Let's address some common misconceptions about hospice care and unveil the facts:

1. Hospice is not a place; it's a service provided wherever the patient calls home, whether it's a private residence, assisted living community, nursing home, or even some hospitals with dedicated hospice beds.

2. Loved ones and relatives play an integral role in the care team. The interdisciplinary team includes family caregivers, physicians, nurses, social workers, chaplains, hospice aides, bereavement specialists, and volunteers. Families actively participate in the patient's care plan.

3. Hospice is not a last resort; it's a valuable resource for comprehensive pain control, anxiety reduction, emotional and spiritual support, and improved quality of life for terminally ill individuals and their families.

4. Hospice has no religious affiliation and provides spiritual counselors from various faiths and perspectives, respecting all cultures and beliefs.

5. Hospice is not exclusive to cancer patients; it's available to anyone with a terminal illness, such as heart disease, COPD, liver disease, kidney failure, stroke, ALS, Alzheimer's disease, multiple sclerosis, AIDS, or any life-limiting condition.

6. Hospice care is usually more cost-effective than conventional care during the last six months of life. It's an all-inclusive benefit covered by Medicare, Medicaid, Medi-Cal, and most private insurance

companies.

7. A patient's personal doctor can be part of the hospice care team, working collaboratively with hospice physicians to ensure the patient's comfort.

8. Hospice does not withhold medications or treatments; it utilizes state-of-the-art medications and palliative treatments to provide relief and comfort.

9. Families are not kept from the hospice patient; on the contrary, hospice professionals believe that including family members, even children, in the dying process fosters a caring environment and helps address their fears.

10. Hospice is not a sign of failure; it's a compassionate mode of medical therapy that focuses on symptom management, pain control, and overall emotional and spiritual well-being.

11. Hospice does not hasten death; its goal is to enhance the patient's quality of life in their final months, weeks, and days.

12. Hospice is not euthanasia or physician-assisted death. Instead, it supports patients in living comfortably and with dignity until their natural conclusion.

13. Morphine prescribed in hospice does not cause premature death. Hospice physicians administer morphine in carefully calculated doses to alleviate pain and improve the patient's quality of life.

14. Hospice may withhold nutrition and hydration at some point in the dying process, considering the body's natural progression and the patient's ability to process foods and fluids.

15. Artificial nutrition and hydration may not necessarily benefit the hospice patient and are carefully evaluated by specially trained hospice physicians to ensure appropriate intervention.

Understanding the truths behind these myths helps individuals and their families make informed decisions about hospice care, emphasizing comfort, dignity, and support in the final stages of life.

To comprehend how Vienna can assist you or your loved one, it's essential to familiarize yourself with hospice and palliative care terms. This glossary provides explanations for common terms used in these fields:

Advance care planning: Making decisions about the care you desire when you can no longer speak for yourself, including creating a living will and appointing a healthcare surrogate.

Advance directive: A document outlining your healthcare preferences if you become seriously ill and unable to communicate your wishes.

Anticipatory grief: Mourning the impending loss of a loved one, often experienced when the patient is terminally ill.

Bereavement: The period of grief following the death of a loved one.

Care transition: The shift in a patient's care, such as from hospital to home or from curative care to hospice care, requiring careful planning and communication.

Caregiver burnout: Feelings of depression, exhaustion, and anger resulting from the strain of caring for a loved one without adequate support.

Case management: Professional coordination of services to benefit a client, particularly relevant in healthcare settings when transitioning patients between care facilities.

Chaplain: A religious or lay person providing spiritual support in various organizations, including hospices.

Continuous care: One of the four levels of care under the Medicare hospice benefit, involving up to 24 hours of clinical care at home until symptoms are controlled.

Culturally competent care: Tailoring healthcare to meet patients' diverse values, beliefs, and social, cultural, and language needs.

Curative care: Medical treatments aimed at curing a disease.

Diagnosis: Determining the specific disease or condition explaining a person's symptoms.

Difference between hospice and palliative care: Palliative care encompasses all comfort-focused care, while hospice care is a subcategory designed for terminally ill patients who opt against curative treatments.

DNR (Do Not Resuscitate): A written order, placed in a patient's records by a physician at their request, instructing medical staff not to revive the patient if their heartbeat or breathing stops.

