Everyone comes to the end of their life. People with diabetes are no different. Over the course of my career I have worked in many aspects of healthcare. This includes consulting for a local hospice program for 5 years. I had a series of questions recently a about hospice. What is it and at a person nears the end of their life, and would like to consider hospice, how would hospice care for their diabetes?
What does the term hospice mean?
According to The National Hospice and Palliative Care Organization, the word hospice has its roots in medieval times where a hospice was a place of rest for weary travelers. (1)
In modern times, hospice is an organization that assists with care of a patient as death is drawing near. It provides support for the patient and the patient’s family. In most cases, hospice accepts patients with many diagnoses if life expectancy is less than 6 months. Hospice care focuses on comfort. It does not focus on curing ones illness. It provides medical, psychological and spiritual care so people have support to control pain and symptoms of their disease. Hospice care helps people to die with peace and dignity. Hospice care can take place in a person’s home as well as a hospice center. Hospice centers are located in hospitals, skilled nursing facilities and free standing centers. (2)
How does one pay for hospice care?
If you have Medicare part A and meet the other conditions for hospice care, Medicare will help you pay. The other conditions are:
That you are certified by your doctor and the hospice medical director in that you have 6 months or less to live if your illness runs its normal course
You choose to sign a statement choosing hospice instead of other Medicare benefits for treating your terminal illness. (Medicare still pays for other covered benefits that are not related to your terminal illness).
The care you get is from a Medicare approved hospice program. (3)
If you do not have Medicare, Medicaid has hospice benefits. Most private insurance companies also cover hospice costs as well as Tricare. Some people self-pay and charity care may also be an option. (4)
How do I locate a hospice organization?
Enter your zip code at the following link: http://www.momentsoflife.org/find-hospice to find hospice organizations at the locations in the United States.
What happens when a person has diabetes and they elect their hospice benefit?
The Medical College of Wisconsin has published a fact sheet on diabetes management for the end of life. The fact sheet is very informative and provides information on topics such as medication, monitoring blood glucose with finger sticks and A1c testing. Share this information with your physician to plan your diabetes care. To access this document go to this site: http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_258.htm
Another well written journal article is titled: The Diabetic Hospice Patient: Incorporating Evidence and Medications Into Goals of Care. This article focuses on a diabetes care plan in hospice.
According to the authors, the hospice plan should address issues of liberalizing glycemic control, individualizing blood glucose monitoring and preventing symptoms of hypoglycemia. To access this article go to: http://journals.lww.com/jhpn/Fulltext/2011/11000/The_Diabetic_Hospice_Patient__Incorporating.3.aspx
In conclusion, some people have lived with diabetes for a very long time. As the end of life approaches, diabetes care needs to be planned for. If hospice is considered, ask that the plan of care for diabetes is explained to both the patient and their family. It is very important that one understands how the needs of their diabetes will be addressed to allow for a death with peace and dignity.