Coordinating end-of-life care can be one of the most logistically and emotionally challenging aspects of eldercare. Adult children and loved ones will often find themselves immersed in conversations about what is best and honoring while trying to figure out who can take on which responsibilities. Often families are simply not able to provide extended care on an on-going basis. Most commonly we will see adult children who are not able to carry work responsibilities while caring for an aging loved one. It is also common that the level of care becomes so complex that it exceeds the family caregiver’s ability to provide the care. Hospice and Home Care have complimentary and different roles to play during this time. These common services used in end-of-life care often overlap and it can be difficult to understand where one service starts and the other ends. Teasing apart these two services will help clarify the options that families have.
The Role of Hospice
When an individual has made the choice to refuse further treatment or is in the active stages of dying, hospice care is used to relieve the suffering of an individual while attending to their emotional needs. While the disease may not be curable, how the person lives and dies with the disease is the focus of the care. The range of time that an individual is on hospice can vary widely from a few days to a year. A physician will create a plan of care for palliative care that is usually carried out within the home. Support is extended to family as well in the form of education, resources and bereavement support. A hospice nurse is able to administer medications for pain management and comfort. The nurse will create an individual schedule with each family and will stay for varying amounts of time as needed; however 24-hour care is not provided. When it comes to the cost of care, Hospice services are paid for by Medicare and Medicaid patients who qualify for care.
The Role of Home Care
Every end-of-life process is unique and different diseases will impact the body in different ways. In the end stages of a disease it is common to experience the loss of everyday functionality and many individuals will need considerable assistance 24 hours a day. While hospice is able to give guidance of what to expect, they are not able to stay and provide the day-to-day care. This is where in home care services begin. A Certified Nursing Assistant is trained in end-of-life care and is able to adapt to the fragile and changing needs of each individual. They are able to stay as long as needed and provide for the everyday needs such as dressing, bathing, toileting, feeding, rotating as well as other needed comforts such as companionship. This care can come in many forms ranging from a few hours of service, to respite care for families, all the way to 24-hour care. Generally speaking, long-term care costs are not covered by Medicare, leaving in-home care to private pay or supplemental long-term care insurance.
Care Management in End-of-Life Care
The arrangement and coordination of care can also be taxing on families as they are trying to be present to their loved one and their own grief. A Geriatric Care Manager is a professional certified in the care of older adults. They are able to guide families through the paperwork of the healthcare system and are able to arrange needed services on behalf of the family. As a neutral third party, they can also act as an advocate and mediator to help families navigate this crucial time. While they are available for eldercare planning, they can also provide crisis management for families and assist with transitional care from the hospital to home. For more information about this process, be sure to check out our blog categories of “advocacy and transitions” and “crisis management” or give us a call at 800.628.7649.
Published on March 10, 2014.