Questions Most Asked of Hospice Workers

• What is Hospice?
• Is Hospice like home heath?
• Where does the idea of Hospice care come from?
• Is Hospice a sort of Kervorkian-type thing?
• Is Hospice just for cancer patients?
• How is a person referred to Hospice?
• Who is eligible?
• If you sign on with Hospice, do you give up your own physician?
• Do physicians get paid if their patients become Hospice patients?
• Why do you have a Hospice program for nursing homes?
• How many people do you serve a year?
• How is Hospice funded?
• How do you raise money from the community?
• When I give a donation, where does the money go?
• Does Hospice provide bereavement support only to family members of Hospice patients or are there programs for the public as well?
• What is Camp ReLEAF?
• Does Hospice use volunteers?
• How do I become a volunteer?
• Why does Hospice need an Inpatient Care Facility?
• Where is the Inpatient Care Facility?

What is Hospice?
Hospice care addresses the physical, emotional and spiritual pain of terminally ill persons and their family members. Hospice focuses on "palliative" measures (comfort-oriented measures as opposed to cure-oriented measures) to enhance the quality of life, for both patient and family, during their remaining time. A key focus in Hospice care is to keep the patient in familiar and comfortable surroundings. Managing symptoms in a home environment (whether "home" means their personal home or a facility) avoids lengthy hospitalizations and serves to make Hospice a more cost-effective alternative to unnecessary, and often expensive, interventions.

Hospice incorporates the patient's family into the unit of care. Their psychosocial needs, as well as those of the patient's are addressed by social workers. Hospice chaplains are also available to address spiritual issues or concerns. Bereavement professionals have contact with the family to guide them through the difficult transition that accompanies the death of the loved one. Volunteers expand Hospice services in a variety of ways, such as providing respite to patient family members or running errands for the family. In addition, the presence of volunteers is a mandated Medicare standard wherein five percent of the total annual patient care hours are volunteer hours.

Is Hospice like home health?
Well, yes and no. . ."yes" in the respect that home Hospice care, like home health care, focuses on caring for the patient at home. Also "yes" in the respect that both are cost-effective alternatives through their decrease in or elimination of costly hospital stays. But, there are more differences than similarities.

The primary difference is that home health care is largely focused on rehabilitative care, while Hospice is appropriate only for those with limited life expectancies. Hospice also specializes in controlling the pain and symptoms unique to terminal illnesses. Over the years, Hospice methods of pain control and symptom management have come into their own as a specialized body of knowledge. Hospice considers the entire family, not just the patient as the "unit of care."

Where does the idea of Hospice care come from?
The modern concept of Hospice care began with a young woman named Cicely Saunders who, as a clinical aide, became very close to a gentleman for whom she was caring. As the man's condition progressed, they had many conversations concerning the needs of a dying person. They discussed the need to address pain on all levels -- physical, emotional and spiritual -- and how by doing so, the quality of life would be enhanced for those with limited life expectancies. When the gentleman died, he left Cicely Saunders a portion of his estate to carry out their ideas. Cicely Saunders used the money to complete medical school, knowing she would never have the credibility to advance their Hospice concept as a lay person. Dame Cicely Saunders began the first modern-day Hospice, St. Christopher's, in London in 1967.

"Hospice," incidentally, comes from the same Latin root from which words such as "hotel," "hostel" and "hospital" are also derived. During medieval times, a Hospice was a place of shelter for travelers. The idea remains in the modern use of the word - "Hospice" as a place of shelter for those journeying through the final months, weeks and days of their lives.

Return to Top of Page

Is Hospice a sort of Kervorkian-type thing?
No, Hospice neither hastens nor postpones death. The National Hospice and Palliative Care Organization has responded officially to issues surrounding the Jack Kervorkian case in particular and physician-assisted suicide, in general. Hospice care is designed to control pain and symptoms associated with terminal illness, neither prolonging life nor hastening death. In this way the degree of suffering which might prompt some to consider assisted suicide would be lessened. The time patient and family spend together in the patient's last days can be a very positive experience.

Hospice is about choice and maintaining quality of life in the face of death. When looking at the issue of physician-assisted suicide, the issues are far from black and white. While recognizing this issue in present day thought, we maintain that good Hospice care controls the suffering of a large percentage of those who might opt for suicide to end or avoid pain. Even so, many people remain unaware of Hospice care and how Hospice can help.

Is Hospice just for cancer patients?
No, Hospice care is appropriate for anyone facing a limited life expectancy. Approximately half of people on Hospice are dying from illnesses such as emphysema, cardio-pulmonary problems, Alzheimer's disease, and other system disorders.

