A wedding takes place in a beautiful white house with floor-to-ceiling windows that look over a tranquil lake decorated with snow. As the wedding song plays, a father walks the bride down the aisle. Everyone sheds tears, especially the father. Besides being happy for his daughter as she enters a new phase of her life, he knows that the wedding could be his last happiest memory since it is held at a hospice.

Hospice is a place for people at the very last phase of their lives. When a patient is in the later stages of a severe illness, medical therapies may no longer improve the situation but only increase their pain. So instead of treating the disease, the philosophy of care is to treat symptoms and make the patient live their remaining time as happily and comfortably as possible.

If you are new to this term, this article will provide all the essential information you need to know about hospice, which will guide you to make a better decision.

What does hospice care provide?

Palliative care and symptom control are the focal points of hospice. The goal is to help the dying live with dignity and ease physical pain and emotional needs. The care teams comprise a nurse, assistant, social worker, bereavement coordinator, and volunteers. The medical director manages the hospice team and adjusts to the patient’s needs. A hospice team’s primary responsibility is to coordinate all services for patients and their families.

These services include:

• Nursing care focuses on the patient’s physical symptoms.

• Hospice aide that provides personal care, including bathing and grooming.

• Social work visits help coordinate resources from the community and in the family.

• Volunteer companionship.

• Bereavement support for the family after the patient has passed away.

How is hospice care provided?

Hospice care is available at home or in a supportive community. Usually, inpatient treatment is needed when patients have symptoms they cannot deal with at home (e.g., uncontrollable vomiting, acute pain, etc.). It can happen in a hospital, or long-term care community and patients can still return home when they are ready.

The care staff works around the clock to keep in touch with patients and their families, whether at home or hospital. Regular sessions, usually led by hospice nurses or social workers, keep family members informed about the patient’s health and prepare them for what to expect. Families can also express their concerns, learn about death and the dying process, and gain tremendous support and stress relief by attending family gatherings.

Almost everyone who lives in hospice is receiving end-of-life care, and their family is aware of this fact. Hospice care also provides “after-death” care – which we call “bereavement care” – for the families.

Bereavement is the period of grief following a loss. The hospice care team works with family members to assist them in getting through the grieving process. Family members will receive help from trained volunteers and professional counselors through regular visits, phone calls, and other forms of contact, as well as through support groups. The café team can refer family members and caregivers to other medical or professional services if necessary. Typically, bereavement services are provided one year after the patient’s death.

Who qualifies for hospice care?

When determining eligibility for hospice, a doctor must certify that the patient is terminally ill with a life expectancy of no longer than six months.

The situation certainly needs consultation and approval from professionals, such as the health care team, discharge planners, doctors, local health departments, and hospice organizations. However, whether to begin care or not could be highly personal. Even if the patient fits the conditions above, they cannot admit to hospice without agreement.

Types of hospice care

There are four types of hospice care, each tailored to a patient’s specific need. Two are in the home, and the other two take place in healthcare communities. A patient may get one or all four types during their hospice stay.

Routine home care

Routine home care is the most common type of hospice care. This is provided at the patient’s home, whether it is an assisted living home or in a senior healthcare community. The care team, which includes home health nursing aides, RN case managers, licensed practical nurses, social workers, spiritual care specialists, community educators, and volunteers, will make a regular visit at home.

Many patients prefer routine home care because it allows them to remain in their familiar surroundings. It also makes it more convenient for family and friends to visit on their own time.

The care team will bring medical equipment and medications to the patient’s home and make regular visits as needed. Some group team members may attend the holiday visit daily, while others may come once a week or as needed. Telecare services are available to the patients 24/7 to answer questions, and, if necessary, the team will send a professional to the patient’s home.

According to the stats from the Hospice Valley, the average cost of routine home care from day 1 to day 60 is $199.25, and from day 60+, the payment would be $157.49.

Continuous home care

Continuous home care is more intense than routine home care, which provides ongoing assistance to patients experiencing acute symptoms (e.g., intractable pain or nausea, breathing difficulties, bleeding, agitation, seizures, or changes in the state of consciousness). This is usually only done for a short period to enable patients to stay at home through a more challenging situation.

Just as routine home care, continuous home care comes with two different prices based on the needs. The hourly rate of constant home care is $59.68. If the care needs for 24hours, the total rate would be $1432.41 (data from the Hospice Valley).

