Most patients wait too long to start looking into hospice options once they receive a terminal diagnosis.  It would be helpful to start looking at local hospice organizations sooner, rather than later. 

If ineligible for Hospice care, you can look into Palliative Care which manages the pain & symptoms of a non-terminal disease, keeping the patient comfortable & as pain-free as possible.

A great organization in the Phoenix metro area is Hospice of the Valley where I am a hospice volunteer. 

It is time to consider hospice care when a patient exhibits one or more of the following:

• Patient/family chooses comfort care

• Loss of function/physical decline

• Increase in hospitalizations

• Dependence on others for most activities of daily living

• Multiple co-morbidities

• Increase in ER visits

• Weight loss

Hospice is typically a public agency or private organization that is primarily engaged in providing a comprehensive set of services coordinated by an inter-disciplinary team. 

Hospice provides for the physical, social, spiritual and emotional needs of a terminally ill patient given six months or less to live through a specified patient Plan of Care. 

Hospice care includes palliative care – but not all Palliative Care is hospice. 

(E.g. Patient with terminal illness and given six months or less to live.)

Palliative Care is patient and family-centered care provided by an MD that optimizes quality of life by anticipating, preventing, and treating suffering and pain. 

Palliative care throughout the illness involves addressing physical, emotional, social and spiritual needs, and is focused on facilitating patient autonomy with access to educational information and choices. 

It is sometimes referred to as “chronic care management” with relief from suffering and pain.

(E.g. cancer diagnosis with a chance of recovery while having pain management or comfort care needs met.)

No, the actual dying process is not painful, but inflammation and complications from other disease symptoms may cause discomfort or pain.  In fact, some processes that the body performs as systems begin to shut down can serve to decrease pain naturally, without any medical intervention.  Those symptoms can be treated in hospice as they will keep the patient comfortable throughout the duration of their stay.

It is absolutely okay for there to be times when your loved one may need (or want) to be alone.  There is science behind the philosophy that when we’re actively dying, we have an element of control over when we decide to “pass on”. 

How many times have we heard stories about a patient waiting for a long lost loved one to arrive to say their goodbyes before passing away.  Sometimes, hospice patients will wait until their loved one leaves or goes to get a cup of coffee when they decide to pass.  It is an act of love that they don’t want to cause any undue distress to loved ones left behind.

Most people don’t realize that embalming is almost never required by law in any state in the United States.  State laws may dictate embalming if there will be delayed disposition, but in most cases refrigeration or cooling will suffice. 

Embalming has long been refuted by medical authorities.  The Center for Disease Control (CDC) has never prescribed embalming as a public health measure.  It is not needed for body preservation, and it puts chemicals into the earth. 

(Excerpts taken from Final Rights by Joshua Slocum and Lisa Carlson.)

What’s become known as a “green burial” is simply what has historically known as a “burial” – laying a body in the earth without chemical embalming, a metal casket, or a vault.  No state laws require embalming or the use of a coffin or an outer burial container as a condition of burial (though many cemeteries have policies that require vaults). 

Interest in green burial is increasing.  While counter-intuitive, some “green” cemeteries charge premium prices as their goal is to preserve the land.  Many conventional cemeteries have set aside parcels that don’t require embalming, a vault or a non-degradable coffin.  More information can be found at the Green Burial Council's website.

While Medicare typically covers regular Hospice care, it is starting to look at reimbursing for doula work, however, there are not many states yet that allow for Medicare reimbursements.  For more information, please check www.medicare.gov.