End-of-life care: it’s not a subject we want to think about. Yet as we watch our loved ones age, it’s important to learn about hospice care. The word ‘hospice’ originates from the name for lodging offered by monks for weary travelers. Today, it’s become an increasingly trusted form of medical care and comfort for terminally ill people who aren’t expected to live longer than six months. Hospice care focuses on making the dying patient comfortable and providing a peaceful and dignified setting.
Many people believe that hospice care is only for people at home, but in fact, depending on the state regulations, assisted living residences can also offer hospice care programs to their residents. Some states won’t allow the assisted living center to provide hospice care, meaning that residents have to be moved elsewhere. Fortunately, Tennessee assisted living residents can, for the most part, stay in their community and receive hospice.
For Tennessee assisted living communities, the rules were set forth by the 2009 Long-Term Care and Community Choices Act (LTCCCA), which restructured the Medicaid Long-Term Care service delivery program in Tennessee. The LTCCCA was intended to help people who needed long-term care to age in place and at the same time to provide independence, choice and good quality of life for those long-term care residents.
The rules on hospice care state that:
- “An assisted care living facility (ACLF) resident qualifying for hospice care shall be able to receive hospice care and continue as a resident if the resident’s treating physician certifies that hospice care can be appropriately provided at the ACLF.”
- Furthermore, the rule allows ACLFs to admit people who have already qualified for hospice care, which gives it the ability to both admit new residents qualifying for hospice and to retain current residents who need hospice care.
- When a resident of Tennessee assisted living becomes a hospice patient, the community must work with the hospice provider and develop a plan of care that maximizes the safety and well-being of the resident.
Questions to ask
It’s essential that family members get deeply involved when the discussion turns to hospice care. Good communication with both the assisted living and hospice staff can go a long way to minimizing conflict and confusion. Some good questions:
- Has assisted living staff worked with hospice care providers before?
- What hospice organizations do they prefer to work with – are they private or non-profit?
- Can family members choose a particular hospice provider if they know of one with an especially good reputation?
- Is the assisted living staff comfortable working with residents in end-of-life; how often did your staff work with hospice last year?
- What care is provided by assisted living staff and what care will hospice staff provide? Make sure there’s a coordinated care plan between the two staffs so no unnecessary conflicts occur.
- How is pain medication administration handled? Sometimes, patients in end-of-life situations have significantly increased pain that is eased only by powerful opioids such as morphine. Ask if someone is available round-the-clock to administer these meds when needed.
- Under what conditions would your loved one have to be moved out of the assisted living community to a nursing home or hospital?
The most important thing you can do when your loved one is in an assisted living residence is to stay involved. Understand who is taking care of your loved one and what kind of care plan is in place for that unfortunate, but inevitable, time when the end of life draws near. What questions do you have about hospice care?