Dysphagia: Difficulty swallowing.

Dyspnea: Labored or difficult breathing.

Edema: Excess fluid in body cavities or under the skin, causing swelling and discomfort.

Election of hospice: Choosing to enter hospice care and signing the necessary paperwork.

End-of-life care: See hospice care.

Family caregiver: Someone providing physical and emotional care to an ill or disabled loved one at home.

Four levels of care: Medicare hospice benefit mandates four levels of care: routine home care, continuous care, inpatient care, and respite care.

Free-standing hospice: A hospice facility, typically freestanding, exclusively dedicated to end-of-life care and supporting patients and their families.

GIP (General Inpatient Care): One of the four levels of care mandated by the Medicare hospice benefit, providing around-the-clock care in a healthcare facility until symptoms are controlled.

Grief: Profound sadness experienced after the death of a loved one.

Holistic services: Special treatments, such as music therapy, massage, pet visits, reiki, and acupuncture, addressing the whole patient's well-being, not just their disease.

Home hospice care: See routine home care.

Home medical equipment: Supplies and equipment supporting a patient's unique needs at home, such as hospital beds, wheelchairs, oxygen delivery systems, etc.

Homelike setting: A healthcare environment emphasizing comfort and aesthetics, designed to be less clinical than traditional hospital rooms.

Hospice: A healthcare organization providing comfort-focused care for terminally ill patients, emphasizing quality of life over curative treatments.

Hospice aide: A certified nursing assistant offering personal care and assistance to patients near the end of life.

Hospice care team: A group of professional caregivers, including RNs, physicians, social workers, chaplains, hospice aides, bereavement specialists, and volunteers, working together to provide comprehensive care.

Hospice care: Comfort care, aimed at pain and symptom management, enabling terminally ill patients to live fully each day.

Hospice eligibility: Guidelines determining a patient's qualification for the Medicare hospice benefit, usually requiring two physicians' certification of a life expectancy of fewer than six months.

Hospice house: A standalone building designed for end-of-life care and support for patients and families.

Hospice volunteers: Community members dedicating their time to perform tasks for a hospice, contributing to patient care and other services.

IDT (Interdisciplinary Team): A team of professional caregivers with various specialties collaborating to provide comprehensive patient care.

Inpatient care: One of the four levels of care under the Medicare hospice benefit, providing continuous around-the-clock care in a healthcare facility when symptoms cannot be managed at home.

Inpatient unit: A healthcare facility area exclusively designated for end-of-life care and supporting patients and families.

Interdisciplinary team: A group of professional caregivers with different specialties working together to provide holistic patient care.

LGBTQ: Acronym for individuals who identify as lesbian, gay, bisexual, transgender, or queer/questioning.

Living will: A document specifying medical treatment preferences for individuals with terminal illnesses while they are still alive.

Medicare hospice benefit: A Medicare service offering free medical and psycho-social care to patients with a prognosis of six months or less to live.

Palliative care: Comfort-focused care aimed at reducing the severity of a disease or its symptoms without curing the underlying condition.

POC (Plan of Care): A document created by the hospice team, outlining the necessary services, providers, frequency, and expected results.

Power of attorney (POA) for healthcare: A document designating someone to make healthcare decisions on your behalf if you become unable to communicate.

Primary care physician (PCP): The personal physician responsible for a patient's overall care and referrals to specialists when necessary.

PRN: Instructions to take medication as needed.

Prognosis: The expected course of a disease or illness.

Recertification: Document confirming a patient's continued eligibility for hospice services beyond the initial certification period.

Referral: A healthcare professional's suggestion that a patient might be hospice eligible, initiating an evaluation and discussion leading to hospice admission.

Respite care: One of the four levels of care under the Medicare hospice benefit, providing up to five days of inpatient care to give rest

Vienna is committed to providing comprehensive care to our patients, and we offer four distinct levels of care in alignment with the Medicare Hospice Benefit:

1. Routine Home Care: The majority of hospice care takes place at the patient's chosen residence, whether it's a private home, nursing facility, or assisted living facility.

2. Continuous Home Care (Intensive Comfort Care®): When necessary, we provide acute symptom management in the patient's home, with hospice staff available in shifts up to 24 hours a day. This service helps the patient avoid hospitalization.

