Hospice Basics for Physicians



Hospice Basics

Hospice referrals are appropriate for patients with an expected prognosis of less than 6 months where the primary goal is comfort and quality of life. Patients generally do not return to the hospital for care.

- There are 2 types of hospice: inpatient and home. “Home” hospice can also be provided to patients in nursing homes.

- Currently, patients must be well enough to be transported out of Hopkins to receive hospice care; we can also help provide excellent end-of-life care for patients dying here. There are 4 excellent inpatient hospices in Baltimore. In general, inpatient hospices are for patients very close to death or with uncontrolled symptoms. For patients in other parts of Maryland who cannot be at home or have weeks or months to live, there may be other facilities available; home hospices can provide care in many nursing homes, but the family often needs to pay room and board in this situation.

- Home hospice provides nursing visits 2-3 times a week and 24-hour on-call in conjunction with the patient’s physician. They provide all medications that are related to the hospice diagnosis. They also provide up to 5 visits/week by a home health aide for personal care (bath, mouth care, etc), usually 1 hr/visit. Hospice also provides home visits by social work, chaplain, volunteers, & bereavement. Patients can go to an inpatient facility at any time if needed for symptom management, respite, or if the family does not want the final days to be at home.

- Hospice does not routinely provide life-prolonging or invasive care such as hospitalizations, frequent blood draws, parenteral nutrition (enteral is usually OK if maintaining comfort), transfusions, dopamine, chemotherapy or radiation therapy. However, if you have a patient receiving complex care, please call – we are often able to work out a treatment plan.

Some myths about hospice

- The hospice decision is irreversible

Prognosis is often uncertain. 10-20% of patients are discharged from hospice, either because they change their mind, stabilize or improve temporarily, or need invasive care for another reason (e.g. break a bone). There is no time limit on hospice and a patient can always be readmitted.

- Hospice will provide all the patient’s care at home

Hospice enables the caregiver(s) to care for the patient at home. Usually this is the family or caregivers hired with private funds. Otherwise, patients need nursing home or inpatient hospice placement.

- All hospice patients need a 24-hour caregiver

If a patient can care for himself, he does not need a 24-hour caregiver until he becomes unable to do so. When the hospice team determines that this point has been reached, the patient either needs 24-hour caregiving at home or can go inpatient.

Home hospice referrals: Requirements are expected prognosis < 6 months and patient desires comfort approach. DNR/DNI is NOT necessary. Call as soon as possible!!

Call the social worker or home care coordinator. Hospices can send a liaison out to review the chart and meet with the family.

( Give your hospice discharge patients 2-3 days’ supply of medications in case of emergency

( Have them fill prescriptions at the oncology center pharmacy - many local pharmacies do not carry morphine. We recommend: ( morphine liquid, 20mg:1cc, to give SL or PR in an emergency;

( lorazepam, 1 mg tab, which can be given SL if needed for agitation/seizures;

( prochlorperazine suppositories if uncontrolled nausea/vomiting is a concern.

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