Grace Hospice of Texas is a member of the National Hospice and Palliative Care Organization and we support this group’s commitment to improve care at the end of life. Their website that contains many instructive videos about hospice is https://www.nhpco.org.
The Texas Department of Aging and Disability (https://www.dads.state.tx.us) is a part of Health and Human Services (HHS) in Texas (https://hhs.texas.gov/services/aging/long-term-care/hospice). This website contains useful information about hospice and how to sign on for services.
Life and Disease Progression
Life and the disease process have three phases. We are born in the Curative Phase, which progresses to the Disease Management Phase and then to the Life-Limiting Phase.
In the Curative Phase, an afflicted person is treated by their Physician, which in most cases is the Family Physician or Primary Care Physician (PCP). If the curable disease symptoms become exacerbated, the person is admitted to a hospital where their PCP has admitting privileges.
The hospital is considered an acute care facility. In the acute care setting of a hospital, the patient is no longer cared for by their physician but by a “hospitalist physician” that is contracted by the hospital to manage the patient’s curable disease and the course for full recovery. The hospitalist will maximize the profitability and reduce costs for the hospital.
Long Term Acute Care (LTAC)
The LTAC is designed to move the patient from the acute care setting (hospital) into a facility with lower acuity. At this facility, the LTAC staff will manage the care plan started in the hospital. The patient must stay in the LTAC for at least 25 days in order to maximize the LTAC’s profit.
If the patient still needs nursing care the family will have two choices: Home Health or Skilled Nurse Facility
The Home Health option is designed to provide care in the patient’s home. The care is ordered by the patient’s PCP and provided by a home health company using a Registered Nurse. The RN will visit the patient several times during the course of recovery, and the family will provide most of the non-skilled (RN) care. If the patient has an exacerbation the PCP will advise the family to take the patient to the Emergency Care (ER). Here the process begins all over again.
Skilled Nursing Facility (SNF)
The SNF will complete the plan of care started at the hospital, and partially treated at the LTAC. The SNF registers the number of the Medicare beds and Medicaid beds with the State Department of Aging and Disability Service (DADS). The Medicare benefit for SNF is 100 days. When the patient gets closer to using all of their Medicare days, the process to apply for Medicaid begins. The long-term care in an SNF will be funded by the patient and Medicaid.
Disease Management Phase
The Disease Management Phase begins once the Curable Stage has passed. In this phase, the disease cannot be reversed and must be managed to give the patient the best quality of life possible. Each disease is managed differently; some can be managed with oral medication taken on a schedule while other diseases require periodic visits to an outpatient clinic or infusion suite for invasive therapy. Invasive therapy can be IV therapy, accessing and draining fluids, or some less invasive like palliative radiation.
This phase can last for many years, depending on the type of disease and therapy.
Life Limiting Phase
In the Life-Limiting Phase, the person enters the beginning of End of Life. This phase, usually associated with hospice care, will generally last around 6 months and will end with the death of the patient. Once the body begins the end of life journey it begins preparation for the death. The nine body systems that work together to produce the life we experience in a balanced form now begin to fail. Sometimes all systems fail at once, but more commonly the systems gradually begin to slow down at different paces. We must remember that just as we were individuals during our prime, so will we reach the end of our lives as individuals.
Hospice is the type of care provided in the home at the end of life. The “home” can be the patient’s actual home, an Assisted Living Facility, a Personal Care home, a nursing home, or anywhere else the patient calls home.
The philosophy of hospice care is to maximize the quality of life for the patient and family. To maximize the quality of life, the Hospice will manage the symptoms of the disease that make the patient uncomfortable. The symptoms can be pain, shortness of breath, nausea, vomiting, constipation, or diarrhea. It is the goal of Hospice to keep the patient comfortable during the end of life journey.