Should we look for a hospice house?

Dear Barbara, our house is not big enough to have a hospital bed and all the medical things that my dad will need now that he's been referred to hospice care. We have to work, so no one will be home to take care of him. Should we look for a hospice house?

Hospice houses are care facilities generally managed by hospice agencies to provide end of life care for those whose life situation prevents them from being at home. 

In the early hospice days, those “houses” were run by specific hospices and financed by fundraisers, charitable donations, and fundraising projects. Generally, a person was not charged and there was really no time limit on how long they could stay. A hospice house was a community blessing, but there weren’t many.

Today most hospices have some sort of a hospice house arrangement. It may be in a designated portion of a nursing facility or in a free standing building of its own. It is financed not through fundraising, but by the Medicare hospice benefit. However with the benefit there comes some rules that were not present in the earlier conception of hospice care.

Sudden deterioration that requires intensive nursing intervention is the criteria for hospice inpatient admittance. It is for pain management and symptom control. The care is intended to last for a limited time -- seven to ten days.

Billing is done through the medicare hospice benefit because the patient needs care that can’t be provided in the home or nursing facility.

The challenge for the hospices, and certainly for the families, is once the seven to ten days has elapsed and death has not come, everyone is left wondering what to do. Currently, the patient is dismissed and returned to their home or admitted to a nursing facility paid for privately by the patient or their family.

It seems most confusion comes from “length of stay.” Family and caregivers are stressed, frightened, and feeling overwhelmed. The idea of mom going to a facility to die sounds reassuring, comforting. Often, the “limited length of stay” portion of the consultation is not heard. Then, when the allotted time expires and talk of moving mom elsewhere occurs, hospice becomes the “bad guy”. Communication, Communication, Communication.

Something More… about Should we look for a hospice house?

Are you caring for someone who is approaching the end of life? Are you feeling overwhelmed? Do you know how to prepare for your special person's death?

I’ve put together a guidebook for at-home caregivers that addresses pain management, funeral planning, end of life care (which is different from the care we give someone who will get better), advance directives and more... My hope is that this guide will be a support that you lean on each day as you navigate these challenging waters. You may get your copy here: BY YOUR SIDE: A Guidebook for Caring for the Dying at Home.