Note: Many families or their loved ones' doctors often wait too long to order hospice. Hospice is a very valuable service and should be ordered at an earlier stage of illness. Many doctors or family don't often consider hospice for Alzheimer's, degenerative old age or other debilitating illnesses where a person is going downhill fast. They should.

It is unfortunate that many people who died in a hospital emergency room or who received heroic treatments to prolong life in a hospital may have had the alternative of dying at home in familiar surroundings, with family or other loved ones at their side.

When someone is in crisis or appears to be going downhill fast but there really is no hope for recovery, family often call 911 and start a process which can result in great stress and great emotional discomfort. The loved one who is dying ends up in a hospital and may die there or be transferred to a nursing home where death eventually occurs.

When there is no longer hope for prolonging life, especially when this decision is made months in advance, hospice is usually a better alternative to other medical intervention.

Hospice is a form of palliative care for patients who are terminally ill. A commonly used definition for terminally ill patients is, "patients who have a progressive, incurable illness that will end in death despite good treatment, and who are sick enough that you would not be surprised if they died within six months."

Hospice care is a valuable service and is generally underused except for terminal cancer patients. Hospice allows for compassion and dignity in the process of dying. Most families wait too long to have their doctor prescribe hospice from Medicare. It should be considered at an earlier stage.

Hospice involves a team approach using the following providers.

• Family caregivers;
• The patient' s personal physician;
• Hospice physician (or medical director);
• Nurses;
• Home health aides;
• Social workers;
• Clergy or other counselors;
• Trained volunteers;
• and Speech, physical, and occupational therapists, if needed.

The purpose of hospice is the following:

• Manages the patient's pain and symptoms;
• Assists the patient with the emotional and psychosocial and spiritual aspects of dying;
• Provides needed medications, medical supplies, and equipment;
• Coaches the family on how to care for the patient;
• Delivers special services like speech and physical therapy when needed;
• Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time;
• and Provides bereavement care and counseling to surviving family and friends.

A person can receive hospice from Medicare if he or she is

• eligible for Medicare Part A (Hospital Insurance), and
• the doctor and the hospice medical director certify that the person is terminally ill and probably has less than six months to live, and
• the person or a family member signs a statement choosing hospice care instead of routine Medicare covered benefits for the terminal illness, and
• care is received from a Medicare-approved hospice program.

A person may continue to receive regular Medicare benefits from his or her customary doctors for conditions not related to the hospice condition.

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