Is Your Loved One Seeing the Light? By Ronni Robinette, LMSW, TXcG

The concept of hospice as medical treatment is a relatively new concept.  Physician Dame Cicely Saunders introduced the idea of specialized care for the dying.  She began working with the terminally ill in 1948 and started the first modern hospice center in London in 1967.  She brought the concept of hospice to the United States in 1963.  In 1969, Dr. Elizabeth Kubler-Ross publishes what would become an international best seller-On Death and Dying.  The book discusses the stages through which terminally ill patients pass.  In the book, Dr. Kubler-Ross strongly advocates for care at home for the dying.


What is Hospice


Hospice is end of life palliative care[1] for the terminally ill that have been given a prognosis of six months or less.  It focuses on caring not curing.  A doctor writes the order then the hospice team does their evaluation to verify the appropriateness of the patient.  If the individual is indeed appropriate, hospice services begin where ever the patient calls home.  Hospice does not require out of pocket expense.  It is paid for by most private insurance and Medicare.  Medicaid often pays when the individual is under the age of 65.


What Does Hospice Care Include


Defined Services of Hospice


  • Time and services of the care team, including visits to the patient’s location by the hospice physician, nurse, medical social worker, home-health aide, volunteer services and chaplain/spiritual adviser
  • Medication for symptom control or pain relief (Any medication that is offered based on the hospice diagnosis) an example of what is not covered is if a patient is diagnosed with dementia/Alzheimer’s hospice would not cover Namenda or Aricept. Those two drugs are considered curative not palliative medications.  Palliative drugs are covered.  Another great point is all medication that hospice provides is delivered by the pharmacy to their front door.
  • In-home IV therapy for a short term length. Medical equipment like wheelchairs or walkers and medical supplies like bandages and catheters.  Also pull-ups, chucks and wipes are provided.
  • Short term physical and occupational therapy
  • Speech-language pathology services
  • Dietary counseling (Boost and Ensure are provided)
  • Any other Medicare-covered services needed to manage pain and other symptoms related to the terminal illness, as recommended by the hospice team
  • Short-term respite care (e.g. temporary relief from care giving to avoid or address “caregiver burnout”) Respite is 5 days per month each month
  • Grief and loss counseling for patient and loved ones (Bereavement Services)
  • Lasting Memories for patients and their loved ones


At the end of life Continuous Care is provided where a nurse sits bed side until the patient passes.  This is usually for the purpose of providing routine medication to control pain so the patient passes peacefully and comfortably.  Continuous Care can also be available for Caregiver breakdown.  If a family is in undue stress and not coping well, Continuous Care can be set in place to help ease the family burden of losing a loved one.  Continuous Care can start and stop a multitude of times as needed until the patient passes.


What is Not Covered by Hospice
Not all services provided to patients enrolled in hospice care are covered by the Medicare Hospice Benefit. The benefit will not pay for:


  • Treatment intended to cure your terminal illness or unrelated to that illness
  • Prescription drugs to cure your illness or unrelated to that illness
  • Room and board in a nursing home or hospice residential facility
  • Care in an emergency room, inpatient facility care or ambulance transportation, unless it is either arranged by the hospice team or is unrelated to the terminal illness (if a patient is on hospice and falls and breaks an arm and needs surgery or sustains a laceration and goes to the hospital they do not have to revoke hospice services because these things are outside the parameters of the hospice diagnosis.


How Long Does Hospice Last


Someone can be on hospice for several months, or even years.  There is no maximum to hospice services.  As long as the person is showing signs of decline they remain appropriate for hospice and the hospice benefit continues.  Also, someone can improve and come off hospice and then sometime later go back on hospice.  There is no limit to the hospice benefit.


Years ago hospice was only brought in when someone was days away from passing.  That is not the case in today’s society.  If someone has a terminal diagnosis and the doctors feel there is no chance for improvement, the doctors may recommend hospice.  Hospice care happens wherever the person is:  at home, an apartment, a nursing facility or anywhere else the hospice team will care for them in their “home”.


Advance Care Planning


Most of us do not want to contemplate our mortality.  But, dying is inevitable for all of us.  You have it within your power to determine what your final days will be like if you suffer from a protracted illness.  You also have the power to determine what that process looks like for your family.  How?  By engaging in advance care planning.  Not only should you talk to your family about what kinds of treatment you do and do not want, but you should also memorialize that in writing in the form of an Advance Directive.


The Advance Directive for Physicians and Surrogates (aka living will) is your opportunity to say what you want to have happen with your care if you are determined to be either terminal or incurable.  This document is truly a gift to your family.  It releases them from the burden of having to make significant medical decisions and the possible guilt for having made a particular choice.  It can help reduce any family disputes about what should be done regarding your care when you are terminal or incurable.


About the Author


Ronni is a Licensed Masters in Social Work in the state of Texas, as well as a Certified Texas Guardian.  She has 15 years experience in the field of Social Work focusing in Gerontology and Heathcare.


Ronni has been working in the area of Hospice and Palliative Care for approximately 12 years.  She currently is working as a Hospice Social Worker for Asana Hospice and Palliative Care located in Fort Worth, Texas.  She has been with Asana in this capacity for one year.  She worked approximately three years as a Texas Certified Guardian with Guardianship Services in Fort Worth, Texas.


Ronni is currently a board member for Tarrant Area Gerontological Society (TAGS) for two years serving as Secretary starting 2017.  She is also a member of the National Association of Social Workers (NASW).  In March 2017, Ronni filled a position at Texas Christian University working as a Field Instructor in the area of Social Work mentoring Social Work students in the field of Hospice and Palliative Care.


Ronni is with Asana Hospice.  Asana Hospice’s mission statement is to guide our patients and families during periods of terminal illness, to provide medical and emotional comfort, and to inspire meaningful moments and lasting memories.


Asana’s multidisciplinary team is comprised of compassionate, trained professionals who believe their career is a calling.  Each team member is dedicated to creating life affirming experiences that offer patients and their loved one opportunities to find comfort and connections.


The thing that sets Asana apart from other Hospice Services is not only their dedicated professional staff, but their Lasting Memories Program.  Asana Hospice will assist each patient and their loved ones create an event that will assist them in celebrating a lasting memory or help them fulfill a dream.


[1] Although hospice care is palliative care, palliative care is not the same as hospice care.  Palliative care is specialized medical care that helps patients and their families live as fully as possible when facing life-threatening illnesses.


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