Hospice care is defined not only by the services and care provided, but also by the setting in which these services are delivered. Hospice care may be provided in your home or in a special facility.
Most cancer patients choose to get hospice care at home. In fact, more than 90% of the hospice services provided in this country are based in patients' homes.
Before making a decision about the type of program that is best for you and your family, it is important to know all your options and what each requires. Your doctor, hospital social worker, or discharge planner can be very helpful in deciding which program is best for you and your family.
Home hospice care
Many, if not all, of the home health agencies in your community, as well as independently owned hospice programs, will offer home hospice services. Although a nurse, doctor, and other professionals staff the home hospice program, the primary caregiver is the key team member. The primary caregiver is usually a family member or friend who is responsible for around-the-clock supervision of the patient. This person is with the patient most of the time and is trained by the nurse to provide much of the hands-on care.
It is important to know that home hospice may require that someone be home with you at all times. This may be a problem if you live alone, or if your partner or adult children have full-time jobs. But creative scheduling and good team work among your friends and loved ones can overcome this problem. Members of the hospice staff will visit regularly to check on you and your family and give needed care and services.
Care begins when you are admitted to the hospice program, which generally means that a hospice team member visits the home to learn about you and your needs. Return visits are set up so that your needs can be re-evaluated regularly. To handle around-the-clock patient needs or crises, home hospice programs have an on-call nurse who answers phone calls day and night, makes home visits, or sends the team member you may need between scheduled visits. Medicare-certified hospices must provide nursing, pharmacy, and doctor services around the clock.
Hospital-based hospices
Hospitals that treat seriously ill patients often have a hospice program. This arrangement allows patients and their families easy access to support services and health care professionals. Some hospitals have a special hospice unit, while others use a hospice team of caregivers who visit patients with advanced disease on any nursing unit. In other hospitals, the staff on the patient's unit will act as the hospice team.
Long-term care facility-based hospices
Many nursing homes and other long-term care facilities have small hospice units. They may have a specially trained nursing staff to care for hospice patients, or they may make arrangements with home health agencies or independent community-based hospices to provide care. This can be a good option for patients who want hospice care but do not have primary caregivers to take care of them at home.
Independently owned hospices
Many communities have free-standing, independently owned hospices that feature inpatient care buildings as well as home care hospice services. As with long-term care facility hospice programs, the free-standing hospice can benefit patients who do not have primary caregivers available at home.
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