When To Consider Hospice For A Sick Loved One

We spend our lives dodging death but no matter how hard we try, the death reaper will eventually find us one day. The quest to stay alive is understandable but we should also prepare something for death.\

 

The sight of losing a loved one can give you goosebumps but the reality is that anyone can fall prey to a lethal illness. It is generally seen that the overwhelming feelings of love abstain many from discussing death and disease with loved ones. This makes making the decision of hospice care an uphill task.

 

If you have a loved one who has been diagnosed with a terminal illness and you wonder when to consider hospice, then this article is for you.

 

What Is Hospice Care?

Hospice care is a type of medical care given to patients who are terminally ill and chances of treatment working are very thin. Hospice care is also known as end-of-life care. This type of care is aimed at improving the quality of life but not curing the illness.

 

Hurdles In Acquiring Hospice Care: Myths And Ambiguities

 

I Am Not Giving Up!

The biggest hurdle in calling hospice care is the feeling of the sick that they are giving up. Studies show that despite enthusiasm regarding autonomy in the last few days, there is unease in commitment to hospice care.

 

This is certainly not the case. Hospice care is aimed to help ease out symptoms and make life better rather than shun the patient to die.

 

No More Medical Care!

It is a common myth that elderly patients won’t receive medical treatment if they opt for hospice care. The myth needs to be debunked as any terminally ill patient receiving hospice care can get optimal medical treatment too. In fact, providing hospice care to patients receiving medical care leads to greater cost-efficiency and less aggressive treatment. This phenomenon was seen in a 2019 study carried out on advanced lung cancer patients.

 

It Is Only For Terminally Ill Patients!

No, hospice care can also be given to family members too. Elderly patients who suffer from cognitive issues or suffer from paralysis may also take help from professionals. It offers counseling and help that makes the patient autonomous in daily chores such as cleaning, washing, and shopping.

 

Palliative Care And Hospice Care Are The Same

Hospice differs from palliative care. The former offers care to anyone seriously ill and not just those who are dying while the latter is imparted to people to those who no longer seek a cure and are waiting for death.

 

Aim Of Hospice Care

The aim of hospice care relies on the preferences of the patient that are mentioned below:

 

• Receiving adequate pain/symptom management
• Avoiding inappropriate prolongation of dying
• Achieving autonomy and a sense of control
• Strengthening relationships with loved ones
• Relieving burden

 

These above-mentioned domains were identified as focal points in hospice care, in a study. Members of hospice care also provide spiritual care and may help you perform last rituals at the time of death.

 

A 2019 study suggests that home hospice care facilitates nursing care for patients and should be provided by hospitals.

 

Levels Of Hospice Care

Hospice care is offered at four different levels. Two of these happen at home.

 

Routine Home Care

This is administered at the patient’s place of residence. The hospice team (doctor, nurses, etc.) visits the residence and assesses the patient’s and family’s needs for additional services as well.

 

Continuous Home Care

This level is more intense than routine home care. It is given during brief periods of crisis management. It is provided by skilled professionals as a nursing home can not provide this level of care.

 

General Inpatient Care (GIP)

This level of care is provided out of the patient’s home environment. It is usually imparted when the pain and symptoms of the patient can not be managed without a hospital setting.

 

Respite Care

As the name indicates it is designed to provide respite to the caregivers. This is short-term care given in a facility during times when the caregiver needs a break. However, it should be given for no more than 5 consecutive days.

 

The Right Time To Call Hospice Care

If you see these signs in your loved one don’t miss a second in calling hospice care:

 

1.       When The Treatment Isn’t Doing Any Good And The Patient Prefers Quality Of Life

When combating a terminal illness many people get tired along the way. Medicinal drugs and therapies are responsive for some but in many cases, they cause more harm than good.

 

Studies show that with hospice care, quality of life is significantly improved for patients requiring palliative care.

 

If your loved one is fed up with taking numerous prescription medicines and pricks of needles, it is high time that you ease them out and call hospice care. As per a study, embracing hospice earlier is linked to a better quality of life due to the stoppage of burdensome and ineffective curative treatment.

