The Hospice Timeline: Signs Your Patients May Benefit from Hospice

Hospice provides supportive care for people who have a terminal diagnosis and a life expectancy of six months or less as certified by the physician. The patient who meets criteria can be admitted to hospice and they and their caregivers can experience comfort and quality of life through hospice care. With only around 32% of patients understanding hospice care options in detail, providers represent the front line of providing education on this type of care. ¹

By recognizing key signs that it may be time to have the hospice conversation and understanding how the hospice timeline supports patients and their families, you can be better equipped to guide your patients through the referral process and support compassionate end-of-life care earlier in the journey.

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Signs That It’s Time for Hospice

Serious health challenges along with a terminal diagnosis are indicators that hospice care might be the best support option. End-of-life decisions can be overwhelming for your patients and their families, so providing some key signs and symptoms can help them make an informed decision.

1. Life Expectancy of Six Months or Less

Along with physician certification of terminal illness, a life expectancy of six months or less if the disease runs its normal course is a core requirement for hospice eligibility. As long as the patient continues to meet eligibility requirements, hospice care eligibility may be recertified, and can continue until the end of life. Other key eligibility requirements for the Medicare hospice benefit include:

• The patient elects to stop curative treatment, and wants care that focuses on comfort and quality of life instead
• The patient’s hospice provider is Medicare-certified

2. Worsening Health

If your patient needs considerable attention from medical professionals and continues being admitted to the hospital due to complications related to their terminal illness, hospice might be appropriate. Research shows that the risk of death increases for older adults with repeat hospital readmissions. ² Common terminal diagnoses that hospice can help address in late/end stages include:

• Cancer
• Amyotrophic lateral sclerosis (ALS)
• Alzheimer’s disease and other dementias
• Liver disease
• Renal failure
• Cardiopulmonary disease
• Stroke

3. Decreased Appetite

Many terminal illnesses can cause the body to decrease the need for nutrients, so a decreased appetite is common. Pain, nausea, lack of energy, and medications can also interfere with a patient’s appetite and need for hydration.

4. Increased Sleep

Increased sleeping is another common symptom of terminal illnesses because the body is trying to conserve energy.

5. Notable Changes in Behavior

Changes in behavior for a terminally ill patient may include issues with mental clarity, confusion, forgetfulness, irritability or restlessness. Challenges with communication can also be a sign of advancing illness.

6. Difficulty with Activities of Daily Living

 The terminally ill patient may have decreased functional status and need assistance with activities of daily living (ADLs). When eating, toileting, bathing and dressing independently become a challenge, hands-on assistance from hospice support can help. 

7. Caregivers Lacking Support

Remember that caregivers are also part of the equation. Caregivers are responsible for providing care to ensure their terminally ill family member is as safe and comfortable as possible. One recent survey found that 67% of family caregivers report struggling to balance their caregiving roles against their job responsibilities. ³ If the caregiver is struggling with their responsibilities, hospice care could help.

Navigating the Hospice Journey

The hospice care journey can be emotionally draining for patients and their families. The hospice timeline below can be used as a guide to help them understand the full process:

Step 1: Referral

When curative treatment is no longer an option or one the patient wishes to pursue, a terminally ill patient and their doctor can agree to a referral for hospice care. Hospice will contact the patient or family members to schedule an informational meeting with a hospice care provider to discuss their concerns and goals. Typically, referral and admission to hospice can occur within 24 hours.

Step 2: Admission

A hospice registered nurse will visit your patient to assess their individual needs. Based on this assessment, if the patient is determined to be eligible for hospice, medical equipment, supplies and medications related to the patient’s terminal illness will be incorporated into an individualized care plan. The plan of care includes what matters most to the patient and caregiver, and the patient and caregiver contribute to key decisions.

Step 3: Continuing Care

The individualized plan of care will be managed by the interdisciplinary team including specially trained physicians, nurses, nursing assistants, social workers and chaplains based on patient and caregiver needs. Continuing care is provided with intermittent visits from the team members. The focus is on maintaining quality of life and providing expert pain and symptom management. Medical professionals and volunteers also offer support and education to caregivers.

Step 4: Final Days

At the end of life, care is focused on providing comfort and support through pain and symptom management and support for the patient and caregivers. Hospice can assist in notification of loved ones and in making final arrangements.

Amedisys uses a protocol called “Code Green” to ensure appropriate care and support for the patient and the family during the final days of life. Code Green is a call to action for the hospice team to work together to address the evolving physical, emotional and spiritual needs of the patient as they approach the end of life.

Step 5: Grief Support

The end of a loved one’s life doesn’t mean the end of hospice care. Bereavement care, grief support resources, including in-person or online support groups, education and follow-up services are available for caregivers for up to 13 months after the death of the patient.

How Hospice Care from Amedisys Can Help

Caring for someone at the end of life can be confusing, frustrating and deeply saddening. One of the best things you can do for your patients and their families is to provide clarity when it comes to their next steps.

For a quick reference, download and print out a copy of The Hospice Timeline to serve as your guide to a typical path for patients and their loved ones, and hopefully bring them some levity in a challenging time.

When you’re ready to refer a patient to hospice, Amedisys offers three easy options to get in touch: our online referral form, by phone, and by fax. You can bookmark our online referral form here for future reference. We’d be honored to join you alongside your patients and their families for compassionate support at the end of life.

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.