Rainbow Hospice - Hospice

[Home] [Latest News] [Calendar]

FAQ's

General

How sick does someone have to be for admission into hospice?

If a patient is admitted to hospice while in the hospital, how long can he or she stay there?

How long can patients stay in hospice care?

Can a patient decide to stop hospice care?

Who provides the around-the-clock care for the patient?

How often do hospice team members visit?

What medications are paid for by Rainbow Hospice?

Does Rainbow Hospice pay for oxygen?

What supplies are provided?

Will a doctor visit at our home?

What happens when our family member dies at home?

What happens when our family member dies in a nursing home or hospital?

Can we call 911?

What kinds of therapy are available to hospice patients?

Does anyone help us after our loved one dies?

How can I learn more about Rainbow Hospice or get specific questions answered?

General

Q: How sick does someone have to be for admission into hospice?

A: The guideline for the hospice benefit is that the doctor must believe that if the patient’s medical condition follows its natural course, it is likely the patient will die within six months. However, no one can predict the exact course a particular disease will take. Some patients come to Rainbow Hospice very late in their illness and receive services for only a few days. Other patients are with Rainbow Hospice for many months and in some cases for a year or longer. Once a patient meets the guideline above, it is the patient’s and family’s decision about when they sign up for hospice care. Many people tell us they wish they had signed up sooner because of the physical care and emotional and spiritual support they receive.

Back to Top

Q: If a patient is admitted to hospice while in the hospital, how long can he or she stay there?

A: It depends on how long it takes to stabilize the symptoms that have caused the patient to be in the hospital. Patients cannot stay in the hospital indefinitely – even if they are hospice patients. Patients are discharged from the hospital when the medical care being provided could be done at the patient’s home. In most cases, patients and their families are anxious to be back home in familiar surroundings and hospice can provide vital support to allow a family to accomplish this. If the family needs assistance with finding a nursing home or hiring a caregiver, a Rainbow Hospice staff member can provide guidance in these areas. If nurses and doctors are managing pain and/or other symptoms that would not be possible to manage at home, the patient can stay in the hospital until these issues are under control. If a patient is expected to die within the day, he or she may remain in the hospital.

Back to Top

Q: How long can patients stay in hospice care?

A: Patients can stay in hospice as long as the primary doctor and the hospice agree that it is appropriate. When a Medicare or Medicaid beneficiary is admitted to hospice, they begin with a 90-day benefit period. During the last month of that period, the hospice team will discuss whether or not the patient should be recertified, meaning they are still likely to die within six months or less following the recertification. If the patient is recertified, he or she will then have another 90-day benefit period, followed by an unlimited number of 60-day benefit periods, as long as he or she continues to be recertified. For people with commercial health insurance, each provider has some type of recertification process. If the patient is not recertified, plans are made to discharge the patient and to help them get the care that they need. A discharged patient may qualify for hospice care at a later date and can be readmitted at that time.

Back to Top

Q: Can a patient decide to stop hospice care?

A: A patient and family always have the right to discontinue hospice care and services. The Rainbow Hospice staff will work with the patient and family to clarify insurance coverage issues and to facilitate continuity of care. There is no penalty for discontinuing hospice care and patients can return to hospice again when they are ready for comfort care to be their goal. However, it is important to remember why a patient and family signed up for hospice, to reevaluate the patient’s goals and to reconsider what they have been told by their doctor about the likelihood of further treatment improving their condition.

Back to Top

Q: Who provides the around-the-clock care for the patient?

A: Family members or caregivers who are hired and paid for by the patient and/or family provide most of the day-to-day care of patients. Rainbow Hospice’s team members will help family members or hired caregivers learn how to best care for your family member at home and will make regular visits to manage the patient’s care. Hospice does not provide staff to stay with patients and families around the clock except in very extraordinary circumstances. Hospice care takes teamwork and the patient and family are important members of the team. Be sure to let staff members know your preferences about all aspects of care, and if these preferences change over time, be sure to discuss this with staff as well.