General inpatient care

General inpatient care is recommended for treating symptoms that cannot be adequately controlled at home. This usually exists in short-term cases at a hospital’s hospice unit or a long-term care home.

Many patients and their families prefer free-standing hospice communities, which have a more tranquil and home-like environment for patients to receive general inpatient care. Also, arrangements can be made for visitors to stay overnight.

Short-term general inpatient care costs can range from $744 to $1045.66 per day, as reported by griswoldhomecare.com.

Respite care

Respite care is short-term inpatient treatment designed to help family caregivers and patients. Caring for a chronically or terminally ill family member can be emotionally and physically exhausting for all parties involved. The patient is usually admitted to a hospice community for a brief time if necessary. It also relieves family caregivers of their daily obligations, which reduces stress. Respite care is only available for a few days, in crises when the family needs to be away or needs a break.

The price may vary in different communities, but the average daily rate of inpatient respite care is about $416.09, as stated by Hospice Valley.

Hospice vs. Long-term care homes

Although some of the services that hospice and long-term care homes provide are mutually inclusive, their mission is the main difference between hospice and long-term care homes.

Hospice concentrates on making the dying process more comfortable and acceptable for those who have realized that death is inevitable. On the other hand, a long-term care home provides full-time skilled healthcare staff to seniors who require higher care. When the condition has deteriorated for a patient living in a long-term care home, they can transfer to a hospice.

How long do patients usually live in hospice?

According to research from the Journal of Palliative Medicine, around 35.7% of hospice patients die within a week. The average length of stay in hospice is 76.1 days. 

Hospice is design for patients have less than six months to live. However, many patients can live longer. 

According to the survey, 12-15% of patients can live for more than six months. It is challenging to predict how long each person will live because each situation is unique. The study found that patients under 65 are more likely to live for more than six months after being referred to hospice.

What if the patient gets better?

Miracles do happen!

People who get hospice care are more likely to recover. Because their food and medicinal needs are satisfied, and the care process provides them with additional attention and emotional support. 

Patients will be discharged when their condition improves enough to start treatment or when life expectancy is determined to be more than six months.

The live discharge also happens when the patient feels better and starts to look for more aggressive treatment. As we said, hospice care is a very personal option, and it may vary hugely from person to person. A report from Health Affairs says that nearly 20% of patients are discharged from a hospice for many reasons.  It could either be the patients’ own decision or the decision from the professional medical teams, but a patient can return to a hospice if needed.

Who pays for hospice care?

Knowing that taking care of patients is already burdensome for the family, many health plans can cover the expense of hospice. The Provincial Health Plans cover hospice care provided in a hospital in Canada. Medicare Health Care Benefit covers the United States. If the patients and their families choose to receive care at home, they can use private insurance to cover the palliative care services or pay from their pocket.

Takeaway

Hospice care provides care for patients with less than six months to live. Throughout the dying process, the care team provides support and resources to the patients and their families, including at home and in a community. Patients and their families discuss whether they should receive hospice care ongoing, as it is a very personal decision. See our post on“How to Communicate with Seniors” to find out the tips.

References:

https://www.npr.org/sections/health-shots/2017/08/11/542607941/nearly-1-in-5-hosopice-patients-discharged-while-still-alive

https://dying.lovetoknow.com/ideas-advice-coping-grief/average-time-person-is-hosopice-care-before-death

https://lifecare.org/news-events/7-signs/

Sending an elderly family member to a long-term care home sometimes feels like placing a bet, and a series of obstacles that follow make the process even more daunting. Weighing the pros and cons of each community, not to mention the number of options, can be highly Taxing. You have probably heard many terrible stories about how things can go wrong in a care home. Thus, setting metrics for your selection has become vital at this point.

After doing lots of research and talking to our professionals, we are here to provide you with a set of pointers to help you size up a long-term care home. 

Today you will learn:

1.     What to look for when choosing a long-term care home.

2.     How to evaluate a long-term care home.

What to look for when choosing a long-term care home:

Here’s a checklist of what you should consider.

Things should check before visiting:

–       Is the community accredited?

             –       Have any critical incidents/complaints/abuse reports happened in its history?

             –       Do they still accept new residents?

–       How long is the waitlist?

