Frequently Asked Questions (FAQs) about Hospice and Medical Conditions

They are:

• The patient has advanced congestive heart failure or advanced coronary disease with frequent episodes of angina
• The patient has an abnormal heart due to disease and suffers from significant symptoms of fatigue, shortness of breath or functional decline
• The patient has received optimal treatment for his/her disease and has chosen not to pursue advanced specialized treatment

Others include:

• The patient can no longer walk and may be bed-bound
• The patient is totally dependent on others for eating, dressing and grooming
• The patient shows signs of severe anxiety

At the end of their lives, Alzheimer’s patients present several challenges to their caregivers. When these patients are in the last stages of life, hospice can relieve some of the burden—physically, emotionally and spiritually—for caregivers as well as help the patient’s end-of-life experience be comfortable and dignified.

Additional signs include:

• Progression* from independent ambulation to wheelchair or bed-bound
• Progression* from normal to barely intelligible or unintelligible speech
• Progression* from normal to pureed diet
• Progression* from independence in most or all activities of daily living (e.g., toileting, feeding, dressing, etc.) to needing major assistance with these tasks
• Choice to forego feeding tubes for hydration and nutrition and supportive ventilation for breathing

* Progression is defined as the development of severe neurologic disability over a 12-month period.

Signs include:

• The patient is rapidly weakening and the cancer is progressing
• The treatment intervention is not fully effective
• The burden of treatment on the patient and family outweighs the benefits

If the chemotherapy were being used to attempt to cure the cancer, hospice would be inappropriate. However, a patient receiving hospice services may receive chemo for reasons of comfort and quality of life; for example, to shrink a tumor that is pressing on an organ.

Other signs include:

• Persistent vegetative state
• Severely reduced level of consciousness
• A significant compromise in breathing and/or swallowing