During the most challenging moments of our lives, we all can appreciate some extra support. Expert words of advice. A friend, a family member, or a shoulder to lean on.
A compassionate and caring heart. At Shalom Hospice, our trustworthy team of trained and highly skilled care professionals work together to design an individualized plan of care that meets both patient and family needs. Both the Hospice Medical Director and the attending physician participate in the development and medical supervision of this plan of care.
Medical Advisory Team
The Medical Advisory team provided by Shalom Hospice physicians brings an additional level of expert care to the treatment of terminally ill patients. The patient’s relationship with their regular physician is preserved, while the hospice physicians bring a new emphasis on pain management, comfort control, and quality of life. At times when a patient’s attending physician is not immediately available, hospice physicians ensure that prompt and trustworthy medical decisions are made.
Our compassionate Registered Nurses are the heart that pumps through hospice, caring directly for each hospice patient during regularly scheduled visits. Other nurses’ duties range from coordinating the delivery of medications and supplies to answering the many questions patients and families often have. Our hospice care team will assist patients and their families, whenever the situation calls.
On-Call Nursing assures a Shalom Hospice registered nurse remains available 24 hours a day, 7 days a week, 365 days a year.
Our experienced and caring Hospice Aides supplement the care provided by R.N.‘s, often assisting patients with manicures, pedicures, hair styling, bathing or other personal care, as well as assisting with light housekeeping. We plan to set ourselves apart from the rest with our tentative ear, to make sure that all of our patient’s needs are met.
Medical Supplies, Equipment, and Prescriptions
Medical supplies, equipment, and prescriptions related to the patient’s comfort or terminal condition are covered by the Shalom Hospice program. Our trained and skilled nursing staff will assess the need for these items and coordinate their delivery, according to the need of the patient. Most deliveries will be made on the day of admission.
Social Services provided by social workers include counseling patients wishing to resolve emotionally painful family issues that take on a new sense of urgency in times of terminal illness. Our trained social workers also are available to assist with other needs. These needs that will be addressed range from helping families communicate with insurance carriers and financial institutions to planning memorial or funeral services. We will also be there to assist with transitioning from hospital to home or care facility.
Spiritual Counseling is available to patients and families by our trained and licensed chaplains. The patient’s personal religious beliefs are always well respected, and assistance is typically limited to the degree and frequency that patients and families themselves have the right to choose.
Bereavement Support helps surviving family members find healthy and comforting outlets for the emotional needs that accompany the loss of a loved one. Shalom Hospice maintains contact with family members for at least a year but is not limited to, following the patient’s death. We will be with you until your family feels that the extension of support is no longer needed.
Trained Volunteers also provide emotional and compassionate support when patients and families need it most. Services may include everything from visiting to offer companionship, socialization, and assistance with fun and enjoyable activities, to helping with errands and providing a break for caregivers if needed.
Round the Clock Continuous Care
Round-the-clock Continuous Care can be coordinated, either in the patient’s home or in a licensed long-term care facility, should the patient’s condition warrant it. Although most acute conditions can generally be brought to a manageable level within 48 hours, our registered nurses and home health aides will remain on-site around the clock as long as their services are required.
Transitioning to In-Patient Care
In-Patient Care is provided in a hospital when a patient suffers an acute setback that precludes on-site treatment in either the home or care facility. Should pain or other symptoms become unmanageable, Shalom Hospice arranges for the patient’s admission to a hospital until the condition can be brought under control.
Respite Care consists of the hospice patient’s admission to a skilled nursing facility for as long as five consecutive days. This allows direct care family members to get relief from caring for their loved one with the assurance that their loved one is receiving the best possible care in their absence.
Specialized Therapies addressing the patient’s physical, occupational, speech, or dietary therapeutic needs are available whenever they may be required to manage pain or symptoms related to their terminal condition.
How Hospice Is Paid For
Many hospice patients are eligible for the Medicare Hospice Benefit that covers medications and equipment related to the terminal illness, visits by the Hospice team, and bereavement support for the family. Shalom Hospice also accepts Medicaid and private insurance. The financial services specialists at Shalom Hospice will assist you in negotiating with individual insurance carriers.
If you or someone you love is interested in learning more about hospice services, we want to help. Once we receive your response, a hospice representative will be in touch promptly to explain our services and how we can meet your needs.
Our admission nurses are available 24 hours a day, 7 days a week to travel to any location within our service areas (50-mile radius of a Shalom hospice office) – whether it’s a person’s home, skilled nursing facility, nursing home, hospital, adult living facility, or other residential settings.
Once the decision to trust in Shalom hospice has been made, your physician will be contacted by a hospice nurse to obtain admission orders.
On admission, we will work with your physician to develop a customized plan of care to meet the needs of both the patient and family.
Following admission, the Shalom care team will remain available 7 days a week, 24 hours a day to provide the best in compassionate care and support that you can count on.
When Is It Time to Consider Hospice?
Patients and families often say that wish they had known about hospice care sooner.
It is a common myth and misconception that hospice is only for the last few days of life when in fact, hospice can be a great benefit for a loved one or someone you care about when initiated early on, in the final weeks, or even months of life.
