Hospice is a comprehensive service available for patients who have a life expectancy of six months or less and their families. Medicare A, Medicaid and most Insurances have hospice benefits.
Predicting a life-expectancy of six months or less usually involves a significant, documented deterioration in a patient’s physical and functional status, such as weight loss, decreased function and/or an end-stage disease. Decline may also be due to refusal of treatments, medications or hospitalization aimed at improving or stabilizing an advanced disease.
If a patient does better than initially expected, he or she may get discharged from hospice, yet can always receive hospice service at a later time when more appropriate. There is no penalty for early referral.
Please call us if you think your patient may benefit from hospice services. We would be happy to evaluate your patient for hospice eligibility. A consult by our Hospice Medical Director is also available.
To refer a patient for hospice at home or to our inpatient Hospice facility, please call: 919-938-7582
SECU Hospice House
426 Hospital Drive
P. O. Box 1376
Smithfield, NC 27577
Johnston Health Home Care and Hospice
514 N. Bright Leaf Boulevard
P.O. Box 1376
Smithfield, NC 27577
- Hospice benefits include nursing, home health aide and counseling visits to address physical, personal, emotional and spiritual needs; medical equipment; medications related to the terminal illness; and bereavement support for the family for at least one year.
- Our Hospice programs provide three levels of care: routine home care, respite care and inpatient care.
- Respite and inpatient levels of care are generally provided at our SECU Hospice House located at 426 Hospital Road in Smithfield.
- When the patient elects hospice, they waive all rights to Medicare payments for services related to treatment of the terminal condition by health care providers other than their hospice or their attending physician.
- Patients can continue to receive medical care from their attending physician for all illnesses related and unrelated to the terminal diagnosis. Attending physicians who are not employed by the hospice continue to bill Medicare for their services with the same ICD-9 and CPT codes they have previously used.
- Patients can be hospitalized and continue to receive medical care from health care providers other than the hospice and attending physician for illnesses unrelated to the terminal diagnosis.
- Patients can continue to receive Medicare room and board benefits in a nursing home for conditions that are not related to the terminal diagnosis.
- Patients can continue to receive home health benefits for conditions that are not related to the terminal diagnosis.
- By 2040, it is expected that one in two Americans will die in a nursing home. In 1986, the nursing home/facility was recognized as a surrogate home for America’s elderly, and that hospice care was a patient’s right in this new home setting. Now the nursing facility provides the daily care for the patient that used to be provided by the family (i.e., bathing, feeding, toileting, giving medicine, etc.) Hospice provides the same service as in any other home setting (i.e., specialized services of pain management, psychosocial and spiritual care, and bereavement care for at least a year).
- In a study conducted by the Center for Gerontology and Health Care Research, patients who receive hospice care are less likely to be hospitalized in their final days of life than those who don’t. Also, many family members bemoaned the fact that hospice was brought in too late to be of much comfort to them or the patient.
- According to the Patient Self-Determination Act passed on November 5, 1990, Medicare hospice providers are prohibited from discriminating against a patient who does not have a Do Not Resuscitate (DNR) order.
Communicating difficult news on end of life issues with patients and their families is important. Patients and families want to know what to expect during the dying process. Explaining what will happen strengthens the physician-patient/family relationship. It also fosters collaboration and permits planning and assessing coping behaviors in patients and families. You can follow a six-step protocol for delivering difficult news:
Step 1: Set up a meeting specifically to discuss a patient’s end of life with the person and their family members. Plan what you’ll say about their condition and their future. Create an environment conducive for the meeting. Choose a quiet place where you’ll be undisturbed, and allot adequate time to answer questions. Consider the number of people in the meeting and how informed they are going into the meeting. Determine the patient’s decision-making capacity and who the patient would like to have present for the conversation. If the patient is cognitively impaired and has not chosen a durable power of health-care attorney, contact their next of kin or a known family member and invite them to meet with you.
Step 2: Establish what the patient and family already know, and assess their ability to comprehend new information. Postpone the conversation if they are emotionally unprepared to talk about end of life.
Step 3: Find out how much they want to know. If the family has indicated that they don’t want the patient to be told their prognosis, explain the benefits of being informed and propose talking to the patient together.
Step 4: Promote dialogue by determining previous experiences. Avoid using medical jargon or euphemisms, and use periods of silence frequently. Check for the patient’s and family’s understanding — you can observe their facial expression for comprehension.
Step 5: Be prepared for outbursts of strong emotion or a broad range of reactions. This is a perfect opportunity to observe family dynamics, which may be useful in the future.
Step 6: Plan for next steps. Discuss potential sources of support; affirm your continued support; provide written information; and assess the patient before leaving.