When is it time for hospice care?

Mentioning hospice, or end-of-life, care to the people you help is never easy. But at Aurora Health at Home, hospice care is about celebrating life. When people choose our hospice care, they’re entering a new stage of life that we help fill with comfort, dignity and peace.

How hospice care works

How to suggest hospice care to the people you help

You likely have cases in which you feel hospice provides the best option. When you’re ready to initiate a conversation about hospice care, follow these steps for a productive discussion:

• Focus on goals of care: Establish what people want care to achieve moving forward. Start by talking with them about the disease status and what’s likely to come next. Determining how much they understand will guide you in the conversation.
• Review previous treatments: Remind them about the measures already taken to attempt a cure. Discuss the results of those efforts. Gently illustrate that the disease state is not improving.
• Provide choices: Lay out the care options, discussing the disease path and possible side effects associated with each. Introduce hospice care as one of the possible choices.
• Read the signs: If they want to continue curative treatment, respect their wishes and don’t push further for hospice. If they suggest a preference for comfort care, though, give details about the supportive services available through hospice care.

Factors for admission into Aurora Health at Home hospice care

People ready to consider Aurora Health at Home hospice care must meet certain requirements for admission. They must have a:

• Life-limiting illness with a prognosis of six months or less
• Clinical progression of a terminal disease
• Confirmation of terminal condition by two doctors
• Desire for hospice care

How to know when it’s time for hospice

Clinical indicators and goals-of-care conversations can help you determine when it’s a good time to discuss end-of-life care. Indicators for hospice care usually include a combination of the following:

• Life expectancy of six months or less
• Recent decline in functional status as determined by:
  • Karnofsky Performance status less than 50%
  • ECOG Performance Scale status of 3 or 4
  • Palliative Performance status less than 50%
  • FAST Scale stage 7 for dementia patients
  • Dependence in at least three of six activities of daily life (ADL)
• Impaired nutritional status, as shown by either significant weight loss (10% or more over 6 months) or serum albumin less than 2.5 gm/dl
• Repeated hospitalizations or emergency department visits
• Recurring infections
• Presence of decubitus ulcers

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