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  • Mitch Ware

Episode 7: What is the Real Difference Between Hospice in the Home and Inpatient?

In this episode we take a look at the differences between hospice home care and hospice inpatient care as well as the benefits of each. What we discover might surprise you!

"The primary caregiver continues to be the main person to help make decisions for the patient throughout the length of the hospice care for patients receiving in home hospice care."


hello and welcome to another episode of Living with Hospice. I'm your host, Mitch Ware I'm a long term hospice volunteer as well as an experienced client of several hospices. I'm not a doctor. I'm not a nurse. I'm not a social worker or a therapist. But I have years of firsthand experience with several hospice organizations, and I'm a certified in vetted volunteer for several of them. Today we're going to take a look at the difference between a hospice in home care and hospice in patient care. And when the two can overlap and really, what the benefits of both are and ah, stay tuned. Because I think you might be surprised at what we're going to discover today. If you hear a noise in the background, we've got the whole gang here. Cosmo Kramer, the silly big Irish wolfhound slash Alaskan Husky is laying by my feet and ah, Chloe, the female orange kitty is in her condo looking over the top at me, watching me, which drives me nuts and Charlie Boss Cat. And he's run around here somewhere trying to keep order of things.

Every Medicare certified hospice provider must provide four levels of care That's number one routine. Homecare number two, Continuous homecare number three, general Inpatient care and for respite care. Let's take a look at those a little closer routine Home care is the basic level of care under anybody's hospice benefits. If a patient resides in a nursing home, it can also be called routine nursing home care. And it includes things like, Well, nursing service is, ah, physician participation. Social service is home health aides. Counseling service is is, you know for spiritually past Auriol. Breathe mint dietary. It also includes, um, the management of medications. It involves the providing medical equipment, medical supplies and lab and other diagnostic studies and tools related to a terminal diagnosis. If you have continuous home care, a nurseand or Home Healthcare aide will remain in the patient's home environment for 8 to 24 hours a day. Continuous care is a short term level of care reevaluated every 24 hour. So you may be asking, Well, jeez, how do you qualify for that? Or what constitutes the need for that continuous home care like that? Some of the symptoms requiring this would be things like unrelieved pain, severe nausea and vomiting. Ah, severe shortness of breath, anxiety or panic attacks that just really aren't being controlled. Or maybe perhaps a breakdown in the primary caregiver support system. And, boy, there are a 1,000,000 war stories that we could we could share with each other about that one. But let's not go there. GENERAL Inpatient Care Some patients have short term symptoms so severe that they can't get adequate treatment at home, or they may feel more comfortable getting treatment at an inpatient facility. Symptoms requiring inpatient care are the same is those requiring continuous care. On Lee, The setting of care is different, with inpatient care nurses air available around the clock to administer medications and treatments and emotional support and all of that to make the patients on the patient's family. We're comfortable. There's several types of facilities that offer inpatient hospice service is there's a freestanding facility owned and operated by the hospice company. There's an inpatient hospice unit within an existing facility or institution like a hospital, for example, and a hospice unit in a skilled nursing facility, or what some folks call a nursing home or assisted living. The next level is what we call respite care, respite care Service's are more for the family than the patient if the patient doesn't meet the criteria to qualify them for continuous care in impatient. But the family is having a difficult time, which is almost all the time. In my experience, this is really a great option if a patient's family is a primary source of care and can't meet their loved ones needs due to caregiver stress or just being worn out. Or maybe there's some other extenuating circumstances. A patient can be temporarily admitted to an inpatient facility to give the family a much needed break a respite. And, quite frankly, that's what happened in our lives. And I'm gonna share that story a little later on. In this episode, we need to Note here that there's a five day limit on respite Care. Once that period expires, the patient is discharged in returns back to their home or to their assisted living facility or whatever. Okay, so let's back up just a little bit. In order to qualify for hospice care, patients, doctor and often a hospice doctor as well must determine that the patient is terminally ill. That means a life expectancy of six months or less in order to qualify for hospice. The decision to treat someone at a higher level of care falls to the hospice physician. With four levels in