Q and A: When is the right time to call in hospice?

Question: When is the right time to call in hospice? My Mom is resisting contacting them for my dying father.

Answer: I’ve seen family members get into quite a debate as to whether or not to call in hospice care, even though everyone knows that their loved one is dying. Sometimes the answer lies within the heart and mind of the person who is dying. If your father is aware of his end-of-life condition, which I image he is, then perhaps a heart-to-heart conversation with him is in order.

Today, oncologists and family physicians are much more open about telling patients the status of their disease, including “how much time they may have left.” This is so different from the 1950’s when my grandfather died of cancer. Everyone walked around acting like Grandpa would get better-especially around Grandpa. Families and physicians believed it was best to spare the loved one from the agony of knowing. Your Mom, being part of that generation, might still feel that she wants to spare your Dad from the heart-wrenching reality of his impending death. So, she holds off calling hospice because she feels it is a symbol of dying.

Yet, if your Dad knows his illness is terminal, then chances are there are some very strong needs he’s internally wrestling with: he wants to be reassured that his dying will be as painless as possible, and that your Mom will be spared from being physically ill herself from the toll of caring for him. And I’m sure that your Mom also wants to see your Dad out of his pain.

So, if you stay focused on these two needs and then re-introduce the concept of hospice, your Mom may be more receptive. If she sees hospice as helping your Dad’s pain management and if your Dad sees it as helping your Mom by coordinating all of his care, then they may both see hospice in a new light. You can also reassure your Mom that if your father decides to pursue treatment to extend his life (e.g. chemotherapy or radiation) he can opt out of hospice and go back to the service later.

There is another advantage to hospice care, as Medicare will also cover respite care for your mother as long as your Dad is receiving hospice care. Thus, if your Dad needs to stay in a nursing home, in-patient hospice facility or hospital to provide him palliative care in order for your mother to get a break, Medicare will pay almost all of the cost for his inpatient respite care for up to five days. Your parents may be responsible for a small co-pay for the respite care, depending on the assessment of the hospice medical team.

Information provided by Dr. Linda Rhodes, Finding Your Way, 250 Real Life Questions and Commonsense Answers http://lindarhodescaregiving.com/index.htm