The decision to choose hospice is a very personal one. Though it is an individual’s choice, it also involves their physician and loved ones who may serve as caregivers. It is imperative that everyone understands the patient’s desire to receive expert comfort care and to remain in their home or place of residence among family and friends.
Physicians are sometimes reluctant to recommend hospice as early as possible. They may feel the patient is not ready to consider hospice and may assume that the patient and family want to continue aggressive treatments. Or a lot of times, with some diseases it may be very difficult to determine life expectancy.
Always remember, you can sometimes inquire about the option of hospice care to your physician. If you are considering hospice but unsure if it is time, here are some signs that might be of help.
- Are we at a point that treatment is no longer helping?
- Have you had repeated visits to the ER or hospital?
- Has there been an increase in shortness of breath, fatigue, pain, or nausea?
- Has daily living become increasingly difficult?
- Has the fact that you caring for your loved one become overwhelming?
If you answered “yes” to any of the above and would like more information about how hospice can help, we encourage you to speak with your physician or call us 24 hours a day, 7 days a week. We are here to explain our services and answer any questions you may have.
Discussing Hospice: The Key To Timely Referrals
Some common possibilities to why physicians may delay a discussion of hospice with their patients and families:
- The perception that a referral to hospice is “giving up” on the patient and their family
- Lack of knowledge concerning the benefits that hospice services bring
- Uncertainty about the eligibility of a hospice referral
NOTE: With a physicians’ order, Shalom hospice can send a Nurse out to evaluate you are your loved one, to assess whether or not he or she may qualify.
Important reasons to discuss the hospice option as soon as your patient is eligible:
- Hospice care is most effective when started, as early as possible; at this point, the patient first meets eligibility criteria. Nationally, though, half of all terminally ill patients die within one month of admission, while only 20% die within the first week of care.
- While hospice is normally able to control the physical pain of late referred patients, a late referral eliminates the opportunity to provide a much-needed spiritual and emotional support system to patients and their families.
Some of the compelling reasons to introduce the concept of hospice care to your patient include:
Medical Care – Pain management is a major focus of the Shalom hospice care team. Shalom Hospice stays up to date on the latest in pain and symptom management techniques. Most treatments designed to keep people comfortable can be provided in the patient’s home, but should more extensive care be required, we will assist in locating a facility that will meet the patient and family’s needs.
Emotional and Spiritual Support – Your Hospice team includes chaplains and social workers who help patients and families come to terms with the process of dying. They assist patients in completing some of those important tasks associated with dying, such as saying their final good-byes, mending broken relationships, and giving and seeking forgiveness.
Caregiver Support – The chores of daily living can be overwhelming to the caregiver. Hospice can relieve some of the burdens by providing home health aides to assist in the personal care of the patient. Hospice volunteers perform many functions, including providing friendly visits for support and socialization and sitting with the patient to allow the caregiver an opportunity to take a break.
Financial Relief – Most patients on Hospice care access the Medicare Hospice Benefit that covers medications and equipment related to their diagnosis, visits by medical and nursing professionals, home health aides, short-term inpatient care, and bereavement support for the family following death. Hospice also accepts Medicaid and private insurance. The financial services specialists at Hospice will assist in negotiating with individual carriers if needed.
Bereavement Care – Shalom Hospice will follow the family for a full 14 months after the death of their loved one with visits, phone calls, mailings, offers of support groups, and invitations to grief education programs.
Guidelines For Hospice Care and Treatment
Physicians will often recommend comfort care when it becomes clear that continuing aggressive or curative treatment is no longer beneficial to the patient.
The focus of hospice care is to provide the best quality of life possible for patients and their families. Hospice specializes in pain and symptom management. Often the symptoms are not physical, but spiritual, emotional, or social. Hospice attempts to control pain in such a manner that patients are able to remain alert and active to the extent possible.
Electing hospice care is a very personal decision. It is crucial that certain information be thoroughly understood by the patient and family at the time that the decision for hospice is made. For example, it is important to clarify that hospice care neither hastens nor prolongs the natural dying process and that the patient has the right to exercise choice with respect to services.
Interdisciplinary Team and the Plan of Care
The patient and family work together with the Hospice team to design an individualized plan of care to meet the patient/family needs. Both the Hospice Medical Director and the attending physician participate in the development and medical supervision of this plan of care.
Comprehensive Hospice Benefit includes
Treatments related to the terminal diagnosis typically covered under a hospice benefit include:
- Medication-related to the primary diagnosis
- Nursing care
- Home Health Aide/personal care
- Spiritual comfort
- Social work support
- Volunteer support
- Medical equipment and supplies required for the comfort and safety of the patient
- Oxygen therapy
- IV therapy required for the comfort of the patient
- Respite care (temporary care of the patient in a facility to provide a break for the family)
- Inpatient General Care (temporary care of the patient in a facility to better manage pain or symptoms)
- Continuous Nursing Care (see Availability of Care)
- Physical therapy
- Speech therapy
- Nutrition counseling
- Bereavement support
Items Excluded from Comprehensive Hospice Benefit
Treatments focused on curing the terminal illness, or treatments that or intended to extend the length of life but compromise the quality of the time remaining, are generally not provided for under the comprehensive hospice benefit.
