There are a lot of misconceptions about hospice care. One of the biggest? That hospice is where you go when you’ve given up.
But hospice isn’t a place. It takes place in whatever setting the person who is receiving hospice care calls home, including assisted living and memory care communities. And hospice doesn’t necessarily mean someone is going to die right away.
“When people think of hospice, they think death is going to happen at any time,” says David Watson, a medical social worker with a hospice care company in Vancouver, Washington. “But I see hospice as added care, not less care. We provide extra care in the patient’s place of residence with the goal of providing as much comfort — physical, spiritual, and social — for the rest of their life.”
For many seniors, that place of residence is an assisted living or memory care community. About 68% of residential care communities offer hospice, according to a study from the United States Department of Health and Human Services.
So how does hospice care in senior living work? What are the benefits of hospice in assisted living or memory care? And how do you know when to bring hospice into the community?
What Is Hospice Care?
Hospice care, which is covered by Medicare and most private health insurance plans, is care designed to help someone with six months or less to live, according to a physician, live as well as possible for as long as possible with the goal of increasing their quality of life.
Care is not only physical, such as medication for symptom control or pain relief and medical equipment and supplies like bandages and catheters. It also includes coordination of care, clarification of goals of care, and grief and loss counseling for the patient and their loved ones.
“My main job is to help make the end-of-life experience as pleasant and as non-stressful as possible for the person who is on hospice and their family,” Watson says. “As social workers, we assess the need and then figure out how to meet that need utilizing our team approach. For example, if they need a nurse for a symptom issue, then that’s where our hospice nurse would come in. If it’s a spiritual or religious issue, our non-denominational chaplain will come in. If the family and/or the patient is having a difficult time grieving or if they’re having a difficult time adjusting to the decline in the patient, that’s where our bereavement counselor can come in.”
The whole point of hospice care is to bring comfort and dignity to the person whose life is drawing to a close and to support their family and loved ones — and some people actually live somewhat longer with hospice care than those with the same illness who don’t choose hospice care.
How Does Hospice in Senior Living Work?
Many senior living communities partner with an outside hospice provider to provide end-of-life care so that their residents can remain in the community during their last months. “By allowing our residents to receive their hospice care within the community, they get to remain in a setting that is familiar and with a team that they already know and trust,” says Steve Lin, Healthcare Director of Highgate at Vancouver.
The hospice agency works closely with the senior living team as well as the resident’s family doctor or specialist to coordinate care, reduce pain and discomfort, and increase quality of life. “For example, we had a resident, Polly, who lived in our memory care community,” Lin says. “Polly was an avid exit seeker and had quite a bit of anxiety and agitation. We felt that Polly would benefit from hospice care. We worked carefully with the hospice team to manage her agitation, and her last weeks were spent more peacefully.”
One of the biggest benefits of bringing hospice care into the senior living community is that it reduces hospitalizations and the resident doesn’t often have to move to a higher level of care, which can cause a lot of trauma and stress on the family. “We’re really good about preventing hospitalizations,” Watson says. Hospice care often eliminates what can be intrusive procedures while increasing a resident’s access to caregivers and other professionals that provide both physical and spiritual support.
What Are the Benefits of Hospice in Senior Living?
One of the biggest benefits of hospice is the support it offers families. Hospice professionals teach family members how to care for their loved one, provide counseling to family and friends, and offer education about the care process. The hospice team can also help families deal with the wide range of emotions that surround this difficult time as well as the after-death tasks that need to be completed.
“I try to make sure the family’s questions are answered, that they’re well supported emotionally,” Watson says. “I make sure that any final planning is all taken care of prior to the loved one on service passing as a way to decrease stress at the time of passing. For example, we help make sure there’s a funeral home selected prior to the loved one passing so when they do pass, the family can just be family and not worry about selecting a funeral home at the time of death.”
Ultimately, choosing hospice care makes end-of-life a more calming and comforting experience for both the resident and their family.
“I’ve had families say, ‘I had no idea hospice was going to be as supportive as you were’ and ‘I couldn’t have done it without hospice. You made it so much more manageable. I couldn't have done this alone,’” Watson says.
Which is why it helps to choose hospice early.
When Is the Right Time for Hospice?
Hospice is available to individuals with six months or less to live — yet most people don’t opt for hospice services until the very end. In fact, research shows that most people receive hospice care for less than 13 days.
“People are underutilizing the hospice benefit,” Watson says. “There's still a stigma around hospice that I hear from families we work with. When people think of hospice, they think death is going to happen at any time, but hospice is meant for when you have six months or less.”
That’s why Highgate Senior Living believes in using hospice proactively, instead of waiting for the inevitable. “This allows the resident to have the extra attention and improve their quality of life in their last months, not just their last days,” Lin says.
He shares the story of a Highgate resident, Ed, who is currently on hospice: “He had declined in his dementia and was aspirating on his food and fluids. He also had quite a bit of wound management needs. We were able to get him on hospice, and after some time, he slowly regained some strength. He started eating better and participating in some activities, and his wound even healed. The past few weeks he has been enjoying the sun out in our courtyard. He is still on hospice, but now we see him interacting with others more and smiling more.”
Trying to decide what’s best for your aging loved one? Learn how you can navigate the decision between home care and assisted living with our helpful guide.