HJNO May/Jun 2021

HEALTHCARE JOURNAL OF NEW ORLEANS I  MAY / JUN 2021 31 MYTH 1: Hospice is a place where one goes to die. REALITY: Hospice care is provided in the comfort of wherever a person calls “home.” This could be in a private residence, nursing facility, assisted living home or in a residential care facility. The hospice team provides care to people where they reside. MYTH 2: Hospice patients only have a few days left to live. REALITY: Hospice cares is provided to those with a prognosis of six months or less and who also have a life-threatening or terminal illness, if the disease runs a typical course. If the disease does not follow a typically aggressive course, the person could possibly live longer than six months. Myth 3: Only cancer patients are eligible for hospice services. REALITY: Hospice provides care for any person with any end-stage disease, including cancer, liver disease, pulmonary disease, heart disease, kidney disease, CVA/stroke, Alzheimer’s disease, HIV and any other disease that is considered to be in the end stage. The Center for Medicare Services provides guidelines to follow for hospice to determine if the disease qualifies as being end-stage and appropriate for hospice admission. MYTH 4: The patient’s physician will no longer be involved with the patient’s care. REALITY: The patient’s primary physician collaborates with the hospice medical di- rector in managing the patient’s care and medications. The hospice medical director is available 24/7 for consult, but the patient’s primary physician actually follows the patient’s care and oversees the medication recommendations. Information about the patient’s care is routinely reported to the patient’s primary physician. MYTH 5: Hospice overmedicates patients to hasten death. REALITY: Hospice does not overmedicate patients to hasten death. Hospice pro- vides specialized care in providing comfort and symptom management to patients with a terminal illness. Its team strives to find the correct medication balance to pro- vide optimal comfort for the patient they are caring for to ensure quality of life. All medication recommendations are made under the guidance of the hospice medical director and the patient’s primary physician. MYTH 6: Hospice will cost too much. REALITY: Hospice is a benefit of Medicare, some Medicaid programs and many private insurance companies. Most hospices do not charge their patients for any services they provide, including durable medical equipment and medications. How- ever, some hospice agencies do charge copayments and other related fees to the patient. It is always important to investigate the differences in hospices and select the one that has the patient’s best interest in mind. MYTH 7: I must have a “do-not-resuscitate” order to be admitted to hospice. REALITY: One does not have to have a DNR order to be admitted to hospice. Patients have a right to choose which life-sustaining procedures they do or do not want implemented. MYTH 8: Once the admit documents are signed, a patient must remain on hos- pice care until they die. REALITY: Patients have a right to revoke the hospice benefit at any time and for any rea- son. They also have the right to be reinstated to hospice at a later time, provided they meet the eligibility medical criteria as established by the Center for Medicare Services. MYTH 9: All hospices provide the same care. REALITY: All hospices must follow governmental regulations outlined by state and federal agencies, however, not all hospices are the same. Hospices can differ in the scope of services they provide, the medications and/or therapies for comfort they provide and the durable medical equipment they will provide. Additionally, there are four levels of hospice care that can be provided: routine care, respite care, continuous care and inpatient care. Not all hospices are able to provide all four levels of care to their patients. MYTH 10: Patients do not have a right to choose their own hospice agency. REALITY: Most patients consult with their physician when hospice is introduced. The physician usually makes the recommendation to the patient that they should have a hospice consult. The physician must certify that the patient meets the criteria to be admitted, and he/she must write an order for hospice to evaluate and admit to the hospice program if the patient’s situation is appropriate. However, the patient/ guardian has the right to decide whether or not they actually want hospice care. They also have the right to interview and choose their own hospice agency. The patient/ guardian should let the physician know which hospice agency they should send the order to. HOSPICE MYTHS VS REALITIES What has surprised you by this work? McCann: I think the thing that surprises me the most about working in hospice is that it gives me a sense of fulfillment. People often ask how can I do this kind of work (working with people dying) day in and day out? The answer is that I like helping people have a successful death. My first nursing job, many years ago, was on a postpartum/GYN floor. The goal of every mother who came into that hospi- tal was to have a successful birth. Also, to help obtain this goal, there was a team approach — the obstetrician, the anesthe- siologist, the nurse, the coach, the mother and ultimately the newborn baby. With the help of the team, prayerfully the deliv- ery resulted in the successful birth of the baby! Likewise, I believe that every patient should have a successful death. I believe that there should be dignity and comfort on all fronts — physically, emotionally and spiritually. The interdisciplinary team, working alongside the family (coach) and the patient, is in place to aid in the success- ful transition of the patient. Valteau-Sorapuru: What surprised me the most about this work is patients’ and fami- lies’willingness to open up their homes and personal lives to a complete stranger while treating me as if I am part of the family. When you enter into someone’s personal space and life, you must be very respectful of their beliefs and be sensitive toward their culture and values. Will you share a beautiful passing you have witnessed? What made it special? McCann: I have had the privilege of working withmany patients during my career in hos- pice. I have also had the intimate privilege of being present at numerous deaths. Being by the bedside of a patient who is dying, seeing that the patient is comfortable, and seeing the family effectively coping is one of the most fulfilling things I have experienced — successful death! Being able to walk them through the last few minutes of their love