place, No terminally ill patient should ever be left without the appropriate care. Hospice Agency's most often provide service is in the patient's home. In fact, hospice care can also be provided by free standing or independent facilities, especially designed to provide hospice care or through programs based in hospitals, nursing homes, assisted living centers or other health care systems. Some of these agencies offer both care in the home and care in an impatient facility. In fact, quite a few do. I know there's several hospice organizations here in our community that offer both in any hospice setting. The comfort care is designed to be available 24 hours a day, seven days a week. Your doctor, hospice, social worker, case manager or discharge planner can be helpful in deciding which type of hospice program is best for you in your family. Now, when someone enters into hospice care, they're asked to pick someone to be their primary caregiver. Usually this is a family member or close friend in our situation, it was always a family member, actually was several family members that were involved in the care. But one of us was chosen as the primary caregiver. And the primary caregiver works with the hospice team as well as the patient to develop a care plan based on the patient specific needs and preferences. Patients differ from patient to patient, and their preferences certainly defer. The primary caregiver continues to be the main person to help make decisions for the patient throughout the length of the hospice care for patients receiving in home hospice care, the primary caregiver not only provides most of the physical care for the patient, but also helps with keeping records, and records are kept on symptoms and medications and any other problems that might occur. The primary caregiver can share the physical care responsibilities with other family members or maybe even hired caregivers like visiting nurses. But the primary caregiver still takes the responsibility for communication with the hospice team and the scheduled caregivers in the home as needed, and vice versa. This works great because that way hospices, hearing from one person and not a whole family, and if hospice needs to get a hold of the family. They work through one person for patients getting hospice care in a setting other than at home. The primary caregiver, who was a family member, is still considered to be part of the hospice care team. The primary caregiver attends meetings and helps plan the care for the patient not very often, but sometimes there's no family available to take on the primary caregiver rule. The patient needs to to share that with the hospice team member who first comes to talk to them about hospice service is they'll also need to talk to their insurance company. There may or may not be other care setting options available depending on your insurance coverage, depending on your network of friends. Maybe it's your church or whatever. The types of hospice programs that are available will be discussed with you by the hospice professionals and together. As a team, you make a decision that works for you. You worked together in planning in forming a solution that will meet your needs. Okay, let's review a little bit. Most people get hospice care at home, people who live in places like residential facilities, certain types of assisted living. Um, nursing homes all can get hospice care there. Most of the patients that I see are in assisted living facilities, yet I do see some patients in their homes. If hospice care is needed for a person leaving him one of these assisted living facilities or nursing homes, it may be considered in home care, since the facility is the patient's home. Health insurance coverage can vary on this, so check with your insurance provider in ask questions. Don't be afraid to ask questions. That's why they're there. It's important to know that home hospice care may require that someone be home with the patient 24 hours a day, seven days a week. Now, this may be a problem for people who live alone or whose partner or adult Children have full time jobs and can't be there. But in most cases, creative scheduling and good teamwork among friends and loved ones can overcome this problem. I have yet to see it not overcome. Members of the hospice staff will visit regularly to check on the patient. They also check in with the family and the caregivers. They will make sure that any symptoms are under control and give any needed care and service is care begins when the patient is admitted to the hospice program. That generally means that the hospice team member visits you at home to learn about you and your needs. If you're in assisted living, they come there and visit with you. Sometimes they'll visit you in the hospital. If you decided to receive passports, care while there. Or maybe you've decided to to transition from curative care in the hospital to hospice care or palliative care at home or in assisted living, and the hospice team will meet you there. If this is a concern for you, rest assured that most hospices confined. Ah, volunteer to help you if there is no one else available to handle around the clock needs or crisis Home Hospice programs have an on call nurse who answers phone calls day and night every single day of