3. Inpatient Care: If a patient's needs cannot be effectively managed at home, we offer general inpatient beds in local facilities or proprietary Vienna inpatient hospice units. Our team provides around-the-clock hospice care to address uncontrolled symptoms until the patient can return home.

4. Respite Care: For a maximum of five consecutive days and nights, we offer respite care to provide a brief break for the patient's primary caregiver. During this time, the hospice patient is admitted to an inpatient setting without meeting the full criteria for continuous inpatient pain and symptom management.

Specialized Care Services at Vienna

At Vienna, we strive to deliver the highest quality of care to our patients and their families. As part of this commitment, we offer specialized care services, which include:

1. Veterans Care: We understand that veterans have unique needs at the end of life, and our staff members undergo specialized training to provide tailored care. Vienna is proud to be a certified We Honor Veterans provider.

2. Music Therapy: Music, in its various forms, can address emotional, cognitive, and social needs of patients, and we utilize music therapy as a valuable component of our care.

3. Pet Visits: Many of our hospice locations have pet volunteers with screened, friendly pets that visit patients and provide comfort. Additionally, our inpatient hospice units allow family pets to visit as well.

At Vienna, our goal is to ensure that every patient and family receives personalized and compassionate care, tailored to their unique needs and preferences.

At Vienna, we firmly believe in placing the patient and their family at the heart of our care. At Vienna, "The patient and family are always at the center of our care."

This philosophy means that the decisions rest with the patient and their family. They are the ones in the driver's seat, and our role at Vienna is to provide unwavering support throughout their journey.

A Compassionate Team by Your Side

The Vienna hospice team comprises a group of dedicated professionals, all working in unison to serve the best interests of the patient and their family:

1. Nurse: Our skilled nurses assess and manage pain, offering hands-on care to ensure comfort and well-being.

2. Social Worker: Providing emotional and community support, our social workers also assist with financial matters and future planning.

3. Physician: Collaborating closely with the patient's primary physician, our doctors consult on pain and symptom management, making house calls when needed.

4. Hospice Aide: Our compassionate hospice aides offer assistance with personal care, such as bathing and mouth care, as well as light housekeeping.

5. Chaplain: Our chaplains are available to provide spiritual support, respecting and catering to the patient's beliefs.

6. Volunteer: Volunteers play a crucial role by offering support in various ways, lending a helping hand wherever needed.

7. Bereavement Specialist: For grief and loss counseling, our bereavement specialists are there to provide solace and understanding.

Personalized Care on Your Terms

Our team members typically visit one at a time, always adhering to the schedule chosen by the patient and their family. We are here to offer assistance and guidance whenever it's needed.

At Vienna Hospice, our commitment is unwavering: the patient and family remain in control throughout their journey, and we stand by their side, providing compassionate care and support every step of the way.

Can a patient's health improve while on hospice care? Absolutely. It is not uncommon for patients to experience improvements in their health for various reasons while receiving hospice services. These improvements can arise from factors such as proper nutrition, adjustments to medications, increased social interactions, consistent medical and personal attention, and more.

Hospice care is a Medicare benefit that belongs to the patient, and individuals enter hospice because they qualify for this benefit and choose to access it willingly.

In some cases, if a patient's condition shows marked improvement, the doctor may reevaluate the initial prognosis of six months. If the patient's physician believes they will live beyond six months, hospice care can be discontinued.

However, if the patient's condition later starts to deteriorate, the doctor can reassess the situation. If the patient remains eligible for hospice care, they can elect to resume hospice services.

Is it possible for a patient to decide to stop hospice care? Absolutely. Patients have the right to choose to discontinue hospice services without requiring a doctor's consent. This process is known as "revoking" hospice.

At times, patients may decide to revoke hospice services to give curative treatments another chance. Upon revoking hospice, they can opt for surgery or resume curative efforts. Some patients may also choose to transfer to another hospice. In any scenario, hospice care is always the patient's choice.

When a patient revokes hospice services, it also means relinquishing any benefits they may have been receiving through the Medicare hospice benefit, such as home medical equipment and supplies, holistic or therapeutic services, and home visits.

Can a hospice decide to discharge a patient? Yes. If the hospice determines that the patient is no longer terminally ill with a prognosis of six months or less, they must discharge the patient from their care.