–       What are the waitlist rules (do they prioritize the people in critical situations?)

–       Do they offer tours, and how do you book one?

Things to check during the visit:

Physical Surroundings:

1.     Is the community conveniently located for family members to visit?

2.     Whether there public transit in the area?

3.     Is the community clean, well maintained, and nicely decorated?

4.     Would be the neighborhood smoke-free, or are there areas where smoking is prohibited?

5.     Is a community nurse call system provided in each room?

6.     Are there accessible emergency call devices equipped around beds and toilets?

7.     Are the locks on residents’ room doors/washroom doors readily releasable and easy to open outside?

8.     Is the room temperature controlled separately in each room?

9.     What types of rooms do they provide?

10.     What furnishings does the community provide?

11.     Is there a safe outdoor environment accessible for the residents?

12.     Are there clear signs for residents to get around the community?

13.     Is it easy for inhabitants to access phones, television, and the internet?

14.     Are there specific units for residents with dementia?

Resident Care:

1.     Does the community have policies regarding residents’ privacy and safety?

2.     Are there doctors on call?

3.     Do they have procedures in place in case of an emergency?

4.     Do the residents have flexible daily routines?

5.     Is there a wide variety of recreational activities provided (more than 10)?

6.     Are the residents taken to the activities if they cannot go on their own?

7.     Can residents choose their meals?

8.     Are healthy snacks available and accessible between the meals?

9.     Can residents bring their furniture?

10. Are there spiritual/religious services provided?

11. Do they provide personal care services (hairdresser, barber, etc.)?

Staff:

1.     Does the staff seem friendly to the residents?

2.     Do the caregivers seem to talk to the residents with respect?

3.     Is there a healthy rapport between the residents and the staff?

4.     Do the staff patiently answer your questions?

5.     What is the caregiver to resident ratio? (The support worker to resident ratio in most Ontario long-term care homes is 10:1)

Others:

1.     Do the residents look generally happy, friendly, and well-dressed?

2.     Do you and your family members feel welcome while visiting?

How to evaluate a Long-Term Care Home:

1.    Use certifying agency searching tools:

Some local public agency websites provide complete reports of long-term care homes in the area. For example, ltchome.net provides details of inspection and licensed beds in long-term care communities within Ontario. Check these sites to see if the homes you’ve selected are certified.

You can also see the history of critical incidents and complaints inspections on a government website like ltchome.net(Canada) or medicare.gov (the U.S.). Try to pay special attention to their past three years of critical incident inspection reports. Note that the lower the number of health citations, the better the community performs in the inspection.

2.    Call the community:

Call the long-term care homes before you visit. Ask if they still accept new residents and find out about waiting lists. If your loved one is over 80 years old or has severe physical/mental impairment, ask them if they could prioritize applicants in critical conditions. Figure out these questions before you go there.

3.    Tour the Long-Term Care Home and take notes:

When you arrive at the long-term care home, calculate how long it takes to get there.  If it is convenient for you to get there, it will give the care workers a sense that their services are being watched and you are actively involved in your loved one’s living. Also, ask yourself if you feel the surrounding area is quiet and safe. Since you never want your loved one to live in a noisy and dangerous neighborhood that has many break-in cases.

It is helpful to print and bring the checklist we provided with you. Aesthetically appealing furnishing is desirable, but don’t be impressed just by that. It is better to walk around and check wherever the residents may access. Pay attention to the details, and jot them down. Also, don’t forget to smell – it is a non-neglected indicator of the community’s cleanliness.

4.    Talk to the caregivers:

Don’t be afraid to ask questions! They should understand your concerns. Ask how they take care of the residents, and observe if they are patient when answering your questions. Then, you can ask yourself if you feel comfortable with their response and attitude – they likely communicate with the residents the same way.

5.    Ask for references:

Ask to speak to the families that have their loved ones living there, and ask the questions above to see how well the community has held up. If the staff at home seem reluctant to have you speak to families, this is not a good sign.

6.   Check online reviews:

Using professional agency review sites is not the only way to help you find out the community’s accreditation. You can also go to online review platforms such as Google Reviews to search about the general feedback for the long-term care home or use professional agency review sites such as Medicare to find out their accreditation. Recruiting sites are also helpful. You can use Indeed or LinkedIn to see how staff rate the home and check the hiring requirements of the community so that you’ll know if they perform background checks and training for the employees.

