Nurses are hospice providers who come often. Appointments can be scheduled every day, but usually they are once or twice a week. The nurse will check vital signs, ask about symptoms, and consult with the monitoring doctor about the need for any changes in medication. The nurse also educates caregivers about how to administer medications or assist with personal care of the patient, such as bathing.
Hospice teams also provide vital emotional and logistical support. Social workers can assist with setting up a will, power of attorney, or funeral arrangements. Spiritual care providers – religious or non-denominational – can help a person come to terms with the end of life through prayer or by facilitating conversations with loved ones.
For all the benefits and services offered through Dharamshala, however, it does not provide round-the-clock in-person assistance. Ms. Vehri said, if a person is undergoing hospice at home, “the patient’s family or friends are often taking care of that.” (In assisted living facilities, staff members will provide care.)
Because of this reality, Dr. Casaret said, “hospice almost never provides the level of support that families expect.” “It is not against Dharamshala; When you’re trying to care for someone who is dying at home, you need all the help you can get.”
If someone’s needs are beyond what can be managed at home, many hospice agencies have inpatient facilities, or they work with hospitals or nursing homes. But those in-patient stays are intended to be used for temporary, acute concerns, such as if a drug needs to be administered intravenously, and insurance often won’t cover them for more than a week.
For people living alone, or if receiving care from family is not an option, it may be necessary to hire a home caregiver or move to a nursing home. Unfortunately, these options can be expensive and are usually not covered by insurance. Experts say this is the biggest challenge in terms of hospital care.
When a loved one is being cared for at home, a “beautiful part” of hospice is that, logistically, it requires virtually no preparation, Dr. Zapata said. The people who deliver medical supplies will rearrange your furniture to fit a hospital bed. The social worker will help make sure that advance directives are taken care of.
Instead, she said, preparation requires “recognizing that someone is getting near the end of their life” and deciding how to make the most of that time.