Hospice to Funeral: “Fact or Fiction?”

On Tuesday June 6th, Lake Ridge Chapel was happy to host Scott Myers, Executive Director at Hospice of the South Plains in our free Education Event series.  This time we turned to the topic of “Hospice to Funeral: Fact or Myth”.  With Scott going through a list of Myths and misconceptions about hospice, the interactive audience asked many relevant questions.  This article follows the evening as a transcript.  We hope you enjoy learning from Scott as much as we did!

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The “H” word – gets different responses
Some feel so strongly you can’t even say “Hospice”

“You do a great work” vs “You are the angel of death”
Someone will talk to Scott about his work or run the other way
Hospice – think “call Lake Ridge Chapel” or “I have three days left”
Together we can destigmatize the talk about Hospice

Some people have a great experience and to others it’s a negative topic
One thing is to deal with myths and facts about Hospice

Myth:  Hospice is a place

Not a place, but a philosophy that focuses on the quality of life up to death
How do we do that?  It’s not the same for everybody; not a cookie cutter.
All of us are different and have different expectations with different wants and wishes

Question:  Does hospice only deal with terminal illness?  Is there a time limit for care?

Hospice does have to do with a terminal illness, but no time limit on the medicare benefit

The doctor has to sign a “certification of terminal illness” that says disease progression means life expectancy is 6 months or less.  Patients have been on hospice for 2 years.  Nobody knows when the Good Lord will take you.

Myth:  Hospice only takes care of cancer patients

a patient may be terminally ill with heart disease, COPD, alzheimers, liver disease, AIDS
Or a combination of these

Myth: To receive Hospice Care, a caregiver is required

Part of the job as hospice is to come in and out of the home
Have to plan for when that person may die and help make arrangements

Question:  When you speak to a doctor about alzheimers, can they predict symptoms?

Yes and no, it’s hard to predict
A person progresses as they progress
Certain indicators have been given to us
Government has doctors coming together to share indicators that life is coming to an end
One is incontinence, the other is “How many words can they say”
A chart goes from 1 to 7, then 7a, 7b, 7c, 7d.  Patients have to get through all 7+ words.

Breathing and heart are the last ones to go.  The person gets where they can’t talk.  Then they start repeating words.  1. Don’t recognize family, 2. Trouble walking 3. Confined to bed 4. Doctors can refer to Hospice to go check on someone to see where they are in needing hospice

Question:  Is it the same in every state to assess Alzheimers?  

It won’t differ state to state because Medicare is national and pays the same state to state
Doctors recommendations could be different from one to another

Question:  Qualifiers – is there a big list for qualifying for hospice?

People might have Congestive Heart Failure – diagnosis of 20% circulation qualifies
You’ll have swollen feet, chest pain, and the systems to verify New York Heart Hospital’s list
Category 4 – gets hospice care, Category 3, 2, or 1, may not get hospice care

Question:  In the hospital, when the nurse or doctor says “You are ready for hospice”

Who makes the decision to take you to hospice and what hospice do you choose?
There are about 12 hospices in the city of Lubbock, about average.  Dallas has upwards of 300.

You make the decision. The doctor, as much as we’ve been programmed to go by what they say, we still have the choice of what to do.  Doctors are smart but we get to choose the hospice.  Doctor may only suggest 1 of 3 but we are allowed to choose for from among all of them..

Joint Commission inspects hospitals.  Some hospices are inspected and accredited.  Jaco, Chaps, choice of the entity.  Doesn’t make the institution better or worse necessarily.

Myth:  To receive hospice care patient must stop receiving treatments

Not necessary to stop treatments that provide comfort, palliation, pain control

You’re not going to get chemo to cure your cancer, you’ll get chemo to help control pain possibly. If that is the treatment necessary for pain control.

That’s a palliative measure.  The goal for hospice is to make you as comfortable as possible.

Question:  What if someone is diagnosed with incurable cancer and they don’t opt for conventional method of treatments?

Doctors and Hospice would look at weight loss and pain threshold.  Physician would say yes.  Has the cancer spread or is it local?  Pancreatic cancer, nobody would even ask.  They qualify.  One patient received one treatment and said “no more treatments, give me hospice.”

Every 90 days there will be a recertification for six months, then every 60 days after 6 months.  The patient will never lose their medicare.  Looking for weight loss and disease progression.

Myth:  Patient must have a DNR for hospice care

Can’t descriminate and don’t have to have a Do Not Resecitate
Do you want a ventilator, CPR and fracture a rib, other things to keep you alive?
Do you want to pass away peacefully with your loved ones and no hoses or tubes?

For example:  Patient had no family or friends
They found a daughter living in another state that hadn’t seen her dad in years
A lot of people may not be ready to die, yet is has been suggested they call hospice.
What are the patients goals for their life?  As best they can, talk about what life remains.
Getting somebody ready to die, we’re all going to at some point.  When are you ready to die?
It’s hard to get family members on board with family members ready to die.

Question:  Does going on hospice eliminate the need for a medical examiner?

DNR eliminates the need for a medical examiner.
When a patient dies at home, fire truck, ambulance, police all come to the 911 call.
Nurse will come out once a week, twice a week.  Nurse will help with bath weekly.
Social work will be out within the first few days to talk DNR, nursing home, end of life.

Chaplain will ask if patient has a church affiliation and volunteers may stay an hour or just a visit.
3-4 times, possibly 5 times per week, people will be coming by to visit under hospice

Question:  What can people do when they are taking care of a patient?

