Question: We live in a mostly rural community on family land where my brothers, sister, and I were born, as were my mother, grandparents, and great- grandparents. Throughout the years, our family members have taken care of each other at home, generally until death.

This has been the case with my mother, now 83. Over the past four months, she has lost 35 pounds, refuses to eat, and has become dehydrated several times, requiring hospitalization. The local hospital is 15 miles away, and the doctor there suggested that we look into hospice. This never crossed our minds because Mom is not terminally ill. Our family made this decision, and hospice has been a godsend. We read your column faithfully, and felt that other readers might benefit from knowing this fact. Thank you.

Answer: Since its introduction in the United States in the early 1970s when most people died in hospitals, the criteria for admission into hospice have expanded from being limited to end-stage, terminally ill patients to those with other types of illnesses that cannot be cured and lead to death.

Medicare beneficiaries who choose hospice as a benefit under Part A (Hospital Insurance) are provided with medical and support care services geared toward comfort, not cure, during the last stage of their lives. Using a team approach that includes nurses, social workers, physicians, clergy, and volunteers, the patient and family members can co-ordinate care. Hospice professionals are available 24/7. Services can be provided in the home, assisted living and nursing facilities, and in the hospital when required.

While eligibility for hospice requires a physician’s certification that the individual is terminally ill and has a life expectancy of six months or less, Medicare has recognized that it is sometimes difficult to establish a six-month-or-less projection when the patient is clearly declining but has no specific disease. For this reason, Medicare has created the diagnosis of “Adult Failure to Thrive Syndrome / Debility Unspecified” that allows hospice treatment.

As is being experienced by more and more families who care for elderly relatives, many of these individuals may decline rather rapidly, lose weight and become weaker in the last months of their lives. Often, their physical function is impaired, they are cognitively impaired, they suffer from malnutrition, and they are depressed. They become dehydrated, and their immune system is compromised to the extent that catching a cold can be fatal.

The treatment of elderly persons in decline is difficult for physicians because the causes for the deterioration cannot always be identified, especially in those who don’t have acute illness or severe chronic disease, but ultimately lose the willingness to eat and drink. Physicians now recognize the “failure to thrive” diagnosis as a key point in the care of an elderly person, and open dialogue with families about end-of-life care alternatives that will avoid needless medical treatments that might only prolong the suffering.

The Medicare hospice benefit covers physicians’ services, nursing care with 24- hour call, medical hardware and supplies related to the end-of-life situation, outpatient prescriptions for pain relief and symptom management, short-term inpatient care for acute situations, home health aide and homemaker services, physical therapy, occupational therapy, speech/language pathology services, medical social services, and counseling, including dietary and spiritual counseling.

Hospice services can be extended past six months so long as the physician certifies the patient as terminally ill at the beginning of each period. Hospice services must be certified by Medicare, and a patient who chooses hospice has the right to change programs, if desired, once during each benefit period. Hospice enrollees have the absolute right to cancel hospice care at any time and return to their regular Medicare coverage.
You can learn more about approved hospice programs in your area by contacting your local Social Security office, your state hospice organization, or click these links:
Hospice Foundation
American Hospice
National Hospice