Ask the doctors: Hospice care includes end-of-life planning

Dear Doctors: Our grandfather is 84 and has prostate cancer. He has been declining and has asked to stop treatment. He and his doctors decided that he will begin hospice care. What happens in hospice care? How do you choose a provider? We hope this can be done at home.

Dear Reader: When someone lives with a serious illness, they are faced with an ongoing series of decisions regarding their medical care. For some people, this eventually includes the choice to discontinue treatment. It may be that the available interventions are no longer effective, or that they interfere with the individual’s desired quality of life. When this occurs and doctors have determine that the person is nearing the end of their life, hospice care becomes an option.

The words “hospice care” may bring to mind a nursing home or other type of facility. And while some medical facilities are devoted to hospice care, the term actually refers to a specific type of end-of-life medical care.

When someone enters hospice care, it means that the treatments, medications and procedures that had been employed to stop or slow disease progress are no longer used. Instead, the focus shifts to addressing the person’s physical, mental, emotional and spiritual needs as they navigate the final stages of illness.

Medications and treatments may still be part of hospice care. So may specialized equipment and supplies. However, they do not treat the disease itself. Instead, they are used to manage pain and discomfort. The goal is to bolster the patient’s physical and emotional well-being as they near the end of life. If appropriate, spiritual support is offered, as well. While hospice care acknowledges death as an endpoint, it doesn’t postpone it. And it never takes any steps to hasten it.

As we mentioned, some hospice care is carried out in a specialized facility. However, it can also take place at home. Programs may be run by independent nonprofit organizations, or they can be affiliated with hospitals, nursing homes, religious institutions or home health care agencies. There are also some for-profit providers.

The practice of hospice care involves a team approach. It typically includes nurses, doctors, home care aides, a spiritual adviser, social workers and case managers. Offering help and support to family members is an important component of hospice care. This can include something known as respite care. This is when family members, who are the primary caregivers in home hospice care, are given time away to recharge and regroup.

Most communities have at least one hospice care provider. Your medical care provider and the person overseeing a patient’s discharge from the hospital can offer information on available options. The departments of health or social services of each state also maintain a list of licensed agencies. National organizations, including the National Hospice and Palliative Care Organization or the National Association for Home Care and Hospice Care, are also excellent resources.

Send your questions to askthedoctors@mednet.ucla.edu.