How Hospice Works


The Hospice Team
Terminally ill hospice resident Evelyn Breuning, 91, (R), sits with music therapist Jen Dunlap at a hospice facility in Lakewood, Colorado. The hospice accepts the terminally ill regardless of their ability to pay, although most residents are covered by Medicare. John Moore/Getty Images

Every hospice patient, once registered, is assigned an entire team of professionals. A nurse performs an initial assessment to ascertain what the patient's physical, emotional, psychosocial and spiritual state are. Using those details, a plan of care is drawn up and agreed upon by the team and patient. According to Mastrojohn of the National Hospice and Palliative Care Organization, the interdisciplinary team typically consists of the following:

Registered nurse: Generally, the nurse, who is also considered a case manager, visits once or twice a week to assess the patient, answer questions, and order prescriptions and equipment. More frequent visits will be necessary as death draws nearer, and typically a nurse or assistant is present continuously for the last day or so of life. They know the signs as death draws nearer (changes in heart rate, blood pressure, breathing), and that makes them able to know when to have an increased presence.

Hospice physician: You might never lay eyes on, or even speak to him or her, but an M.D. signs off on all treatment and medication orders made by the nurse. Think of them as the Great and Powerful Oz of hospice.

Home health aide: Visits two to three times a week to help bathe the patient and provide other hygiene assistance. The home health aide can also do light hospice-related housekeeping, like changing bedsheets.

Social worker: Advises or helps people work through complex hospice-related issues like stress, anticipatory grieving and caregiving decisions. Many hospice groups also provide post-loss grief counseling to the family, as well.

Clergy or other spiritual counselor: These professionals are optional, but available if needed to help patients and families deal with spiritual concerns.

"Frequency of visits and the types of folks that will come out really are based on the patient's condition," Mastrojohn says. "Typically, there's more service in the beginning because they're coming out and making assessments, then typically as the patient declines those services will pick up again."

Some hospice groups offer extra services, like dietician consultations, and art, music or massage therapy, as well as aromatherapy to reduce anxiety and stress associated with hospice.

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