the year. They also make home visits, and they send out team members as appropriate, Uh, who you may need between scheduled regular visits And if you're wondering Medicare certified hospices, which almost all of them are all Amar to my knowledge. But that doesn't mean they all are. I guess there could be some that aren't ah, but Medicare certified hospices have to provide nursing pharmacy in doctorsservices around the clock every day of the week. Now let's take a look at impatient hospices for just a minute, Um, and what we refer to as free standing or independent hospices. Many communities have inpatient hospice facilities. Thes may be operated by ah hospice agency that also offers in home care. Or they could be just freestanding. Independently owned hospice is that may or may not also offer In HomeServices, the freestanding hospice can be helpful to patients who don't have caregivers available to them at home or need around the clock physical care. Hospital based hospices often have a special program within the hospital itself. This gives patients and their families easy access to support service's and allows the patient to get around the clock care and to help get control of OH, symptoms and issues that pop up. Some hospitals have a special hospice unit, while others use the hospice team. The visits patients with advanced disease or whatever in pretty much any nursing unit in other hospitals. The staff on the patient's unit and our certified as the hospital's hospice team. The patient returns to in home hospice care when they're again comfortable nursing home or long term care. Facility based hospices are very common. Many nursing homes and other long term facilities have small hospice units. They might have specially trained nursing staff to care for the hospice patients or they might make arrangements with home health care agencies or independent, community based hospice is to provide that care. This could be a really good option for people who need hospice care but don't have someone to take care of them home. Now let's look att Hospice, Inpatient care, Sometimes severe pain and other symptoms just require an advanced level of care that is more effectively provided during an inpatient hospice facility. They're the patient receives 24 7 palliative care by the medical staff and the volunteers in that facility. Most inpatient facilities are at full capacity, and there's a waiting list in order to get started. For those who wish or need to transition to inpatient care. If that's the case in your situation, don't take it personal. It's just that there's a lot more people needing inpatient care than there are inpatient facilities to handle the need. And there is another option. A compromise of sorts, short term respite care. Respite care serves as well more of a thing for the family than for the patient. If the patient doesn't meet the criteria to qualify them for continuous care in an inpatient facility. And, quite frankly, the family's having a very difficult time. If a patient's family is a primary source of care and can't meet their loved ones needs due to caregiver stress or any other extenuating circumstances, a patient may temporarily be admitted to an inpatient environment to give the family a much needed break or respite. Now, to be clear, there's a five day limit on respite care. But, wow, those five days are just golden. And once that period expires, a patient is discharged and returns back to home. As you know, our son Matt wanted to stay in his own home in battle cancer and, well, you was taking its toll on his body. After several years of curative care, he made the decision to turn to hospice home care. My wife and I were his caregivers, and I was the designated primary caregiver. I left my job to be with him during the days and he had roommate that was with him at night. During one of her visits, the nurse shared with us that we looked wiped out. Boy, was she right. She then went on to share with us about this thing called Hospice Respite Care told Matt that if he came over to the inpatient care facility, he would be totally pampered and that his parents could once again be, well, parents and that caregivers parents could get some much needed rest knowing that, well, he would be in terrific hands. And golly, she was right. I remember my wife and I both slept through the night like babies. That's the first time in a very, very long time. We got a full night's rest and same for Matt. You know, we we'd put on a good face for him, and he did for us, too. We all states diligent, you know, for the fight this time out was just what we all need it. If you're in a hospice care situation, ask your nurse or social worker about their particular hospice. Inpatient respite visit. Trust me, you'll be glad you did. Thank you for tuning in to us today. It's always an honor to share time with you and discuss this difficult subject. If you have questions or comments, or maybe you have some interesting stories you'd like to share with us, please send them to our email at We may cover your question or your comment, or maybe even share your story if you like. In one of the upcoming episodes for Living With Hospice, this is Mitch Ware and the whole gang have a blessed day.

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