 

Hospice care usually begins when the doctor finds that the patient’s life expectancy is six months or less. You can consult your doctor about acquiring hospice.

Common illnesses that become refractory to treatment include:

 

• Cancer
• Degenerative disease of the lungs
• Cardiovascular issues
• Cerebrovascular accident/injury (stroke)
• End-stage kidney disease (uremia)
• Liver failure

 

 

2.       You Have To Visit The Doctor/Hospital Frequently

A 2017 study reveals that there are nationwide efforts being made to make an early transition from hospital readmissions to hospice care. The aging elderly of our homes fall prey to infections and maladies very frequently. This leads to regular visits and admissions to the hospital. Adults over 75 have increased visits to the emergency department.

 

Sepsis and shock are identified as major causes of frequent hospitalization in adults. There are a number of issues entailed to these visits including:

 

• The physical and financial burden on family
• Commuting issues
• Change of environment for the elderly

 

A study (carried over a 10-year period) found out that acute respiratory infections are very common in the elderly. Community-acquired pneumonia and Acute exacerbations and respiratory failure in Chronic Obstructive Pulmonary Disease (AECOPD) lead to ICU hospitalization. The greatest numbers were seen in patients aging 95-89 year-olds.

 

A good criterion to call hospice care is to count the number of hospital visits in the last six months. If the frequency is high then it can be an important sign of declining health and the need to call hospice care.

 

3.       Increased Frequency Of Falls

Older people usually have compromised vision and weak muscular systems to support the body. The negative effect of these aging changes is an increased frequency of falls.

 

Falls are no issues for toddlers but for the elderly, a fall can be catastrophic. The greater the age, the higher the consequences. In a follow-up study of 11 years, it was found that almost 2900 individuals suffered falls, all of these sufferers were aged 69-99 years. Therefore, it is pivotal to save our loved ones from falling.

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This, however, requires a full-time attendant with the elderly. Younger members of the house are given the responsibilities of earning and making the ends meet for which they have to go out of the house. This is where hospice care can be of benefit.

 

Adults with cognitive impairment are at a greater risk of falling. Changes in visual motion perception and balance control also contribute to the chances of falling.

 

If your parent(s) is/are experiencing frequent falls, then it is high time to take help from hospice. A 2019 study claims that functional rehabilitation carried out by the hospice teams leads to significant improvements in biomechanical parameters. A 6-month intervention can improve the balance and impart autonomy to the elderly, thereby, improving quality of life as well.

 

4.       Abrupt Changes In Weight

It is a common observation that old people undergo weight changes as they enter later stages of life. Older people are not concerned about their looks so, this falls under the category of unintentional/involuntary weight loss.

 

It is important to keep track of the changes in the weight of the elderly. According to a study, weight loss greater than or equal to 5 kg is an early predictor of early institutionalization (hospice care).

 

Another important reason for tracking the weight of your sick loved ones is because unintentional weight loss is reported to be indicative of an underlying neoplasm (in one-third of the patients). The malignant disease accounts for 16-36% of cases of unintentional weight loss.

 

Similarly, abrupt weight gain can also have some serious complications. As per a prospective study, weight gain and obesity in individuals above 65 years of age are linked to decreased quality of life, reduced physical function, and body pain.

 

You should call hospice when the abrupt changes in weight hinder your loved one’s daily activities. Becoming frail or obese can pose to be a problem that can be solved by hospice care as early as possible.

 

5.       Reduced Desire To Eat

Terminally ill patients usually get distressed and this distress may lead them into bequeathing all the pleasures of the world. One of the prime pleasures that senile members of the house give up is eating.

 

A reduced desire to eat should be a serious concern. If your parent(s) is/are lacking a desire to eat, then you should take help from hospice care. Studies suggest that poor appetite is directly linked to malnutrition. The changes in BMI can seriously complicate the quality of life and it is suggested to treat the issue with early intervention in the elderly.

 

6.       Uncontrolled Symptoms Of Disease

You can contact a hospice team if the symptoms of a particular disease are not being managed by regular treatment. The hospice team may utilize complementary and alternative medicine (CAM) to relieve the patient of symptoms such as pain, nausea, vomiting, and diarrhea (contrary to routine medicinal management). A systematic review indicates that CAM can bring short-term benefits in patients with symptom burden.