How is a person referred to Hospice?
Referrals to Hospice come from a variety of places: the patient's physician, discharge planners at hospitals (in consultation with the patient's attending physician), nursing homes, family members, friends, members of the person's church, co-workers, home health agencies. All a person has to do to make a referral is to call our office, with the prospective patient's permission. Hospice will contact the referred person's physician to see if in fact they have a terminal prognosis. (Hospice cannot contact the patient's physician without the express approval of the patient.) Only then is the family contacted to explain the Hospice program and asked if they are interested in our assistance. If so, an assessment visit is arranged, at which time, if appropriate, the person may elect to be admitted.

Who is eligible?
As a Medicare/Medicaid provider, Duke Hospice is subject to guidelines for admission which require: 1) the patient has a prognosis of 6 months or less IF the disease runs its normal course, and the physician confirms that prognosis: 2) the patient, patient's family and the physician agree upon a non-aggressive course of treatment. In other words, there has been agreement that curative measures be ended and comfort-oriented treatment becomes the focus of care.

Hospice evaluates each referral for its "appropriateness." Hospice does not provide 24-hour in-home care, but does have nurses on-call twenty-four hours a day. Hospice social workers can help arrange 24-hour care through hired nurses’ aides or similar contract personnel. It is not mandatory that a patient have a primary caregiver, but this factor along with the patient's physical condition and support system, is taken into consideration at time of admission. When remaining at home is no longer feasible for a patient without a primary caregiver, arrangements can be made to admit the patient to one of many local care facilities with which Hospice works.

Return to Top of Page

If you sign on with Hospice, do you give up your own physician?
No. The intent of the Hospice program is to help the physician with care at the end of life. The doctor is notified of patient status changes, and is involved in the care plan. Patients may make visits to their doctor's office or clinic if needed.

Do physicians get paid if their patients become Hospice patients?
Physicians are reimbursed for office visits as usual. Time spent on the phone in consultation with Hospice staff concerning status or prescription changes may also be billed to Medicare. The doctor is responsible for billing that time to Medicare.

Why do you have a hospice program for nursing homes?
Nursing homes are no longer places where "old folks go to die." Many focus on rehabilitative care and nursing home staff are not always familiar with terminal/palliative care needed by residents with limited life expectancies who choose this approach to care. The Duke HomeCare & Hospice's PARTners (Palliative Care in Alternative Residences) Program allows people who call a long-term care facility "home" to receive the benefits of Hospice care and avoid relocation to hospitals. Our staff works with nursing home staff on issues of death, dying and bereavement so that they, as the primary care givers for their residents, can offer care for terminally ill residents.

How many people do you serve a year?
During fiscal year 2006-2007, Duke Hospice served 865 terminally ill persons.

Return to Top of Page

How is Hospice funded?
Approximately 85% of our Hospice receipts come from patient care reimbursement, including Medicare, Medicaid, private insurance, State Employees Health plan and patient fees. The remaining 15% comes from community support.

Does Hospice provide bereavement support only to family members of hospice patients or are there programs for the public as well?
Hospice offers support to the families of Hospice patients for a year following the death of their loved one. Bereavement Counselors are in touch to evaluate the survivor's grief process, and to direct them to additional counseling if they experience complicated grieving. Bereavement Services are offered to the community at-large as well as to hospice families through Unicorn Bereavement Center in Hillsborough.

What is Camp ReLEAF?
Camp ReLEAF is a bereavement camp for children in grades 1-8 who have experienced the death of a family member or friend. The camp is designed to allow kids to express their feelings about the loss, and meet peers who have endured similar experiences. Camp ReLEAF has been held by Duke Hospice for the last ten years and is not limited to children of hospice patients.

Does Duke Hospice use volunteers?
Volunteers serve hospice by working with patients and families, working in the office, helping with special events or other fund raising efforts, manning booths at health fairs and speaking on the behalf of hospice. Volunteers are needed in every department of the agency in addition to those who train to serve patients.

How do I become a volunteer?
By calling the Volunteer Supervisor for information (919-620-3853). Volunteer training classes are held several times a year for those who wish to volunteer with patients and their families. Office volunteers and others do not need to go through patient care training (although it is still very informative).

Click here for more information on volunteering.

Why does hospice need an Inpatient Care Facility?
Hospice at The Meadowlands provides service to individuals in need of acute care. In recent years, what Hospice has been asked to do is provide intensive physical, emotional and spiritual interventions for dying patients and their families during an increasingly limited time between admission to Hospice and death. Hospice service is most intense during the first two weeks of admission and the last two weeks of life. Additional patient care costs include expenses for medication and equipment supply. Initial nursing, social work, and chaplain visits require thorough assessment as well as documentation processes for patient data initialization. The Inpatient Care Facility is devoted to patients in need of symptom management that cannot be handled at home, i.e. when death is imminent and the patient and/or caregiver is unable to cope at home or if there is the need for complex patient and/or family instruction to prepare for transfer from the hospital to the patient's home. The facility at The Meadowlands is a cost-saving alternative to admitting the acute patient to the hospital. Thus, service at the Inpatient Care Facility is geared for shorter rather than extended lengths of stay.

Return to Top of Page