Local hospice officials say one of their main tasks is trying to demystify end-of-life care, so that individual entering hospice, and their families, understand the type of care they can receive.
“Let me just emphasize that a patient is going to come first,” said Jenna Campbell, director of patient services at the Elkin office of Mountain Valley Hospice.
Sometimes that means finding other agencies to assist with a patient’s needs.
“We’re not a long-term care facility,” said Campbell, explaining the government-regulated guidelines for care can sometimes create confusion for families.
“A hospice home, just like all hospice, is regulated by Medicare. They set the guidelines for us,” said Campbell.
Those rules classify the types of care required by a patient.
“The most common we use is called GIP, which is general inpatient. Those are patients that have a symptom to manage,” said Campbell.
Comparing this level of care to someone going to an emergency room, Campbell explained the patient would only be admitted if there was a symptom to be managed.
“Uncontrolled shortness of breath, agitation, pain, nausea/vomiting, any symptom like that that needs inpatient treatment is what you go to a hospice home for. There are no set guidelines as to how long you stay for that. If we get your symptoms managed in 48 hours, you’re going to go home. If it takes two weeks, it takes two weeks, but we keep the patient until their symptoms are managed in that level of care.”
Such patients might be admitted to the Woltz Hospice Home in Dobson or the recently opened State Employees Credit Union (SECU) Hospice Care Center of Yadkin in Yadkinville.
Most hospice patients are seen in their home.
“We can do more in the home than what people realize,” said Campbell.
Even with patients who do go for GIP general inpatient care often find they can return home soon afterward.
Even though most of the patients seen in the 17 counties covered by Mountain Valley Hospice in Virginia and North Carolina are visited in their homes, many receive another category of care called respite.
“Respite is for those patients at home that the caregiver needs a break,” said Campbell, explaining Medicare allows five days of inpatient care at the hospice home.
“[For example] the caregiver’s going on vacation, the patient can’t be left at home, so they go for five days and then they come home. It’s just a routine level of care just like we do at the home, just that we do it at the hospice home.”
“The last one is residential stay,” Campbell said of the third level of care. “That may be part of the confusion where people think you can just go and stay. They have to pay for that and they discuss the cost of that upfront with the patient. We typically try to limit that stay just because we’re not long-term care.
“Very commonly people feel like that they can stay under that general inpatient level of care,” said Campbell, “longer than once their symptoms are managed.”
Once a patient’s symptoms are managed, they are released home.
“They no longer qualify and that’s not Mountain Valley Hospice, that’s Medicare so that’s any hospice follows those guidelines,” said Campbell.
Some patients do not have a home to return to with the level of care they need, which may cause them to be transported to a long term-facility where hospice can attend them.
“We’re not going to leave a patient outside in the cold with no help,” said Campbell.
“We do have lots of resources, but typically those patients that have no family, the majority of them are eligible for Medicaid and you can get what you call PCS services [Personal Care Services] and that’s additional CNA help in the home so that they have someone to stay with them throughout the day also or the night.”
The social workers help throughout the process no matter the level of care or the community of care a patient has.
“The social worker is there from day one just like in a hospital,” said Campbell. “You start discharge planning on day one. Same thing for the hospice home. We’re going to start looking at what their needs are at home. Whether it be equipment, additional help, things like that, and the social worker is going to help guide those and get those in the home prior to discharge.”
It is easier for families when patients decide ahead of the need what they would like to do, which is why Director Denise Watson encouraged attendees of a recent Hugh Chatham Memorial Hospital Leadership Luncheon to talk to their loved ones about their end-of-life wishes.
“It’s going to be difficult enough. If you have these things in place before you need them, you are going to save your loved ones at least a little bit of heartache,” said Watson, describing such programs as Transitions.
According to governmental guidelines, a patient must have a prognosis of six months for hospice care; however, Mountain Valley Hospice offers the Transitions program as a resource to ease the process.
“Let’s say we have a patient with cancer,” said Campbell. “If we can get them early enough, they’re still ambulatory, they still live alone, they are still able to go out and do things, we’re already having that discussion upfront.”
Instead of waiting until the patient is unable to care for themselves before deciding how they want their care to progress as well as making their funeral plans known, hospice staff can help connect to resources and educate from the beginning.
Beanie Taylor can be reached at 336-258-4058.