7.   Revisit the facility:

You can drop by unannounced on another day. If you can, try to visit the community at a different time to get a sense of how caregivers interact with the residents. If you haven’t seen it there at mealtime, this is time for you to do so. Ask them if you can buy their meals to investigate the quality and the taste of the food. Sometimes a second visit can either confirm the community is suitable for your family or turns out the total opposite.

Takeaway:

Try to search and visit several long-term care homes (preferably five of them) instead of just focusing on just one. Put each of them into the checklist and use checkmarks to evaluate if they meet the requirements. Taking time to do the comprehensive research on choosing the best long-term care home might sound arduous, but at the end of the day, it will give you peace about your selection and secure a better quality of life for your loved one.

Download the free checklist.

Checklist

Resources:

https://affinityhealth.ca/5-answers-about-long-term-care-homes-in-ontario/

https://www.health.gov.on.ca/en/public/programs/ltc/docs/home_design_manual.pdf

http://healthcareathome.ca/hnhb/en/care/patient/Pages/LongTerm_HOME_%20E1016%20final%20website.pdf

http://healthcareathome.ca/Northwest/En/Documents/Selecting-A-LTC-Home.pdf

https://www.medicare.gov/care-compare/

Have you ever struggled with whether or not you should send your parents to a long-term care home? After we see our beloved parents start to experience aging and disability, we often try to provide care for them by ourselves first.

After Tammy noticed her mother, Madeline, began to experience aging and disability, she often went home early to ensure her mother was doing well. But one day, her mother fell while at work, and she could do nothing about it. 

She started looking for information about senior care services from that day on. Initially, she chose home care services. Home care professionals provided medical and personal care for Madeline when Tammy was working. When the home care staff was off duty, Tammy took their place and became a caregiver. 

But as Madeline got older, the situation became worse, and Madeline often needed care at night. Tammy hadn’t had a proper sleep for a while, and she ​​stayed up all night again. She only slept 5 hours in the past three days, and she was exhausted and burned out. 

“I just want my mom to get the best care she deserves.” Tammy stressed this matter with us many times, “But at the same time, I also have other concerns, like budgeting and my mom’s will. So, should I send my parents to a long-term care home?”

Unfortunately, CareStory cannot answer the question for you, but we are here to help you make the decision easier. Check out some essential factors with us before you make the decision! 

Factors to Consider for Transferring Seniors to Long-Term Care Homes

When we talked to professional care staff, seniors, and their families, some issues kept coming up — 

1. How to predict whether seniors need a long-term care home or not
2. When should seniors and their families start to consider arranging a long-term care home?

Unfortunately, it is difficult to predict how much or when an individual might need long-term care. However, several factors might increase the probability of needing long-term care. If your parents are in line with most factors mentioned below, plan for long-term care services!

• Age

In general, the risk of needing long-term care increases as people get older. According to the U.S. Administration for Community Living and Administration on Aging research, seniors over 65 have an almost 70% chance of needing long-term care services and support for their remaining years. If your parents are about to turn 65, it’s a good idea for you to consider arranging a long-term care home in advance!

• Health and Family History

A family history of health problems also contributes to the need for long-term care later in life. Conditions can be physical disabilities, sensory disabilities, cognitive disabilities, and other chronic diseases. The most common aging health issues are arthritis, heart disease, dementia, and chronic lower respiratory diseases, where most patients need professional treatment and care in the long term. Therefore, you need to raise awareness of common aging disease symptoms and inherited or acquired disabling conditions. It is crucial to check your parents’ health conditions regularly and book professional long-term care services in advance, just in case!

• Independent Living

If your parents live alone, boom, pay attention! They are more likely to need care from paid caregivers than elderly adults who live with their family members. Keep in touch with your parents at all times and ask them how they are doing daily. If you’re too busy and there are no home care services available, a nursing home should be the best option.

From a Budget Perspective, Is A Long-Term Care Home The Best Option?

Budget and cost are always huge components in our decision-making. When approaching whether or not I should send my parents to a long-term care home, spending accounts for a lot! If you want to know more about other kinds of long-term care homes, please check our “What is Long-term Care” blog. Here, we will discuss three different scenarios, calculate the budget and inform you, from a budget perspective, whether a long-term care home is the best option.