Other reasons for patient discharge from hospice may include the death of the patient, the patient revoking the hospice benefit, the patient moving or transferring out of the hospice's service area, or discharge for cause, which may result from disruptive or abusive behavior.

It's essential to remember that hospice care is patient-centered, and patients and families have the ultimate say in their care. If, for any reason, they decide it is in their best interests to stop hospice care, their hospice provider will respect their decision and welcome them back if they choose to return in the future.

As a leading provider of hospice care services, Vienna specializes in end-of-life care, bringing comfort and support to patients wherever they call home. We often receive inquiries about how hospice services compare to home health, as both are Medicare-funded home services. To make the right choice in care, it's essential for patients, family members, and caregivers to comprehend the similarities and differences between the two.

Home Health vs. Hospice Care: The Distinctions

While home health care and hospice care share some similarities, they cater to distinct patients with unique needs and goals.

Hospice Care:

Hospice care provides comfort to patients with advanced illnesses when curative treatments are no longer effective or preferred. It is focused on enhancing the quality of life for patients with a prognosis of six months or less if the disease follows its natural course, as certified by a physician.

What to Expect:

Hospice care is delivered wherever the patient calls home, which could be a private residence, nursing home, assisted living community, or residential care facility for the elderly. An interdisciplinary team of hospice experts, including nurses, aides, physicians, chaplains, social workers, volunteers, and bereavement counselors, provides daily care and compassionate end-of-life support.

In addition to routine hospice care at home, three other levels of care are mandated by the Medicare

Hospice Benefit:

- Continuous care (known as Intensive Comfort Care® at Vienna) involves around-the-clock attendance by a nurse or hospice aide to manage acute symptom flare-ups per Medicare guidelines.

- Inpatient care provides temporary care in an inpatient hospice unit or hospital bed until symptoms are under control and the patient can return home.

- Respite care offers temporary inpatient care in a Medicare-certified facility to give family caregivers a break of up to 5 days and nights to prevent burnout.

Home Health Care:

Home health care provides intermittent skilled nursing care, physical therapy, speech-language pathology services, or continued occupational services, as prescribed by a doctor. It is typically prescribed for patients recovering from surgery or injury or those with chronic conditions.

What to Expect:

For a patient to receive Medicare benefits for home health services, they must be homebound. The duration of home health services depends on the patient's care plan and goals. Unlike hospice, home health care is curative in nature, aiming to help patients recover or improve functionality.

Patients receiving home health care may have out-of-pocket expenses related to medications, supplies, and equipment. Additionally, home health services do not cover inpatient stays if symptoms escalate and become unmanageable at home.

When Home Health Becomes Hospice:

As an illness progresses, a home health patient may become eligible for hospice care. If you notice signs of decline while receiving home health care, such as significant weight loss, increased dependency on others, or difficulty breathing, discussing hospice eligibility with your doctor can help relieve symptom burdens and enhance quality of life.

Similarities Between Home Health and Hospice:

Despite their differences, home health and hospice share similarities, including:

- Provision of care wherever the patient calls home

- A doctor's order based on eligibility as a prerequisite for both types of care

- Coverage by Medicare, Medicaid, the Veterans Administration, and many private insurance companies

- Assistance with daily living activities, such as bathing and dressing

- Cost-effectiveness compared to hospital or facility care

- Continuation based on physician certification and continued eligibility

Understanding Palliative Care:

Palliative care, a board-certified medical specialty in the US since 2006, focuses on providing comfort, symptom management, and pain relief. It has been practiced for centuries and aims to make a disease or its symptoms less severe or unpleasant without removing the cause.

Palliative care is often provided in the context of serious illnesses, addressing physical, emotional, and psychosocial needs to improve the patient's quality of life. It complements curative treatments and offers support for chronic, progressive pulmonary disorders, renal disease, chronic heart failure, HIV/AIDS, progressive neurological conditions, cancer, and more.

Palliative care grew out of the hospice movement, and today, numerous hospitals offer specialized palliative care teams that work alongside a patient's healthcare team and specialists to address distress associated with serious illness and its treatment.