Change sheets, bathing, making sure there are no wounds, they see and report to a nurse, tidying up the bath area and making sure it looks OK.

Some assisted living workers might at least start the patient eating, but not feed them the whole time

Question:  Can a patient receive hospice at a hospital?

Those scenarios revolve around unpredictable symptoms:  pain, vomiting, seizures, but not for more than seven days

Terrible ice storm, a patient was sent from hospital to a nursing home after a stroke
She did get hospice at the nursing home but died three days later.

Myth:  Patient and family must be ready to die to receive hospice

The patient and/or family must able to have a full understanding of hospice and the palliative, not curative, nature of the treatment provided.  The role of hospice can be to prepare the patient and family but the patient does not have to be ready to die to receive hospice.

Question:  Should family of a patient in a nursing home put pressure to go on hospice?

The patient needs to receive the care they are needing. If the family feels the patient needs hospice and the patient cant make their own decision, then the family must request a hospice eval

Myth:  Need a doctor’s order to talk about Hospice with a hospice company

We don’t need a doctor’s order to talk about hospice benefits
“I think I would like to have hospice” then you need doctor’s orders to treat

Question:  Do you need long term health insurance to receive hospice?

With hospice there is no need for long term insurance.  It’s 100% medicare paid
Hospice is paid by medicare 100%, team of nurses, counselors, volunteers, chaplain.
First choose who you want to provide your hospice care and then start the process.
All hospices are not created equally.  How we do it is what sets us apart from the next one.
Office and phone number for Hospice of the South Plains.
Happy to answer questions whether or not HospiceSP is the final choice

Laura Landes is the Restorative Artist, the Embalmer, but also the Pre-Needs specialist
When a lady’s husband came in, he had a brain tumor, the wife came on her own.
She wanted to be prepared and was asking questions about caring for her husband in pre-plans.

Question:  I’m afraid.  When he doesn’t wake up, what am I supposed to do?

They had not called in hospice care, but Laura knew they qualified.
Advice:  Obtain some hospice care.  Answer: “Well he’s not dying right now”

Hospice is like the good friend or moral support that knows what they’re doing when we may not know what we’re going if it’s our first time in that situation.

Without Hospice:

  1. Call the police 2. They call the medical examiner 3. They take his body to the medical examiner 4. He’ll lie in wait from the medical examiner’s office 5. Then funeral home

With Hospice:

  1. Invoke hospice care 2. Hospice takes care of the body after death 3. Automated process  

Call hospice and hospice will call your doctor – if your heart is pumping less than 20%, you qualify, symptom management can happen.  Ask doctor:  “Do you want to follow this patient or do you want to defer to the hospice medical director?”  When doc says “I defer to the medical director” hospice begins

Question:  If someone has a pacemaker that keeps him alive has a stroke, how would they qualify?

They pacemaker gets him close to qualifying, but the stroke would likely give him a diagnosis that qualifies for hospice.  When a nurse starts asking questions, they will find out if the patient qualifies.

There’s no way to predict death, but it’s possible to predict a qualifying standpoint.
Families working together to take care of parents, everyone may have high emotions.  

Hospice won’t just sign up everyone for hospice.  They will refer you to home health or get extra help in the house until you are eligible for hospice service.

Hospice of the SP wants to take care of your wound.  Bad wound care can cut life short and hospice can take care of the problem and diabetes.  Home health care does clash with hospice.

Cleanliness, as far as the patient is concerned, if the patient is unable to take care of themselves.  Could hospice prepare a single meal?  Social services gets real handy.  Meals on Wheels will bring one meal per day.  Social services are more resourceful  than hospice for organizing meals.

Those are hard conversations.  If you tell an independent guy that he needs to go to a nursing home, it will register as all independence being gone.  Taking care of the patient the way they need to be taken care of and insuring them it is a good place are part of the process to make it happen.

People don’t know what they don’t know.  New resources that can be utlized.  The social workers are very good and getting people what they need.

Aaron Lee with Inspirations will be the next workshop July 6th – Laura Landes will cover The Power of Preplanning August 1st, and September 5th Lake Ridge Chapel will provide information about completely medicare funded funeral care for Veterans and families of Veterans.  For all kinds of things, including depression, working with Alzheimers and working with Care Givers.

Future Education Events listed below and on The LRC facebook page.

Thursday July 6th – Counseling and Mental Therapy

Join Nolan Lewis of Inspirations in a discussion about Counseling and Mental Therapy with a focus on “Alzheimer’s and Dementia”.

Tuesday August 1st – The Power of Pre-Planning

Laura Landes will be leading her audience as the resident expert on funeral pre-planning.

Tuesday Sept 5th – Be in the know about Veteran Health Care!  

Good snacks.  Good people.  Two people with the VA Hospital will be at the September event.  

For more information:

Scott Myers RN, Executive Director

Hospice of the South Plains
Office 806-783-0382
Cell 806-777-2778
4413 82nd Street, Suite 135, Lubbock TX 79424

Laura Landes, Restorative Artist and Education Event Director

Lake Ridge Chapel & Memorial Designers
Main 806-698-8085
6025 82nd St, Lubbock, TX 79424

1 thought on “Hospice to Funeral: “Fact or Fiction?””

  1. That’s good to know that your Medicare won’t have a time limit on how long you could have hospice care. it would be bad if you were only covered for a year or so and then lived another few years after that. I would think it would be best that you could be covered until you don’t need the hospice anymore.

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