Dear Savvy Senior,

Can you give me some information about hospice? My aunt has terminal cancer and wants to stay in her own home as long as possible.

Preparing for the End

Dear Preparing

According to a Gallup Poll, 90 percent of Americans, if faced with a terminal illness, want to be cared for and die in their own home, free of pain, surrounded by their loved ones. Not a bad way to go! Hospice can help make that happen. Here’s what you should know.

Hospice is a unique type of care that provides medical care, pain management, emotional and spiritual support to people who are in the last stages of a terminal illness – it does not speed up or slow down the process of dying. Hospice’s goal is to simply keep the patient as comfortable and pain-free as possible, with loved ones nearby until death.

Hospice services

The various services provided by a hospice program comes from a team of professionals that works together to accommodate all the patients’ end-of-life needs. The team typically includes hospice doctors that will work with the primary physician and family members to draft up a care plan. Nurses who dispense medication for pain control.

Home care aids that attend to personal needs like eating and bathing. Social workers who help the patient and the family prepare for end of life. Clergy members who provide spiritual counseling if desired, and volunteers that fill a variety of niches, from sitting with the patient to helping clean and maintain their property. Some hospices even offer massage or music therapy, and nearly all provide bereavement services for relatives.

Most hospice patients receive care in their own home. However, hospice will go wherever the patient is – hospital, nursing home or assisted living residence. Some even have their own facility to use as an option.

To receive hospice, a patient must get a referral from their physician stating that their life expectancy is six months or less. It’s also important to know that home-based hospice care does not mean that a hospice nurse or volunteer is in the home 24 hours a day.

Services are based on need and/or what you request. Hospice care can also be stopped at anytime if the patients’ health improves or if they decide to re-enter cure-oriented treatments.

Choosing a Hospice

The best time to prepare for hospice and consider your options is before it’s necessary, so you’re not making decisions during a stressful time. There are around 4,700 hospice programs in the U.S., so depending on where you live, you may have several programs to choose from.

Ask your doctor, nurse or local hospital social worker for a referral or call your Area Aging Agency (call 800-677-1116 to get your local number) or state hospice organization to locate programs in your area. When choosing, be sure to select a hospice that can provide the care you need (services can vary) and make sure they accept Medicare – most do.

Two other resources to help you search are the National Hospice and Palliative Care Organization (nhpco.org, 800-658-8898) and hospicedirectory.org. Both provide hospice directories, along with a list of questions you can ask to help you make your decision.

Who pays?

If your aunt has Medicare, hospice will be paid for through the Medicare hospice benefit (Part A). This covers virtually all aspects of care with little out-of-pocket. In addition, most private health plans and Medicaid in most states cover hospice.

Savvy tips: If possible, help your aunt draw up a living will and healthcare power of attorney that spell out her wishes for end-of-life medical treatment when she can no longer make decisions for herself.

To create one, visit caringinfo.org where you can download state-specific advance directive forms with instructions. And for more information on hospice, Medicare offers a free booklet called “Medicare Hospice Benefits” (publication # 02154) that you can order at 800-633-4227.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.