Understanding the distinctions between hospice and palliative care is essential for patients and their families to make informed decisions about their healthcare. Both types of care focus on pain and symptom relief, but their eligibility, goals, and settings can vary significantly.

Hospice Care Definition:

Hospice care provides compassionate comfort care for individuals facing a terminal illness with a prognosis of six months or less, as estimated by their physician if the disease runs its expected course. The focus is on enhancing the quality of life without curative intent, making it a suitable choice when curative treatment options are no longer viable or when the benefits of treatment are outweighed by the side effects.

Palliative Care Definition:

Palliative care offers compassionate comfort care to alleviate symptoms and the physical and mental stress of a serious or life-limiting illness. Unlike hospice, palliative care can be pursued at any stage of the illness, including diagnosis, curative treatment, and end-of-life care. It can be provided with or without curative intent, making it a more flexible option for patients and their healthcare teams.

Hospice vs. Palliative Care Eligibility:

Hospice care requires that two physicians certify the patient's life expectancy of fewer than six months if the disease follows its typical course. In contrast, palliative care can be initiated at the discretion of the physician and patient at any time, regardless of whether the illness is considered terminal.

Hospice and Palliative Care Teams:

Both hospice and palliative care involve interdisciplinary teams that address the patient's physical, emotional, and spiritual needs. These teams offer support to alleviate pain and suffering and address concerns such as loss of independence, family well-being, and the patient's sense of burden.

Paying for Hospice vs. Palliative Care:

Hospice care costs are fully covered by Medicare, Medicaid, and private insurance. Hospice is the only Medicare benefit that includes pharmaceuticals, medical equipment, 24/7 access to care, nursing, social services, chaplain visits, grief support, and other appropriate services. On the other hand, palliative care costs, including office visits and prescription charges, can vary based on individual circumstances.

Where Do I Receive Hospice or Palliative Care?

Hospice care can be provided at home, in home-like hospice residences, nursing homes, assisted living facilities, veterans' facilities, hospitals, and other suitable facilities. Palliative care teams typically operate within hospital settings.

What Kind of Patients Choose Palliative Care?

Palliative care is recommended for patients who fit certain criteria, such as:

- Limited ability to care for themselves

- No longer benefiting from curative treatment

- Ineligible for appropriate clinical trials

- No evidence that further treatment would be effective

Patients should discuss their goals of care with their families and doctors to determine whether palliative care and/or hospice care would enhance their quality of life.

With four decades of leadership in hospice and palliative care, Vienna offers a comprehensive range of services to meet individual needs, including:

- Personalized care plans tailored to the patient's specific diagnosis

- Interdisciplinary care teams comprising various professionals to address all aspects of care

- Therapeutic, emotional, and pastoral support to enhance well-being

- Grief and bereavement services to help families cope with loss

To discover how Vienna can assist you, contact us today.

The Benefits of Palliative Care for Families and Caregivers

For individuals nearing the end of life, palliative care, also known as comfort care, prioritizes achieving the highest possible quality of life by addressing pain, physical symptoms, and psychological, social, and spiritual issues.

Beyond its benefits to the patient, researchers are finding that palliative care also has a positive impact on caregivers. Providing seriously ill patients with enhanced comfort can alleviate the stress experienced by their caregivers.

Reducing Caregiver Stress

Studies reveal that family caregivers of seriously ill patients who receive palliative care experience improved stamina, better social functioning, and fewer symptoms of depression.

For instance, Ann's husband, Bob, is less anxious as she remains calm and pain-free under palliative care. This allows him to get a good night's sleep and approach each day well-rested, ready to care for his wife. With reduced strain, Bob can more effectively handle daily responsibilities and challenges.

When a loved one is seriously ill, caregivers often feel overwhelmed. However, when that loved one is comfortable and at ease thanks to palliative care, it eases the burden of caregiving, providing relief and support to both the patient and their caregivers.

As a cancer patient, you are not alone in your journey, but each individual's experience with the disease is unique. Factors such as age, race, culture, support system, and personality all influence how cancer impacts you and your overall well-being. Palliative care acknowledges these differences and aims to provide personalized support. While it does not cure or treat cancer, palliative care focuses on alleviating physical, emotional, and psychosocial symptoms. It can begin at the time of diagnosis and continue throughout all phases of treatment and follow-up, extending to end-of-life care.