 

Patients with cancer have a hard time dealing with nausea and vomiting. However, pharmacovigilance in hospice care can be pretty beneficial in the management of nausea and vomiting, as indicated by this study.

 

Hospice care teams are trained to carry out pain management at the end of life. You must consider hospice care for the pain management of your loved ones because the pain management of cancer patients receiving hospice care was far superior to the usual patients.

 

According to a retrospective study, pain management at home is efficient and should be imparted to terminally ill patients. The main purpose of these studies is to make you realize that hospice care should be available as soon as possible to carry out symptomatic management of your sick loved ones.

 

7.       Issues In Memory/Cognition And Sleep

A vast majority of adults find themselves confused and oblivious of the world, all due to dementia taking over. About 45% of people receiving hospice in the US suffer from dementia. Therefore, this is an increased demand for dementia management training in hospice care. This is why hospice teams can be of immense help.

 

The professionals can help your loved one carry out simple daily tasks. When compared with non-dementia patients, dementia patients follow a longer enrollment period in hospice care.

 

As per research, hospice care can enable the provision of better services and quality care for people with end-stage dementia. Some individuals receiving hospice care experience a slower decline in health.

 

Another issue that should also receive some light is the aggression associated with cognitive and memory issues. Family members are in a fix trying to manage the aggression whereas a hospice team is trained to manage such a situation.

 

 

8.       Depression And Loneliness

Loneliness and depression are rare in geriatric patients living with their children. The prevalence of depression, anxiety, and stress is higher in the elderly living in geriatric homes.

 

The fact that you are dying puts you into stress and depression. Research shows that depression is a predictor of quality of life.

 

And if this is paired with loneliness, management is even more difficult. So, if you see your adult/loved one becoming quiet and recluse, then take help from hospice care.

 

9.       Inability To Perform Daily Chores

Dependence to run basic errands is a serious disability. An inability to perform daily tasks such as eating, walking, and using the toilet can land the patient and the family caregivers in trouble.

 

If your loved one is becoming dependent and needs someone to stay with them for the whole day, you should call the hospice care team asap!

 

Professionals in a hospice team not only help in performing these tasks but also train sick individuals to become independent. Therefore, hospice is efficient in serving as a rehabilitation modality. A 2020 study demonstrates that rehabilitation in patients receiving hospice can reduce the burden of care for families/caregivers. It also improves a patient’s quality of life, instills a sense of well-being, while controlling symptoms (pain and others).

 

If you want lifestyle medicine interventions in your loved ones with advanced disease then it is better to call hospice care.

 

How Can Hospice Care Benefit My Loved One?

The ideal time for calling hospice care might be difficult to determine. However, the benefits of choosing this service are clear cut and evident because it offers the following:

 

• A familiar environment for the elderly
• Provides a comprehensive plan
• Lessens the financial burden of the family
• Also provides counseling to family and caregivers
• Imparts personalized care
• Lets the patient maintain his/her sense of dignity

 

According to a systematic review, hospice care has a positive impact on the psychological well-being of terminally ill patients while being cost-effective (especially for patients dying with cancer).

 

A 2021 study concludes that hospice centers play a crucial role in helping patients to come out of trauma during the advanced stage of cancer. Thus, hospice care can provide a dignified death to the patients.

 

Conclusion

Admitting to the fact that your loved one is falling into the arms of death is a big ask. Keeping your eyes closed to this harsh reality is the most common response by family members. However, a terminally ill patient needs your help and the best way to aid your loved one is to call hospice care.

 

It is difficult to decide when to call for help but if your sick loved one is experiencing the following issues then spare no time in calling hospice care:

 

• The patient wants the quality of life over aggressive treatments
• Suffers from recurrent infections and falls
• Experiences weight and mood changes (depression, anxiety, cognition)
• Is dependent and unable to perform daily chores

 

Hospice care can greatly improve quality of life and provide relief from unresolved symptoms of the terminal disease (pain, nausea, and vomiting). The professionals also train the patients to become independent and guide the caregivers about managing the patient.

 

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