Back to Top

Q: How often do hospice team members visit?

A: Rainbow Hospice team members’ visits will vary according to the needs of the patient and family. It is important to be aware that when specific needs arise, additional visits will be made as needed. Rainbow Hospice has 24-hour availability of hospice staff for phone consultation and/or unscheduled visits. The Standardized Care Plan below is what staff members work from in customizing each patient’s individual care plan. Each patient’s plan of care and schedule of visits is customized based on their needs and the needs of their loved ones. The nurse will discuss with the patient and family how often he/she should come. The home health aide may come 1-3 times a week, depending on the needs of the patient. The social worker and chaplain visits will vary depending of the specific needs or wishes of the patient and family. For the patient whose condition is worsening or is experiencing increased pain and symptoms, the nurse may visit several times during the week or even daily, if necessary, to monitor the patient’s response to medication changes and to provide support to family members. Volunteers will be offered and generally visit weekly.

Back to Top

Q: What medications are paid for by Rainbow Hospice?

A: Rainbow Hospice pays for medications that are used to control pain and symptoms related to the terminal diagnosis. For example, if a patient has lung cancer that causes pain and shortness of breath, Rainbow Hospice pays for medication to control the pain and shortness of breath. If that same patient also has diabetes, Rainbow Hospice would not pay for his or her Insulin, since diabetes is not the terminal illness. During the admission process and after consultation with Rainbow Hospice’s pharmacist and Medical Director, the Rainbow Hospice nurse reviews with patients and their families what medications are covered.

Back to Top

Q: Does Rainbow Hospice pay for oxygen?

A: As with medications, oxygen that is used to control symptoms related to the patient’s terminal diagnosis is paid for by Rainbow Hospice.

Back to Top

Q: What supplies are provided?

A: Rainbow Hospice provides basic supplies, such as disposable briefs and pads for the bed, gloves, urinals, bedpans, bandages, enemas and catheters. If the patient needs medical equipment in the home, such as a hospital bed, commode or walker, these are supplied at Rainbow Hospice’s expense. Rainbow Hospice does not provide sheets for hospital beds.

Back to Top

Q: Will a doctor visit at our home?

A: Most people keep their primary doctor when they become a hospice patient. Whether that doctor visits at home or not is up to each doctor. Occasionally Rainbow Hospice’s Medical Director will visit a patient in his or her home, with the patient’s primary doctor’s permission. This happens mainly in two instances. First, the Medical Director may visit to help the patient and family clarify goals for care. Second, the Medical Director may visit to assess the patient and advise on complicated pain and symptom management issues.

Back to Top

Q: What happens when our family member dies at home?

A: When a patient dies, the family calls Rainbow Hospice to inform staff of the death. At that point, a nurse, social worker or chaplain will be sent to the home. An effort is made to send a staff member the family has met, but this is not always possible, especially during the night and on weekends. During the time the staff member is there, the funeral home will be called and informed about when to come to pick up the body. The staff member will offer emotional support to the family, dispose of any remaining medications, and call the primary doctor and the durable medical equipment company to inform them of the death. It is important to note that all of the above happens on the family’s timetable. If a family wants several hours of private time before the staff member arrives, or if they are waiting for a family member or friend who is coming from a long distance, they can let Rainbow Hospice know this and we will delay sending a staff member until the family is ready. Weather and traffic may affect the arrival time of the staff member. When hospice patients choose to die at home, no one calls 911, no police or fire department personnel arrive and the family controls the timing of the situation. Many patients and families prefer for death to take place at home. The Rainbow Hospice team will do their best in the time available to prepare each patient and family for what may happen, based on each patient’s disease and circumstances. Sometimes patients seem to wait for family members to gather and they die with family around them. Other patients die while those in the home are asleep or when they have just stepped away for a little while. Occasionally, patients die while one of the hospice team members is visiting. If a family wants someone from hospice to be with them when the patient dies, in some instances a Vigil Volunteer or staff member can be sent to stay with the family for several hours. However, because no one can predict the exact time of death, it is not possible to coordinate the Volunteer’s visit, or staff visits, with the time of death.

