When to begin hospice care

Question:

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

Answer:

It’s not uncommon for family members get into quite a debate as to whether or not to call in hospice care, particularly when older adults are involved. 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 to live. But it hasn’t always been that way. Families and physicians used to believe it was best to spare loved ones from the agony of knowing that they’re dying. Your mom 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.

However, if your dad knows his illness is life-ending, chances are there are two very strong needs he’s internally wrestling with: the desire for a death that is as painless as possible, and sparing your mom from becoming physically ill herself as a result of the toll of caring for him. 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 with 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: Medicare will cover respite care for your mother as long as your dad is receiving hospice care. This way, 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 need to pay a small co-pay for the respite care, depending on the assessment of the hospice medical team.