• Scenario 1: You become a full-time caregiver and take care of your parents at home

In this scenario, you will not send your parents to a Long-Term Care Home. Your parents can stay at home, like what’s happening now, for good. But at the same time, you should gain more professional personal care skills. The most common way to achieve that is to take a private caregiver training course and get certified. Nowadays, those programs can be taken both in-person and online, so you can choose the program that works best for you. 

The benefit of this scenario is that you can provide the most personalized care for your beloved parents. After you take the training and become a certified caregiver, there’s no doubt that you are the best caregiver for them. But on the other hand, it will be pretty costly. To become a full-time caregiver, you have to give up your current career. Therefore, the total annual cost will be Personal Caregiver Training Course + Your Annual Salary and Bonus, an annual expense of at least $55,000.

• Scenario 2: You choose live-in home care services

In this case, you are in a similar situation that Tammy and Madeline were in. Your parents still stay at home, and they can receive professional care from long-term care nurses. Home care professionals can provide similar care and services to average nursing homes. What’s more, since your parents are the only clients for home care professionals, they know your parents better than standard care staff in a long-term care home, so they also provide personalized care for your parents. 

However, when your home caregiver is off duty, there is no professional care for your parents! So now, you need to take responsibility, and take care of your parents after work. But you are worried that you are not a professional. So if your parents need emergency medical treatment and care at night, unfortunately, you cannot handle this issue, and no one can help your parents in time.

On average, senior home care costs $16-$26 per hour or $150-$280 for 24-hour live-in care. So the total annual cost will be around $46,720 – $102,200 per year.

• Scenario 3: You send your parents to a long-term care home

Nearly half of the families end up sending their parents to long-term care homes. Why? Because long-term care homes can provide the best 24/7 care for seniors. Long-Term care homes can provide daily assisted living, nursing care, and emergency medical care and are on hand 24 hours a day. Moreover, long-term care homes are designed for seniors and are often community-based, so your parents can meet more friends there and use the more friendly communities to seniors. 

Long-term care home staff will also provide housekeeping, feeding, and bathing services. However, that means the residents not only need to pay for the medical and non-medical care services, they also need to pay for accommodation and food! But the good news is, some of the long-term care homes’ costs can be reimbursed by the national health insurance program!

The bad news, however, is that elder abuse happens in long-term care homes, and you even need to wait for a long time for long-term care home beds. In Canada, there are only 29 long-term care beds per 1,000 people aged 65 and older. So most of the time, you need to conduct both online and field research on different nursing homes and plan far in advance for your beloved parents! 

The total expenses of long-term care homes vary widely. The monthly cost of a basic (public and non-profit) long-term care home is approximately $1,800 – $2,300, the cost of a private one is around $2,900 per month. Some residents can also receive a subsidy to help pay for basic long-term care accommodation. So, the total annual cost will vary from $0 – $34,800 per year, depending on your health plan and insurance.

Here’s a summary of the recommended options for you and your parents:

• If you and your parents are looking for the care services that cost the least, long-term care homes are the best option.

• If you and your parents are looking for more personalized care services, you should consider home care or become a full-time caregiver, but that will cost A LOT!!!!

• Always remember that long-term care homes are the place that provides more comprehensive professional care, and if your parents need care as well as friendship, long-term care homes are probably the best place!

The last note from CareStory: we will try our best to provide a more holistic view of long-term care and more objective opinions on the pros and cons of long-term care homes. However, we CANNOT make the decisions for you. You should always discuss this question with your parents and other family members and find the answer that is best for all of you. From your beloved seniors’ perspective, what matters more to them? From your perspective, what turns out to be more important? It’s a trade-off, so consider different factors, such as your parents’ will, the budget, waiting time, etc. When making the decision, and choose the most beneficial long-term care plan. 

Still, find it difficult to evaluate the situation? Carestory just created a checklist for you! Feel free to download the checklist here and find your answer!

CheckList

References:

https://www.cihi.ca/en/how-many-long-term-care-beds-are-there-in-canada

https://www.statista.com/statistics/323253/average-number-of-certified-nursing-facility-beds-in-the-united-states-by-state/

https://www.hebrewseniorlife.org/blog/difference-between-nursing-homes-and-skilled-nursing-facilities