Hospice focuses on the body, the mind and the spirit—all what makes us human.
Braden W. Etcheson, spiritual care counselorThe word “hospice” can be hard to hear.
Hospice focuses on a person's quality of life and dignity as they near the end of their life. The word hospice shares its word origins with hospital and hospitality, and it’s an option for anyone in the last phases of an incurable disease like dementia, lung disease, heart failure or metastatic cancer.
“A lot of people hear hospice, and they think it means imminent death,” says Diane Kowalker, RN, a hospice nurse at Dartmouth Health’s Visiting Nurse and Hospice for New Hampshire and Vermont (VNH). “That’s a huge misconception.”
Experts say that entering hospice doesn’t mean giving up. It’s about shifting your focus from curing an illness to living as comfortably and meaningfully as possible during the final stage of life.
How do you enter hospice?
Hospice combines medical care, caregiving, emotional and spiritual support.
Qualifying for hospice care typically starts with a referral from your provider. Eligibility requirements include:
- Focusing on treating disease symptoms. For example, treating shortness of breath or pain at home instead of in the hospital
- Life expectancy of six months or less.
Hospice is something you ultimately choose, as it’s a personal decision. You might go into hospice because you have a terminal illness and no longer want to be hospitalized.
If you or a loved one agree to enter hospice, you’ll find a team of nurses, social workers, spiritual care counselors, licensed nursing assistants (LNAs), volunteers and physicians providing care that extends beyond medical treatment.
“You might feel anxious about dying and the impact on your family, struggling with fears that go beyond medical issues, which our team can help with," says VNH Hospice Medical Director Cristine Maloney, MD.
Dying is a complex and deeply emotional experience for patients and their loved ones, which is why hospice care also offers spiritual support.
“Spiritual support is meeting people where they are, whether through faith, relationships or simply helping them find peace and purpose in their final chapter,” says Braden W. Etcheson, a spiritual care counselor with VNH.
“I try to help them express what needs to be said, find acceptance and understand the natural process of dying so that fear is replaced with peace,” he adds.
What does hospice care include?
You can receive hospice services wherever you call home, whether it’s a residence, a nursing home or assisted living facility. Hospice care includes:
- Pain and symptom management at the end of life
- Emotional and spiritual support for patients and families
- Coordination of available community services, resources and end of life planning
- Home health aides for dressing, bathing and tidying
- Around-the-clock nurse support by phone or in person visits.
“Many hospice patients live better and longer”
“There’s a false dichotomy between quality of life and quantity of life,” Maloney says. “Hospice doesn’t hasten or hurry death. Many hospice patients live better and longer because they’re at home, surrounded by support.”
Research shows that hospice patients may live longer because symptoms are managed, stress is reduced and hospitalizations are avoided.
Medications and interventions are considered for symptom relief rather than prolonging life. Emotional, spiritual and practical comfort are equally important components of hospice care.
“Hospice focuses on the body, the mind and the spirit—all what makes us human,” Etcheson says. “The doctors and nurses care for the body, the social workers help with the mind and the spiritual care advisor focuses on the zest for life, and the things that give life meaning.”
Myths and misconceptions about hospice
Considering hospice care can feel overwhelming and frightening, mainly because there are common misconceptions about what it means to start hospice. Here are the facts:
Myth: You can’t leave hospice once you start
Facts:
- You can stop hospice at any time if you want to pursue other treatments or if your condition improves.
- Hospice also discharges patients whose prognosis goes beyond six months. You can return to hospice later if your health declines again.
Myth: Hospice isn’t covered by insurance
Fact:
- Hospice is almost universally covered by Medicare, Medicaid, private insurance and for uninsured patients through hospice agencies.
Myth: Hospice is a place
Fact:
- Hospice is an approach to care. Most hospice care happens in the comfort of your home.
Myth: Hospice and palliative care are the same
Facts:
- Both share the same philosophy of comfort and quality of life.
- Palliative care can begin at any stage of illness with curative treatments, but hospice is for people with a life expectancy of six months or less.
Myth: Families can’t be involved in decisions
Facts:
- Patients (when able) must consent to hospice care themselves.
- If they can’t, a legally designated healthcare proxy or family member decides.
- Families are integral to hospice planning, caregiving and emotional support.
Myth: Morphine speeds up the dying process
Facts:
- Hospice uses morphine and other pain medications to keep a patient comfortable. Using morphine on a patient does not cause death.
- Morphine and other opioids can be safely used in patients with serious illness at the end of life without speeding up the dying process.
Hospice care is all about helping terminally ill patients live their lives to the fullest—comfortably and with medical, emotional and spiritual support.
“We’re all going to die someday,” Kowalker says. “Hospice allows you that time to reflect and go down that path—to say goodbye, to take that spiritual journey and to reassure your loved ones that they’ll be OK after you’re gone.”
Resources + Related Stories
Dartmouth Health’s Visiting Nurse and Hospice for New Hampshire and Vermont
