should or should not be pursued in the face of a life-limiting illness, the hospice team can craft a care plan that honors the patient’s wishes while focusing on the quality, not the quantity, of time that remains.

If you have questions about hospice appropriateness, contact the admissions department of a local hospice. The staff should be able to answer questions or send a clinician to evaluate the patient and meet with the family at no cost. Aided by this information, you’ll have a better sense of when the time is right for hospice care.