Hospice Services and Practical Care

How to find a hospice provider
Thinking about the end of life can be upsetting and emotionally overwhelming.  However, preparing for and making choices about end-of-life care, while extremely difficult, can offer survivors and families a sense of relief and control.  Such planning can be reassuring for everyone involved.  Knowing what lies ahead can help reduce fears of the unknown.

Most communities have more than one hospice organization.  Ask the survivor’s healthcare team or a social worker to help you find out what hospice care is available in your community and how to arrange for it. 

The National Hospice and Palliative Care Organization (NHPCO) has a state-by-state directory of hospice providers on its website, www.nhpco.org.  You may also receive assistance by calling the NHPCO “HelpLine” toll-free at 800-658-8898.   In addition, the Pancreatic Cancer Action Network’s Patient and Liaison Services (PALS) Associates can provide you with resources to find hospice care in your area.   PALS Associates are available toll-free at 877-272-6226 or by email at pals@pancan.org M-F 7am-5pm Pacific Time.

Who provides hospice services?
Hospice care is a team effort. A team of trained healthcare professionals, including hospice physicians, hospice registered nurses, home health aides, social workers, chaplains and grief counselors, work with caregivers to care for the survivor and guide families throughout the hospice journey. Each person performs a unique set of duties aimed at improving quality of life for the pancreatic cancer survivor.

If home hospice care is provided, the key person on the hospice team is the primary caregiver. The primary caregiver may be a spouse, partner, parent, child, sibling, relative, friend or privately hired person. Most likely this is the person who has been with the survivor throughout the cancer journey, someone trusted and with whom the survivor feels completely comfortable. Caregivers do many things including: giving medication, continually monitoring changes in the survivor’s condition, preparing meals and helping with all aspects of personal care. The primary caregiver works closely with the hospice staff to keep the survivor as comfortable as possible.

Serving as a caregiver can be extremely rewarding. Many partners, family members or friends who have helped with caregiving find it very satisfying and would not have chosen any other option. However, caregiving is also a considerable responsibility that is both physically and emotionally demanding. Talk with your loved one and make sure you are both prepared for the challenges ahead. Hospice may not work for all families or situations.

If a pancreatic cancer survivor does not have a primary caregiver, the hospice team will assist the individual in finding available community resources and support.

Affording Hospice Care
Most health insurance companies have a hospice benefit that pays for all or most of the costs associated with hospice care.  This means that families usually pay very little and often nothing for end-of-life care.  Contact the survivor’s health insurance provider for specifics on coverage.

Some insurers that provide a hospice benefit include:

• Medicare - The Medicare Hospice Benefit
• Medicaid (in most states) – The Medicaid Hospice Benefit
• TRICARE (military health system)
• Some private insurance companies

If the pancreatic cancer survivor does not have or qualify for any form of health insurance, some hospices can still provide care at little or no cost.   Talk with several hospice organizations to learn what is available.   For assistance in finding hospice services available in your area, contact the PALS Program toll-free at 877-272-6226 or email pals@pancan.org.  PALS Associates are available M-F 7am-5pm Pacific Time.

Some costs are not covered by health insurance when hospice care is given in a retirement home or nursing facility.   In this situation, the cancer survivor is responsible for paying for rent, meals, and some routine care services that are provided by nurses and health aide workers who are employed by the retirement or nursing facility.

Practical Care
Hospice can help with practical care, covering everything from insurance and other financial matters to light housekeeping and routine chores.

The people who provide these practical services are housekeepers, social workers and volunteers.

The hospice social worker can also help with many practical concerns including:

• explaining and helping to complete advance directives (see below), if requested
• identifying and explaining insurance benefits
• explaining what services hospice benefits pay for
• setting up a system for staying organized
• linking the survivor, caregivers and family to community resources
• arranging for respite care that gives caregivers time off
• contacting friends and relatives
• assisting with funeral arrangements

Most hospice organizations have trained volunteers to help survivors and their families. Volunteers may be available to:

• help with household chores and responsibilities
• run errands
• help with child care
• perform light housekeeping duties
• stay with the survivor while the caregiver takes time to rest
  

What are advance directives and why are they important?
Advance directives give survivors the control and legal ability to state exactly how they want to be cared for and who they want to make decisions for them if they become unable to communicate their wishes. When survivors are no longer able to discuss medical options with their healthcare teams or their families, advance directives make their wishes known. Advance directives may specify the types of medical support that a survivor does and does not want, including the use of feeding tubes, breathing machines and cardiopulmonary resuscitation (CPR).

Advance directives include documents such as a “Directive to Family and Physicians” (more commonly known as a “living will”), a “Medical Power of Attorney,” and a “Do Not Resuscitate” (DNR) order. These documents can be prepared at the survivor’s request and must be signed by the survivor before they are given to physicians. The survivor decides what provisions will be included in each document. However, if the survivor is incapacitated and not able to clearly communicate his or her wishes when hospice care is needed, then certain family members can prepare these documents on the survivor’s behalf.

A “Do Not Resuscitate” (DNR) order is an advance directive that states that no life-saving medical procedures, including CPR, are to be used if the heart or breathing stops. The use of CPR on survivors with advanced pancreatic cancer may reduce quality of life and prolong the dying process. Hospice staff and the survivor’s physician can arrange a discussion of the benefits and risks of CPR and a DNR order so that an informed decision can be made.

Hospice professionals support the survivor’s right to make their own decisions. Survivors are not required to have a DNR order to receive hospice services. If a survivor wants to have a DNR order, hospice staff can help make the necessary arrangements.

If advance directives have not been completed at the time of hospice admission and the survivor would like to complete them, the staff can help to arrange for and finalize these documents. Each option will be clearly explained so that the survivor can make informed decisions. Advance directives and DNR orders can be changed by the survivor at any time. In all cases, creation or modification of advance directives must be initiated by the survivor, not by the hospice or healthcare teams.

In addition to the hospice team, legal advisors can help finalize details of the survivor’s advance directives.

The information and services provided by the Pancreatic Cancer Action Network, Inc. are for informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment. If you are ill, or suspect that you are ill, see a doctor immediately! The Pancreatic Cancer Action Network does not recommend nor endorse any specific physicians, products or treatments even though they may be mentioned on this site. In addition, please note that any personal information you provide to the Pancreatic Cancer Action Network's associates during telephone and/or email consultations may be stored in a secure database to assist the Pancreatic Cancer Action Network, Inc. in providing you with the best service possible. Portions of the constituent data stored in this database may be used to inform future programs and services of the Pancreatic Cancer Action Network, Inc., and may be provided in aggregate form to third parties to guide future pancreatic cancer research and treatment efforts. The Pancreatic Cancer Action Network, Inc. will not provide personal identifying information (such as your name or contact information) to third parties without your advanced written consent.  111230