Hospice of the Comforter

     Hospice and hospitality share the same root word, hospitem, which is Latin for ‘guest’ or ‘host’. During the middle ages, the original hospices were hospitality stations located in monasteries and nunneries, where weary travelers could stop and find rest, shelter and nourishment before they continued on their travels.
     The idea of using this word for the modern hospice movement derived from the idea that when people are on the final stage of their life journey, hospice will provide the care and support needed, until that person moves on through their death. Part of being a good host is to have sensitivity and flexibility built into your system in order to quickly respond to the needs of your individual ‘guests.’
     Over the last few years, many healthcare services and environments have promoted themselves through the term patient-centered care, but patient and family-centered care has always been an integral part of the hospice philosophy. The plan of care for each patient and family is individualized and guided by their specific needs and concerns.      
     Hospice has built-in flexibility that allows a quick response to changing needs without impediment. Part of that flexibility comes from having a multidisciplinary team assigned to each patient and family, ready to respond if a need is identified in a team member’s area of expertise. Another aspect of hospice’s flexibility is built into to its level of care system, which can adjust the staffing and environment to meet needs as they arise.

Hospice Levels of Care
     Hospice services were designed around the goal of keeping the patient in their home setting, whether a private home or a care facility. However, there are times when the patient may be better served in a different setting involving inpatient care, so the level of care system allows care decisions to be made to best meet the patient’s needs from day-to-day.
     Most of the time, most hospice patients and families receive Routine Home Care, wherever they live, which generally includes the following:

• Care directed by a hospice medical director who has training in providing hospice and end-of-life care, plus the continuing involvement of the patient’s referring physician
• Regular visits to the home by RNs who have training in hospice care, as well as 24-hour, on-call nursing support
• Help with daily needs, such as bathing, provided by experienced CNAs
• Spiritual support and counseling, if desired, provided by a chaplain, trained to work with all belief systems
• Counseling services, both for the person in hospice and for the family members
• Social services support
• Medical equipment — such as hospital beds, bedside commodes, wheelchairs, oxygen — and medical supplies
• Medications to help control pain and symptoms
• Bereavement care for the family following the death
• Access to other therapies, such as physical, occupational, speech and dietary therapies, as needed depending on your loved one's condition
• A wide array of services provided by volunteers, such as companionship, caregiver respite and pet therapy

     The next level of care is Respite Care, which is entirely unique to hospice. This is designed primarily for the benefit of the caregiver, to provide an opportunity to attend out-of-town events, address their own health problems, or if there is an intense need for stress relief and rest. When it is determined that Respite Care is needed, the patient is placed in a facility that provides 24-hour care. The hospice team will continue to visit the patient and manage the plan of care. Respite Care can be provided for a 5-day stay and allows the caregiver to be freed from those everyday demands during that time. It is the least-used level of care.
     A very important level of care is Continuous Care, sometimes referred to as crisis care. This level brings skilled nursing care into the home setting for 8-hour shifts until a “crisis” is stabilized or, sometimes, until the patient has died. The following are examples of criteria for initiating Continuous Care: severe pain, unrelenting nausea and vomiting, "terminal restlessness" or agitation, bleeding, acute respiratory distress, many other symptoms or a breakdown in the primary caregiver support system.
     Continuous care is considered a short-term level of care and is reevaluated every 24 hours. According to Medicare standards, 50% of continuous care shifts must be staffed by an RN or LPN, but at Hospice of the Comforter, ALL shifts are covered by this high level of professional care.
     The final level of care is General Inpatient Care or GIP. In this case, there is a similar “crisis” as described in Continuous Care above, but it is determined that the patient and family's needs would be better served in a skilled inpatient setting, rather than at home. The setting may be a hospital, a skilled nursing facility, a hospice inpatient unit or a free-standing hospice house. The need for this level of care is also evaluated daily, and if the patient is stabilized, they would return to a home setting; however, it is not unusual for the patient to die while receiving this level of care.
     At Hospice of the Comforter, we are fortunate to be able to offer this level of care at our beautiful Hospice House. Our Hospice House team includes an Advanced Registered Nurse Practitioner, chaplains, social workers, licensed nurses, certified nursing assistants, bereavement staff, a dietician, a respiratory therapist, trained volunteers, the hospice physician and features 16 private suites with access to a lanai and outdoor garden.

     Below is a chart from the National Hospice and Palliative Care Organization (NHPCO) showing the usage of various levels of care among hospice patients.

     As you can see, the level of Routine Home Care is by far most commonly used, and is so comprehensive that it meets the needs of the vast majority of patients from the time they are admitted until their death. The four levels of care allow for varying levels of service to care for each individual patient and family as needed day-to-day, and is another unique aspect of hospice care and services.

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