By the time a hospice referral is made and/or the family and caregiver are thinking about hospice services, it is already well past the time guidance is needed.
Waiting too long before calling hospice can happen for a couple of reasons. Some may be in denial of the signs of approaching death. Others simply don’t know what it looks like as death approaches, and sadly the lack of direction by the medical profession to refer to end of life services.
Death from disease and old age doesn’t just happen. There are signs and changes that begin occurring months before death arrives. You can use those signs as a reference indicating when to call hospice. Remember, we really don’t want to see what we are looking for so our judgement and vision are distorted.
When a person has a life threatening illness and the changes below are occurring, it is time to call hospice, at least for an assessment visit.
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Physical weakness is progressing. Walking and talking is reduced. They initially spend more time in the chair than before, and then more time in bed than out of bed.
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Sleeping is increasing. They will add a morning nap to their day. Then an afternoon nap. They will go to bed earlier and wake up later than they used to.
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Emotional and social activity has diminished. They will become less vocal, they will interact with others less, and gradually withdraw from activities around them.
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And eating habits will change — NOT eating is probably the biggest clue that death is approaching. The first thing dropped from their diet will usually be meat. Then they’ll drop soft foods. Portion sizes will be greatly reduced, to the point that they are not eating enough to keep them alive.
This is the time to speak with your physician for honesty about the prognosis and the possibility of returning to an active life. Ask about a hospice referral then call several hospices. Begin interviewing them to find the one that you feel the most comfortable with. The hospice agencies will determine whether you or your loved one are eligible for admission. (*read my blog about the questions to ask in your interview)
Begin the interviewing before you are in crisis mode and death is right around the corner.
Something More… about Think It Might Be Time for Hospice? You’re Probably Right
Remember, hospice isn’t about giving up. It’s about getting the support you and your loved one need — physically, emotionally, and spiritually.
That’s why I wrote By Your Side: A Guide for Caring for the Dying at Home — to help families like yours feel less afraid and more prepared. It is also part of the Approaching Death Support Kit.
