Involving Hospice care at the end of life can be overwhelming. There are many choices to consider.
Am I ready to consider comfort over traditional aggressive care?
How will my family feel about my choice?
Am I giving up?
The Hospice team is expert at guiding conversations related to any barriers and myths that may prevent a person from choosing Hospice and can support patients and families in their decision-making journey.
Early in the relationship with Hospice, the decision for life sustaining treatment is discussed, including wishes regarding a Do Not Resuscitate order (DNR).
In Ohio there are several choices for care:
- Full Code (do everything): this is a choice for a person who is interested in prolonged, lifesaving interventions including CPR with compressions and shock, airway support with intubation (artificial airways) and ventilator, along with aggressive Hospital treatment.
- DNRCC-A (do some things): This is a choice that is most appropriate in a hospital setting, allowing patients to choose some life saving measures that may exclude CPR or ventilator needs, but includes other interventions such as IV medications to help irregular heart rates or other methods of respiratory support.
- DNRCC (keep me comfortable): This is a choice that involves focusing on comfort, managing symptoms rather than the disease and will not include any interventions to resuscitate an individual who is experiencing natural death.
Michigan is either Full Code or Comfort Care.
While choosing to remain a full code or DNRCC-A will not prevent a patient from a Hospice admission, it’s important to understand why Hospice teams focus care and conversation related to DNRCC (comfort care only).
Patients who are eligible for Hospice are considered to have one or more medical conditions that are contributing to their overall decline, and it is likely that end of life could occur in six months. These patients are no longer interested in or have exhausted treatment options and wish to focus on quality of life and time with family and friends. Anything other than a DNRCC (keep me comfortable) negates that focus. Why?
- CPR is an abrupt, invasive and painful treatment designed to regain heart and lung function and is very unlikely to help a patient who is terminally ill. Even if this intervention is successful, a terminally ill patient will likely never regain previous quality of life.
- Hospice care considers patients with a DNRCC-A order (do some things) to be a Full Code (do everything). There is no life-sustaining treatment available to staff in the home or in a Hospice inpatient setting. When patients with this choice are declining or experiencing severe symptoms, Hospice must send them to the hospital for treatment, or the patient can agree to change their order to DNRCC for comfort and have their needs managed by Hospice.
Dispelling Myths
When patients are choosing a comfort-focused plan of care, there are often questions and misunderstandings on how they will receive medical treatment from the Hospice team. Hospice patients choosing a DNRCC still receive the following:
- Treatment for infections with oral antibiotics, if desired
- Medications that provide comfort and medications that treat conditions such as diabetes, high blood pressure, irregular heart rhythms, etc.
- Nursing, Aide, and, occasionally, Nurse Practitioner or Physician visits as outlined in the patient’s plan of care.
It’s All About YOU!
Hospice care is designed by the patient and family with the Hospice team as their partner and guide in discussing goals and, as we ask at every visit, “What is most important to you today?” In planning care, the Hospice team considers the choice for resuscitation to be a top priority in achieving goals.
Even for those not electing Hospice, share your wishes with family and prepare advance directives that outline your goals for care.