Question

"My dad is in his mid 90s and starting to decline rapidly. I think he might be appropriate for hospice care, but my siblings are absolutely against me bringing it up with him or even talking about it with them. I work in healthcare and have heard and seen wonderful care from hospices.

I do not understand their fear and I do not believe that it will somehow shorten his life. Am I wrong? Does it shorten life? Should I just let things play out as they will, or do I keep bringing it up with the clan?"

Answer

To answer your question, I do not think receiving hospice care shortens life. What it does do is add to the quality and comfort of his remaining life. Who wouldn’t sign up for that?

Imagine declining alone with an occasional visit to your doctor’s office. Instead, picture a hospice nurse coming to you on, let’s say, a weekly basis. Her primary purpose is to see to it that you are comfortable. The nurse answers your clinical questions, gets your medications adjusted, communicates with your children and doctor. Then add a social worker to assist you with planning and coordinating, be it funeral wishes, financial concerns, family dynamics, or whatever is on your mind. Then there are chaplains, aides, volunteers, and other support services that all come to you.

I have seen some amazing care provided by hospices and feel that everyone deserves that type of care in their last months of life. Hospice is a healthcare benefit that Medicare created in 1985 and has since become accepted as the care of choice for people near and at the end of life.

The fear that some have is how to know when to start hospice care. Could I be wrong about starting hospice? But there are very specific published criteria that hospices must adhere to in determining if someone is eligible. A reputable hospice will not admit your father for care if he does not qualify. And yes, some individuals actually thrive under hospice care and their decline is arrested. Those folks are discharged from hospice and readmitted when their decline begins again. Hospice patients must be seen by a provider every 60-90 days to determine ongoing eligibility, so it’s not the responsibility of the patient or family to figure this out. The hospice takes that responsibility.

The most common fear is the subject of death itself. Your father may not be as fearful as his children are to talk about it or plan for it. It’s a real gift to slow down and let the conversation go there. Ask him if he would like to hear about hospice for the last months of his life, be it now or five years from now. Being part of a real conversation that’s private, not hurried, and in a relaxed environment may be eye opening.

I recommend that the children explore their own concerns and fears about hospice care. Do a little bit of research about it. Talk to a few hospices. Speak to your father’s doctor. The most important thing is to provide the best care model available.