Frequently Asked Questions

When the patient has six months or less to live, all attempts to cure have been stopped, and the patient/family has been told of the prognosis, then the patient should be referred to hospice. It is best not to wait until death is imminent since the team will not have time to establish rapport or intervene effectively. Sometimes the patient or family members are not all accepting of the prognosis for referral to hospice to be made.

To be admitted to the hospice program, a patient must meet the criteria noted on the Eligibility Guidelines. However, the overriding guideline is a simple one: the patient must be certified as having a life expectancy of six months or less. All definitive curative therapies must be finished.

Anyone, including the patient, family member, or physician may make the initial request for service by calling (714) 844-7777. The admissions RN will record the vital information and, if necessary, contact the patient’s physician for orders and permission to admit the patient to the hospice program.

An initial visit is usually made within twenty four hours of the referral. At that time, the patient’s condition and needs are assessed. The RN will explain services, discuss how other team members will be visiting and answer any questions. This time can be the same day if the family requests.

Medicare, Medicaid and some private insurance pay for the care given by the hospice team. If a patient does not have any payment source, he/she may pay all or part of the bill, personally. The important thing to remind your patients is this: no one is denied service because of an inability to pay.

The referring physician may choose to maintain control of the care of the patient. This is the most common arrangement. If the patient is to be admitted to the inpatient unit of the hospital and the referring physician does not have admitting privileges there, the medical director will take responsibility for the inpatient care and return the patient to his doctor on discharge from the hospital.

A team made up of representatives from a variety of disciplines provides hospice care. These include:

• The Registered Nurse (RN) is the team leader and performs the initial assessment. The RN monitors the patient’s condition, reporting changes and problems to the physician. After the initial assessment, a Licensed Vocational Nurse (LVN) may perform many of the same tasks as the RN.
• The Medical Social Worker (MSW) provides psycho-social support for the patient, family and the hospice staff. The MSW also assists with community referrals and financial concerns.
• The Home Health Aid provides personal care of the patient such as bathing, shampooing the hair, or changing the linens.
• Chaplains are an important part of the hospice team and provide emotional and spiritual care support for the patients and their families. Chaplains come as a friend and along with the bereavement team; they can be an excellent resource for helping with funeral planning or a DVD Life Tribute.
• Hospice Volunteers help patients and families, just as a friend might, by assisting with household tasks, running errands, telephoning or visiting. They are a Medicare mandated member of the team, and invaluable to the care of each and every hospice patient.
• The Medical Director serves as consultant to staff and referring physicians, attends team meetings and oversees the medical aspects of the hospice program.

Expectations Within Time Frame

• Withdrawal from the world and people
• Decreased food intake
• Increase in sleep
• Going inside of self
• Less communication

• Disorientation Physical
• Agitation
• Confusion
• Talking with the unseen
• Picking at clothes
• Physical
• Decreased blood pressure
• Color changes, pale, bluish
• Respiration irregularities
• Sleeping but responding
• Not eating, taking little fluids
• Pulse increase or decrease
• Increased perspiration
• Congestion
• Complaints of body tired and heavy
• Body temperature to be hot/cold

• Intensification of One to Two Weeks signs
• Surge of energy
• Decrease in blood pressure
• Eyes glossy, tearing, half open
• Irregular breathing, stop/start
• Restlessness or no activity
• Purplish knees, feet, hands, blotchy
• Pulse weak and hard to find
• Decreased urine output
• May wet or stool the bed

• “Fish out of water” breathing
• Cannot be awakened