Medical Guidelines for Hospice Patients

Hospice upholds the physician-patient relationship established prior to the patient’s Hospice admission in accordance with the patient’s wishes. These Hospice medical care guidelines have been prepared to assist the patient, family, and health care team in their understanding of certain medical aspects of Hospice care.

Hospice care is a specialized form of treatment and services for a patient and family experiencing an advanced illness or limited life expectancy. The primary focus of care is on pain and symptom management along with other supportive measures. Hospice is an alternative to aggressive medical regimes which may no longer be helpful or desired.

In addition to persons with cancer, persons with other end-stage diseases such as cardiac chronic lung, Alzheimer’s, kidney and liver disease, AIDS, and ALS, may also be appropriate for Hospice care. Each patient’s situation is evaluated by their physician and assessed by the Hospice interdisciplinary team comprised of a Hospice Nurse, Social Worker, Nutritionist, Family Care Giver, Bereavement Counselor, and a Chaplain if desired. Each Hospice patient has a care coordinator who is a registered nurse and a hospice physician is available to the patient’s physician and the Hospice team for consultation.

For a procedure or treatment to be considered appropriate as part of the Hospice care plan, the patient, primary care person, physician, and Hospice interdisciplinary team review the treatment in light of the patient’s life expectancy and quality of life at that point in time. Treatment decision-making is thus focused on enhancing the quality of the patient’s remaining life.

According to Hospice regulations and in order to be covered by insurance, all services and medical treatments must be reasonable and necessary for the management of the life-limiting condition and pre-authorized by Hospice. 

A patient-physician decision to pursue curative or more aggressive therapy through medical intervention will be respected. Patients are always free to withdraw from Hospice. Under such circumstances, Hospice will discuss with the patient and their physician the continuing appropriateness for Hospice care. Upon the decision to discharge the patient, Hospice will make appropriate referrals and schedule a timely transfer to other health care or social services if necessary.

Specific guidelines for Palliative Medical Care:

Palliative medical care includes optimizing the patients’ ability to participate in activities of daily living. Hospice provides teaching for patients and caregivers regarding the provision of safe care.

A Do Not Resuscitate Order (DNR) is appropriate for hospice patients and shall be consistent with New York State regulations. Hospice team members are not obligated to perform heroic measures such as cardiopulmonary resuscitation (CPR) on a Hospice patient for whom a DNR order is not in effect. The hospital medical staff will assume this responsibility when the patient is in the hospital. For hospice patients at home or in a long term care facility, existing emergency medical services such as 911, and caregivers, are instructed or assisted in doing so.

Medications will be administered for the control of pain and other symptoms in order to achieve maximum comfort. The goal is to keep the patient as alert and as involved in the care as possible.

Diagnostic tests and other assessments are appropriate when results are needed for alleviation from symptoms or pain. Testing for the purpose of evaluating progression of disease is usually no longer appropriate unless for the purpose of symptom and pain management.

Hospice works with the patient, family, and attending physician to evaluate the goals, effectiveness, and palliative nature of treatments and therapies such as:

• Radiation therapy
• Chemotherapy
• Surgery
• Total perenteral nutrition (intravenous)
• Enteral nutrition (feeding tube)
• Blood transfusions
• Intravenous antibiotics/medications/hydration
• Spinal pain medications
• BIPAP & CPAP

The risks, burdens, and benefits of such treatments, the patient’s functional status and estimated prognosis, and the supporting medical data will be considered when making decisions about these types of treatments. When possible, Hospice will choose the least burdensome treatment for the patient.

Hospice provides an on-call service which is available to patients and families 24 hours a day, 7 days a week, to handle questions, problems, emergencies, and to provide home assessment of problems. Ambulance or emergency room services are not covered unless authorized by the Hospice plan of care.

HOSPICE REJECTS THE PRACTICE OF ASSISTED SUICIDE OR EUTHANASIA IN THE CARE OF THE TERMINALLY ILL.