Back to Top

Q: What happens when our family member dies in a nursing home or hospital?

A: If a loved one is not present when a patient dies, the nursing home or hospital staff will call the patient’s primary contact person to inform them of the death. They will also inform Rainbow Hospice. Nursing home or hospital staff will usually ask if the loved one plans to come to the nursing home or hospital and it is each person’s choice whether they go or not. If the friend or family member wants to go to the nursing home or hospital, the staff there will offer support and they will coordinate with Rainbow Hospice staff regarding the need for the hospice staff to come to the nursing home or hospital. Whenever the family or friend is ready and gives their permission, the funeral home is called to come and pick up the body.

Back to Top

Q: Can we call 911?

A: You always have the right to call 911. However, it is important to be aware of what may happen when that call is made. Many hospice patients sign a Do Not Resuscitate (DNR) order, directing that if their heart stops beating, or if they stop breathing, they do not want anyone to attempt to revive them. If a patient has signed a DNR order, calling 911 would go against their wishes to let nature take its course. On occasion, family members panic and call 911. Paramedics are required to do all they can to save the patient, including taking the patient to the hospital. Once in the Emergency Room, if staff is not told the person is a hospice patient, doctors will do all they can to save the patient, which may include inserting a breathing tube. If the staff is told the person is a hospice patient, they will likely do what they can to immediately control any pain or symptoms, and send the patient back home. Rainbow Hospice needs to be notified as soon as possible when a family member is considering calling 911 or after they have done so. Our Medical Director will then call the hospital emergency room to coordinate care. Caring for a patient at home can be overwhelming and exhausting. The issues and questions that come up can be challenging. That is why Rainbow Hospice is available 24 hours a day for phone consultation calls. If needed, we will arrange a staff visit as soon as possible. Patients and families usually have the medications and supplies needed for most situations in their home and often some guidance from the nurse is all they need to keep a situation from getting out of control.

Back to Top

Q: What kinds of therapy are available to hospice patients?

A: Occasionally, when it is determined by the hospice team that a patient could significantly benefit from some type of therapy, such as physical therapy, occupational therapy or speech therapy, or a consultation with the dietician, it will be offered. Radiation therapy may also be considered in limited situations since it can sometimes reduce pain. In general, however, therapy that is meant to “cure” a condition is not compatible with hospice philosophy or appropriate for hospice patients. As illness progresses, patients and families frequently ask about how the patient will be fed. Rainbow Hospice has the expertise to work with patients and families to understand the benefits and burdens of artificial nutrition and hydration.

Back to Top

Q: Does anyone help us after our loved one dies?

A: Yes, Rainbow Hospice’s bereavement staff follows up with each patient’s primary care person to offer support and explain the various bereavement services that are available. Families of Rainbow Hospice patients can have up to six counseling sessions with a bereavement counselor free of charge. In addition, Rainbow Hospice offers a wide variety of support groups including groups that focus on the loss of a spouse, sibling, adult child and parent. Primary care persons, and other loved ones who request it, receive monthly mailings about grief-related topics for a period of 13 months after the patient’s death. The Good Mourning Program is a comprehensive program for bereaved children, teens and their families. The Good Mourning Program promotes “good grief” and aims to minimize or prevent the negative consequences of unresolved grief through services which include monthly and weekly support groups for children, teens and adults, family camp, a holiday gathering and remembrance service, and a school outreach program. All of the Bereavement Program services are offered at no charge or for nominal fees.

Back to Top

Q: How can I learn more about Rainbow Hospice or get specific questions answered?

A: Call Rainbow Hospice at 847-685-9900 or visit www.rainbowhospice.org.

Back to Top