Understanding Hospice

AMOREM’s Service Podcast serves the mission to provide quality, thoughtful, loving care to patients and support to their families and to offer education and grief support to communities served. This podcast is intended to transform the way that people view and experience serious illness and end-of-life.

In episode two of AMOREM’s Service Podcast, Understanding Hospice, AMOREM Nurse Practitioner, Chuck Crisp, FNP-C, explains hospice services, debunks hospice myths and shares several of his mission moments from his time in the field. To hear Crisp’s mission moments, please listen to the full episode on one of the many available streaming platforms.

For listeners to better understand the philosophy of hospice care, Crisp takes the audience back to the beginning of hospice. Hospice care began in London around 1948 when Cicely Saunders began working with terminally ill patients and chose to pursue further education to become a medical doctor in the field. In 1965 she held a lecture at Yale University in the United States where Florence Wald was in attendance. After the lecture, Wald became fascinated with the treatment of terminally ill patients.

Wald took a sabbatical and traveled to London where the first hospice was created. In 1974, after returning to the United States along with two pediatricians and a chaplain, Wald established the first Hospice in the United States – Connecticut Hospice. In 1986, Connecticut Hospice was the first to have the Hospice Medicare Benefit enacted which means that the state had recognized the care for terminally ill patients. From there on, Hospice Care became a permanent part of the United States.

Crisp adds that AMOREM has its own bit of history in hospice care; In 1989, the Stevens patient care unit was opened by AMOREM, formerly Caldwell Hospice and Palliative Care, in Lenoir, North Carolina. This was the first freestanding patient care unit in the state of North Carolina. Since building the Stevens unit in 1989, AMOREM has built two additional patient care units in Valdese and Hudson and is constructing a fourth in Boone.

Crisp deepens the understanding of hospice care by explaining that it is a program overseen by the Centers for Medicare and Medicaid Services. Within a hospice program, there is a benefit called the Hospice Medicare Benefit or the HMB.

Crisp shares that when determining whether a patient is eligible for hospice care, there is a large amount of clinical judgment that works alongside the guidelines provided by the HMB and that each illness may have its own, additional, set of guidelines. Many times when evaluating a patient, multiple comorbidities contribute to the decline of the individual’s health.

To be eligible for hospice care, a physician would say that due to the diagnoses and the likelihood of the diagnoses continuing their natural course, there is a high probability that this patient’s life expectancy is six months or less. This is not to say that every patient will meet that prognosis. Many individuals graduate from hospice care due to their illness stabilizing or their health improving, and they no longer need hospice care.

Another set of guidelines for hospice eligibility is the Hospice Needs Assessment. Crisp describes the assessment as a good place to start when evaluating the changes in a patient.

The Hospice Needs Assessment involves 11 questions that act as guidelines for evaluating a patient:

Reflecting on the past few months, have you noticed that you or your loved one:

• Is losing weight?
• Is sleeping more?
• Is unable to do activities of daily living?
• Is in pain or in need of pain management?
• Has had recurrent infections?
• Has had a decrease in food or fluid intake?
• Is not improving despite treatment?
• Is frequently hospitalized?
• Is not seeking aggressive treatment?
• Has received a terminal prognosis from a medical provider with an estimated life expectancy of six months or fewer?
• Is suffering emotionally or spiritually from the prognosis?  

When asked if any of the needs raise more concern than others, Crisp answers that is important to take the functional changes of a patient into account, their primary illness and any comorbidities that the patient may have. There are times when certain changes in a patient are big enough to lend more credence than others. Crisp stresses that awareness of functional changes in a patient is many times the key to recognizing hospice eligibility.

Upon admitting an individual to hospice care, the AMOREM team creates a plan of care designed specifically for the patient and their family. Crisp explains that when creating a patient’s plan of care, the team looks at the patient’s needs in terms of physical body, mind and spirit. Each patient receives holistic care no matter what illness/illnesses may be present.

 There is also an element of comfort care and symptom management that is taken into account and becomes goals in a patient’s hospice care plan. Even if a patient does not have a specific illness, AMOREM still cares for their symptoms, ensuring that they receive the comfort and care that they need and that the patient’s family is receiving support.

AMOREM believes in an interdisciplinary team approach to care. This means that a patient’s hospice care team is made up of multiple disciplines to ensure quality, holistic care for patients and their families. These teams commonly include doctors, physicians, nurse practitioners, nurses, medical social workers, certified nursing assistants, chaplains and volunteers.

Crips does note that there can be many barriers present at the time of admitting a patient to hospice care. Mostly, families view hospice as giving up on their loved one. Crisp explains that this is the barrier that he runs into most often and it is due to a lack of understanding and education about hospice services. To combat this barrier, Crisp and AMOREM teams provide education and resources to families and patients to help them gain a better understanding of how hospice care can impact the quality of their lives. These education materials range from conversations, advance care planning assistance, brochures and disease-specific handouts to other community resources available.

The last point that Crisp makes, and puts a heavy emphasis on, is that individuals do not have to wait for a physician to refer them to hospice services. Anyone, at any time, can make a referral to AMOREM. It could be the patient themselves, a family member, a neighbor, a church member or anyone in the individual's community. Referrals can be made online at www.amoremsupport.org or by phone call at 828.754.0101.

To learn more about how AMOREM services can impact your quality of life, visit www.amoremsupport.org or call 828.754.0101. To keep up with AMOREM events, follow the organization on Facebook, Instagram, LinkedIn and YouTube.

AMOREM’s Service Podcast is proudly brought to you by AMOREM, your local, nonprofit, hospice and palliative care provider. AMOREM has provided services to the community for more than 40 years, formerly as Burke Hospice and Palliative Care and Caldwell Hospice and Palliative Care, and has served the High Country for more than 10 years. To learn more or to make a referral, visit www.amoremsupport.org or call 828.754.0101 to speak with a local team member.