Availability of Care
Hospice patients have the ability to reach Shalom Hospice representatives by phone 24 hours a day. Specially trained on-call staff members are ready to visit at any time of the day or night, 7 days a week when it is needed.
Times, there are sometimes occasions when a patient will require Continuous Care. These extended visits are covered under the Hospice Benefit when they are required for pain and/or symptom management.
Hospice does not provide routine around-the-clock care.
The primary care of the patient is the responsibility of the family. Some families employ private duty caregivers to fulfill this need if they are unable to provide care for the patient themselves.
IV Hydration and Tube Feedings
Hydration is often not helpful during the last stages of life, and may actually cause more discomfort than relief, therefore these decisions are always carefully discussed with the patient/and or family.
Hospice will provide care for patients requiring tube feedings when the patient is already receiving tube feedings upon admission to hospice. If a patient loses the ability to take food and fluids by mouth while under the care of Hospice, the patient and family will be assisted by the hospice team to consider whether the placement of a feeding tube will further the goals of comfort for the patient.
Effective care planning and the availability of the Hospice on-call team eliminate most needs for hospital ER visits or admissions. In rare cases, when symptoms cannot be managed in a home setting, the Hospice may arrange for a General Inpatient Hospital admission. Patients also have a right to revoke their Hospice benefit at any time in order to pursue aggressive life-prolonging treatment.
Shalom Hospice does not discriminate in admission or access to, or treatment in its programs and activities based on race, national origin, color, religion, sex, disability, or age.
Understanding The Role of the Attending Physician
When a patient is referred to Hospice, the primary physician will maintain the role of attending physician. The reason for this is your attending physician typically has established a relationship of trust with the patient and family, and they will continue to look to their primary physician for reassurance that they are receiving the best care possible.
The primary physician will also be asked to review the patient’s plan of care, review and/or amend the Hospice standing orders, sign the DNR status, receive updated plans of care, and participate in telephone consultations with Hospice staff.
In exchange, our team of hospice professionals who are experienced in managing physical, social, emotional, and spiritual pain will care for your patient. For example, a telephone triage RN is available for your patient’s emergency needs, 24 hours a day, seven days a week, to assess your patient’s symptoms or pain issues and dispatch assistance as required.
The Hospice team is not complete without you. We look forward to working in partnership with you to provide comfort and compassionate care to patients and families dealing with the difficult journey of life-ending illness.
Why Refer To Hospice?
Introducing hospice care provides a very important option when you want to be sure that patients and their families are receiving all of the benefits and support they deserve when dealing with a life-ending illness. Hospice care is most effective when provided over a period of several months. Nationally, though, half of all patients die within one month of admission, while a full 20% die within the first week of care. While hospice is usually able to control the physical pain of late referred patients, the late referral also eliminates the opportunity to provide much-needed spiritual and emotional support to patients and families both before and after the loss of their loved one.
Support For The Discharge Planner
Ways hospice can work in partnership to assist the discharge planner:
- Communicating difficult information
- Facilitating family conferences
- Interceding with complicated family dynamic issues
- Identifying common misconceptions concerning hospice care
Common Myths About Hospice Care
Physicians, nurses, case managers, discharge planners, and social workers are held accountable if a patient outlives their six-month prognosis.
It is not uncommon for many hospice patients to exceed their initial prognosis. In fact, patients are sometimes discharged from hospice care because they have experienced a significant level of improvement in their overall health.
It is the responsibility of the hospice team members to continue to monitor patient eligibility. Patients may continue with hospice care as long as they meet eligibility criteria.
Patients die sooner with hospice care than without.
It is the philosophy of hospice to neither speed up, nor slow down the natural dying process. However, it is believed that patients may actually live somewhat longer once their pain is adequately managed.
Therapies such as blood transfusions and radiation automatically exclude a patient from Hospice.
Many therapies that once prohibited a patient from obtaining hospice services are now considered on a case-by-case basis. These therapies must be utilized for palliative (comfort) purposes, not as a means of attempting to “cure” the illness.
Patients must sign a Do Not Resuscitate (DNR) prior to admission to hospice.
Although many hospice patients choose to sign a DNR prior to entry into hospice, this is not a requirement for admission. If a patient or family makes the decision to sign a DNR, the document may be signed at any time. DNR status has no bearing on the care that a patient receives while enrolled in hospice services.
Patients can only receive hospice care for a limited amount of time.
The Medicare benefit, and most private insurance, pays for hospice care as long as the patient continues to meet eligibility criteria. Patients may come on and off hospice care to seek aggressive treatment and re-enroll at a future time of their choosing.
Patients have to give up their own doctor.
Patients may keep their own physician, who will work closely with the Hospice Team to plan and carry out care.
Hospice is only for cancer patients.
A large number of hospice patients have congestive heart failure, dementia, chronic lung disease, or other conditions – see Medical Guidelines in this section
It is complicated to refer a patient to Hospice.
Referring a patient to hospice is a very simple process: