End of Life Resources

You matter because of who you are. You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but also to live until you die.

Dame Cicely Saunders

Hospice, Our Part of the Circle of Life

A 2007 study shows that people enrolled in hospice services live an average of 29 days longer than those who are not enrolled.

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End of Life Care

We know today that 85% of Americans want to die in the comfort of their home yet only 42% do so with hospice care.

A History of Hospice

Hospice comes from the word hospitium which was a place of rest and shelter and hospitality for weary travelers. Today, hospice is not a place but rather a philosophy and practice of compassionate caring for travelers on their final journey of life.
Dame Cicely Saunders, an RN who worked in 1950s London and was appalled by how the terminally ill were treated. Saunders cared for a terminally ill man who inspired her through his request for words of comfort and acts of friendship and kindness. As the result of these experiences and Saunders’ beliefs, she developed the concept of “total pain”. She believed total pain is all of the physical, emotional, social, and spiritual elements that
are part of the terminal process for the person who is dying and their loved ones.
In 1957 she became an MD to better advocate for her patients and founded the first hospice in 1967. In the US until the 1950s, most AMericans were born and died at home surrounded by loved ones and death was accepted as a natural part of life, the circle of life.
As medicine changed in the post-50s era, most people were hospitalized at end-of-life and died in hospitals where they were isolated from their loved ones and where itw as a challenge to find comfort and experience quality of life.
The first Hospice in the US was founded in Connecticut in 1975 after Dame Saunders gave a lecture at Yale on the holistic benefits of hospice care.  Hospice of the East Bay was founded three years later in 1977 by a group of volunteer nurses, social workers, physicians and chaplains as the non-profit community organization it is today.

Why Hospice

Hospice is a choice for people and their families who are facing life-limiting illnesses when curative treatments are no longer available or desired.  For those who desire to stay in their own homes and focus on having the highest quality of life for as long as possible assisted by a team of specialty trained professionals whose focus is on supporting dignity and providing comfort.

The Hospice Benefit

  • The Hospice Benefit is a part of each persons Medicare benefit and of most other insurances
  • A person has the right of disenrollment or to chose an alternative hospice to provide care at any time without forfeiting their hospice benefit
  • A person can exercise disenrollment if they chose but may also “graduate” if their condition stabilizes or improves or they chose to pursue new treatments that may become available.
  • The hospice benefit is available to a person at anytime they meet criteria until they die

Services not covered under the benefit

  • Room and board
  • Medications not related to the hospice diagnosis
  • Any additional staff needed to meet the patient’s care needs such as sitters, health aides or nurses above what is provided by the Hospice care team

Who is Eligible

  • Hospice cares for patients who have a terminal illness with a prognosis of six months or less.
  • Patients who are no longer seeking curative treatment such as chemotherapy, radiation, or dialysis.
  • Diagnoses may include: cancer, end-stage heart, long, liver or kidney disease, AIDS, ALS, stroke, terminal debility or failure to thrive, Alzheimer’s disease/dementia.

Four Levels of Hospice Care

  • Routine home care:  A patient is cared for at home with effective symptoms management
  • Continuous care:  or “Crisis Care” is care provided at home on a continuous basis for a short period of time for the management of out-of-control symptoms
  • General inpatient care:  GIP level of care is for acute symptom management until symptoms are controlled delivered at a free standing facility such as the Bruns House, a Skilled Nursing Facility or in the hospital
  • Respite care: A patient may be moved to respite care for up to five days when the caregiver needs a break.  Care is provided at a SNF or at the Bruns House (if a bed is available)

Who can refer to hospice

Although patients are generally referred by their physician, anyone can refer a person for hospice services; a hospital discharge planner, a concerned family member, a friend, a care provider or the person can refer themself.  A physicians order is required to complete the referral.

Where does hospice occur

The Medicare hospice benefit is designed to cover the care of people in their homes. Home is anywhere a person resides including assisted living or a skilled nursing facility.

Cost of Care

Hospice care is provided to all medically qualified patients and is covered at 100% by Medicare, MediCal, and insurance companies, or private payment.

However, Hospice of the East Bay provides end-of-life care to ALL medically qualified patients regardless of their ability to pay.

Services Provided by Hospice

  • Intermittent care by a team of specialty trained caregivers
  • Pain and other symptom management
  • Emotional and spiritual support for patient and family
  • Assistance with personal care
  • Care is provided wherever the patient resides
  • Bereavement follow-up and counseling for 13 months after the passing of the patient
  • Each patient has an individualized plan of care coordinated by the Primary Care Physician and developed by HEB interdisciplinary team, which includes the Medical Director, RNs, Medical Social Workers, Hospice Aides, Spiritual Care Counselors, and trained volunteers
  • Care as needed is provided regularly by each of the members of the team
  • All medications and equipment related to the admission diagnosis are fully covered
  • On call availability of staff to answer quests and make necessary visits 24/7

Think of Hospice when…

  • There are no therapies that will arrest the disease or a patient choses not to purse additional therapies
  • There is disease progression despite therapies such as blood transfusions, chemotherapy or radiation
  • A patient decides to stop or is failing dialysis
  • There has been a debilitating stroke or other acute event from which the patient is not expected to recover
  • A person has the dwindles
  • There has been substantial, unintentional weight loss (10% in the past six months) or clothes are getting baggy
  • A person’s capacity to live with a disease has changed and their activities are greatly diminished by the disease
  • A person loses interest in life and those around them
  • A person has lost the ability to do 3 or more of their own daily personal care functions: bathing, dressing, eating, walking, managing continence, walking, transferring, shopping
  • There are recurrent trips to the ER, hospitalizations, urinary tract infections or aspiration pneumonias

End of Life Care Information

  • The Bruns House is the first and only free-standing inpatient facility in the East Bay.
  • HEB Foundation allows hospice to be available regardless of a person’s ability to pay through donations, the HEB thrift stores, and Diablo Estate & Appraisals.
  • Contact the Peace Church Office office@peacejourney.org for local Hospice recommendations.
  • See the NewLifeStyles options for a guide to Senior Care.  It presents resources throughout the Bay Area (retirement communities, assisted living communities, alzheimer/dementia care, nursing/rehab care, home care providers, hospice care).