A foundational tenet of hospice care is its adaptability to the patient’s living environment. When an assisted living facility serves as the person’s residence, hospice services are seamlessly integrated into that setting, ensuring the same level of interdisciplinary support, symptom management, and psychosocial care as would be provided in a private home. This approach reinforces continuity of care and aligns with person-centered principles, regardless of the care environment.
With data showing that as many as half of hospice patients only receive care for 18 days or less, 1 it’s critical to understand the role of hospice in assisted living, its benefits and what to look for to help determine resident eligibility and transition to end-of-life care.
Overview of Key Hospice Care Benefits for Residents
As a resident’s needs shift at the end of life, navigating difficult questions, supporting goals (including efforts to avoid unnecessary hospital admissions) and managing family concerns can be a daunting task for assisted living staff.
By partnering with hospice, residents on service experience key benefits, including:
- 24/7 hospice support
- Interdisciplinary hospice care teams comprised of nurses, aides, social workers, chaplains, volunteers and others
- Hospice care plans that outline how to meet each resident’s unique needs and goals
- Improved comfort and quality of life for residents on service with a holistic approach that includes pain and symptom management, companionship, spiritual care and more
- Bereavement support and guidance for families
- Decreased costs for patients: Medicare typically covers 100% of hospice costs for eligible patients, including medications, equipment and supplies related to the patient’s terminal illness
- A decrease in unnecessary hospital visits 2
- Improved patient and family satisfaction during a vulnerable time
Hospice Care in Assisted Living
Assisted living residents may be considered eligible for hospice care if:
- They are diagnosed with a physician-certified terminal illness, with six months or less to live if the disease runs its normal course.
- They are ready to stop treatment to cure their illness and elect the hospice benefit.
- Their hospice provider is Medicare-approved.
Hospice FAQs for Assisted Living Providers
Common questions regarding hospice care for assisted living staff include:
- Who can refer a resident to hospice?
The simple answer to this is that anyone can start a hospice referral. This can be the patient’s physician, a nurse, a family member or even the resident themselves. A referral is the first step in having a conversation with hospice professionals who can help determine eligibility and help with questions and enrollment if appropriate.
- What are some common signs that hospice may be appropriate?
Remember, people are often referred to hospice long after they could have benefitted from the support hospice provides. Signs that hospice may be appropriate do not have to be significant and could be as simple as the patient has expressed that they no longer want to pursue curative care for a terminal illness. Some common signs include:
- Frequent ED visits and hospitalizations in the past six months
- Chronically low O2 sats or significant oxygen requirements
- Stage IV heart failure
- Refusing dialysis
- Declining ongoing cancer treatment
- No longer eating or drinking
- How do I approach the topic of hospice with the resident or their family?
Conversations about hospice can be difficult to have, but thankfully hospice teams are experts at bridging the gap. After introducing the possibility of hospice to help improve their quality of life and support the end-of-life journey, with their permission you can arrange an “informational visit” to allow them to ask more questions and become more comfortable with hospice. You can read some tips on initiating the hospice conversation here.
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How Hospice Collaborates with Assisted Living
Once a referral is initiated, Amedisys hospice reaches out swiftly to collect any additional information needed. A member of the hospice team will reach out to the resident and/or family, if appropriate, to discuss hospice care and begin the consent process, if hospice is elected by the resident or their legal representative and ordered by a physician.
If the hospice physician determines the resident is eligible for hospice care, the interdisciplinary team will develop and begin following the individualized plan of care developed in consultation with the hospice physician, the resident’s physician and the resident and family. This plan will be communicated to the assisted living care team and hospice contacts will be available 24/7 for any care needs as they arise.
A hospice nurse will visit at regular intervals that are based on the patient’s needs and plan of care, providing support for ongoing pain and symptom management, wound care, and more as appropriate. Other members of the hospice care team may also visit if agreed to by the patient, including social workers for emotional care, chaplains for spiritual care, aides to provide dressing and bathing and volunteers for companionship.
As needs increase, hospice care adjusts to meet those needs. At Amedisys, we’ve developed a protocol called Code Green that activates an increased rotation of visits from clinicians during the final days of life so no patient transitions alone — offering comfort and reassurance to patients, families and assisted living staff.
Finally, after a patient’s passing, hospice services continue for affected family members with bereavement support that extends for 13 months beyond their loved ones’ death.3
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Ready to Collaborate with Hospice?
The collaboration between hospice, assisted living facilities and residents and their families is an essential part of the end-of-life journey for residents faced with serious, life-limiting illness. At Amedisys, we have been providing high-quality home health, hospice and palliative care since 1982, and Amedisys Hospice agencies exceed the national average in all nine out of nine Hospice Item Set scores that CMS uses to measure hospice quality. Contact us today to learn how we can support your assisted living facility with high-quality hospice care.
Deb Gallaher, MBA, MSN, RN, NE-BC, CHPN, is a Senior Hospice Clinical Education Specialist for Amedisys. She has 10 years of experience in hospice and is passionate about sharing her insights on high-quality care.
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