Below, discover how palliative care can be of help to cancer patients:

Coping Support

A cancer diagnosis and treatment can be emotionally challenging for both patients and their families.

Palliative care can address depression, anxiety, and fear by offering counseling, support groups, and family meetings to assist in coping with these emotions.

Addressing Physical Symptoms

Cancer often brings forth physical symptoms such as pain, fatigue, loss of appetite, nausea/vomiting, shortness of breath, and sleep disturbances. Palliative care employs a combination of medications and holistic approaches, such as nutrition and deep breathing techniques, to manage these symptoms effectively. Additionally, palliative chemotherapy can be used to shrink tumors causing pain.

Practical Assistance

Cancer patients and their families often face practical challenges beyond the illness itself. Financial pressures, legal issues, employment concerns, transportation, and housing problems may arise. Even navigating through complex medical forms can be overwhelming. The palliative care team can help connect patients with community resources, answer questions, and provide practical suggestions to alleviate these burdens.

Addressing Spiritual Needs

A cancer diagnosis often prompts individuals to confront spiritual questions, whether they draw strength from their faith or grapple with newfound uncertainties. Palliative care acknowledges and respects each patient's culture and traditions, offering guidance and support to help address spiritual concerns and find acceptance.

Enhancing Quality of Life

Palliative care has proven to be effective in improving the overall quality of life for cancer patients. When symptoms are well-managed, and patients feel supported and heard, they experience a better sense of well-being. Notably, palliative care consults have resulted in lower healthcare costs as patients can avoid unnecessary hospital stays and decline treatments that may not contribute to their overall well-being. In situations where curative treatments are no longer effective, palliative care remains dedicated to fulfilling all the patient's needs.

Palliative care services are available in cancer centers and hospitals, where dedicated palliative specialists or teams are present. Many cancer centers even have specialized programs or clinics that address specific palliative concerns like lymphedema, pain management, sexual functioning, or psychosocial issues. If you prefer to receive care in the comfort of your home or a long-term care facility, hospice teams or physicians can also provide palliative care services.

To explore the benefits of palliative care and how it can enhance your quality of life, have an open conversation with your family and oncologist about your care goals and preferences.

The coverage for palliative care, which prioritizes comfort and relief, can vary depending on your provider and insurance plan.

To determine what services are covered, what might not be covered, and whether you are responsible for copays, out-of-pocket expenses, or other charges, it's best to check with your insurance carrier or health plan.

Medicare and Palliative Care Coverage

Medicare Part B and Medicaid do offer coverage for certain types of palliative care, but you might still have co-pays for specific treatments and medications that are not fully covered. Similarly, private insurance plans generally include palliative care coverage, but the specifics may differ for each individual's plan.

Understanding Palliative Care

Palliative care is a specialized healthcare approach that aims to manage pain, alleviate symptoms, and reduce stress associated with serious illnesses. This type of care is available for patients of all ages and at any stage of their disease.

1. Symptom Management: Addressing and alleviating various physical and emotional symptoms associated with a serious illness.

2. Pain Management: Providing effective pain relief measures to enhance the patient's comfort and well-being.

3. Treatment Options Navigation: Assisting patients in understanding and making informed decisions about their treatment choices.

4. Advance Care Planning: Helping individuals plan and document their preferences for medical care in case they are unable to communicate their wishes.

5. Comfort Measures and Community Resource Referrals: Offering measures to enhance the patient's quality of life and connecting them to relevant community resources for support.

Palliative Care and Primary Treatments:

Palliative care solutions can be used alongside primary treatments for a patient's underlying condition. It is also available as an option for individuals who meet the eligibility criteria for hospice care but may not be emotionally prepared to discontinue curative treatments and transition to end-of-life care.

End-of-Life Care Planning:

Discussing and planning for end-of-life care can be challenging, but it is essential to ensure that your wishes are respected during your final months, weeks, and days. An effective way to guarantee your preferences are honored is through an advance directive—a legal document that clearly outlines the types of care and medical interventions you desire or refuse if you become seriously ill and are unable to communicate. By establishing an advance directive, you not only legally define your end-of-life wishes but also alleviate potential crises and relieve the decision-making burden for your family, designated caregivers, and healthcare team.