Hospice and palliative care are specialized care options for persons with life-threatening or terminal illnesses. When medical care cannot offer a cure, hospice provides care, comfort and support for persons with life-limiting conditions as well as their families. The hospice team at Rutland Area VNA & Hospice works to make the person comfortable and relieve their symptoms and pain for the entire length of their illness. Palliative, or comfort care can be started while still in the treatment for the disease and retained throughout hospice.
RAVNAH is your local non-profit hospice and palliative care provider. The care team will take time to talk with you and help you understand what care options are available. They make your goals and wishes a priority and make sure you get the care you want and deserve.
- Affirms life and regards dying as a normal process
- Neither hastens nor postpones death
- Helps individuals clarify their priorities and establish their own goals of care
- Provides relief from pain and other distressing symptoms
- Integrates the medical, psychological and spiritual aspects of patient care
- Offers a support system to help patients live as fully as possible until death
- Provides a support system to help each family cope, both during the period of illness and the time of grief that follows
- Care may be provided at home, in assisted living facilities, nursing homes, hospitals, or any place the patient resides.
- Is reimbursed by Medicare, Medicaid and most 3rd party private insurances.
What services are provided as part of hospice?
The hospice team will provide the following services to individuals in the home, wherever they consider home to be:
- Manage pain and other symptoms
- Offer support with the emotional and spiritual aspects of dying
- Provide medications, medical supplies and equipment
- Teach family members skills to help them provide care
- Deliver special services like speech and physical therapy if needed
- Make short-term inpatient care available when pain or other symptoms become too difficult to manage at home
- Provide support and counseling to family members and loved ones
Essential to hospice care is the view that dying is a natural part of the life course and that every individual has the right to live fully without pain and with dignity until a natural death takes place.
Hospice care is available for children as well as adults. Individuals can be referred to hospice when the goal of treatment shifts from cure to comfort and their prognosis is approximately six or fewer months.
Who can receive hospice?
To receive hospice, physicians must be willing to state that death can be expected within 6 months if the disease follows its normal course. This does not mean that care will only be provided for 6 months; hospice can be provided as long as the person’s physician and hospice team certifies that their condition remains life limiting.
What are the benefits of hospice?
Most people have heard about hospice care. They know that hospices care for people at the end of life. Many even know a family member or friend who was helped by hospice when faced with serious illness. But there’s so much more to know.
For example, did you know that hospice provides what the majority of people say they want at the end of life? Excellent pain management, comfort, and support for the patient and family caregivers.
Ten more things you should know about hospice:
- Hospice is not a place but a special kind of care.
- A hospice care team is made up of doctors, nurses, social workers, counselors, spiritual care providers, trained volunteers and other skilled professionals who provide high-quality, compassionate care.
- Hospice care is available to people of all ages with any kind of life-limiting illness, including cancer, advanced Alzheimer’s disease, heart disease, lung disease, kidney disease, HIV/AIDS and other life-limiting illnesses.
- Hospice care is fully covered by Medicare, Medicaid, and most private insurance plans and HMOs.
- Hospice provides all medications and medical equipment needed to keep a person safe and comfortable.
- There’s no limit to the amount of hospice care a person can receive; it’s available as long as a doctor believes a patient is eligible.
- Most care is provided at home but hospice is also available in nursing homes, assisted living and long term care facilities and hospice inpatient settings.
- Hospice care can include complementary therapies, such as music and art, to bring additional comfort to patients and families.
- Hospice programs offer grief support to the families they care for as well as to others in the community who are grieving.
- One of the most common sentiments shared by families who have been helped by hospice care is, “We wish we had known about hospice sooner.”
Where and how do I get hospice?
Hospice care is a family-centered team approach that includes, a doctor, nurse, social worker, counselor, chaplain, home health aide and trained volunteers. They work together focusing on the dying person’s needs—physical, psychological, social and spiritual. The goal is to help keep the person as pain and symptom-free as possible while offering spiritual and supportive counseling to the patient and family members.
Anyone can inquire about hospice services. In Vermont, Hospice is provided by certified Medicare Hospice agencies. You or your loved one can contact us and request services. Our hospice staff will then contact your physician to determine if a referral to hospice is appropriate. Another way to inquire about hospice is to talk with your physician, and he or she can make a referral to hospice.
Hospice can begin as soon as a ‘referral’ is made by the person’s doctor. The hospice staff will then contact the person referred to set up an initial meeting to review the services the hospice will offer and sign the necessary consent forms for care to begin. Usually, care is ready to begin within a day or two of a referral. However, in urgent situations, service may begin sooner.
Hospice services are available in every region in Vermont through local Visiting Nurse Associations and Home Health and Hospice Agencies.
Who pays for hospice?
Hospice is paid for by the Medicare Hospice Benefit, Medicaid Hospice Benefit and most private insurers. If a person does not have coverage through Medicare, Medicaid or private insurance, hospice will work with the person and their family to ensure services can be provided. Private insurance coverage varies, but generally includes at least some hospice coverage. Contact your insurance provider to verify your level of coverage for these services.
How do I choose hospice?
Vermont is fortunate to have a network of local, non-profit hospice providers that together provide hospice care coverage for the entire state. Vermont’s non-profit Visiting Nurse Associations, Home Health and Hospice agencies are the first Medicare-certified hospice providers in our communities.
Determining if hospice is right for you may best be learned from calling us to talk to a member of our hospice team about our services. You can also talk to people you trust who work in healthcare or aging services or who have received support from a hospice, including:
- Physicians, nurses, and other healthcare professionals
- Social workers, clergy, and other counselors
- Friends or neighbors who have had direct experience with hospice care
Questions to Ask When Choosing a Hospice Program
- What services are provided?
- What kind of support is available to the family/caregiver?
- What roles do the attending physician and hospice play?
- What does the hospice volunteer do?
- How does hospice work to keep the patient comfortable?
- How are services provided after hours?
- With which nursing homes does the hospice work?
- How long does it typically take the hospice to enroll someone once the request for services is made?
When should I begin hospice?
It is a question that all of us will one day face. When is it the right time for hospice?
Families often avoid the conversation or delay asking the question out of fear or uncertainty. When a family is coping with a serious illness and a cure is no longer possible, hospice provides the type of care most people say they want at the end of life: comfort and dignity.
Talk with your doctor about the treatment plans ahead and how these match goals and wishes for you – or your loved one. Your doctor can help you decide if it is time for hospice.
You can also call us at 802.770.1575 and request an evaluation. Hospice teams do this work every day. Hospice nurses and social workers can answer your questions, dispel the myths, and support you and your families in meeting your end-of-life goals.
The most common response heard from families following the death of their loved one is, “I wish that I had known about this type of care sooner.” It is important that you understand the care that is available for you or your loved one at the end of life.
Hospice is considered to be the model for high-quality, compassionate care for people with a life-limiting illness. The wishes of the patient and family are always at the center of care. Ask about hospice.
How do I become a hospice volunteer?
Hospice volunteers are an integral part of hospice care. Volunteers can help the family by providing a needed respite. On a typical hospice visit, a volunteer may read to the patient, or simply sit and hold their hand. The time the volunteer spends with the patient provides family members and other caregivers with a chance to get out of the house or spend time with other family members.
Hospice volunteers go through a rigorous training that is generally provided over several weeks. Hospice training generally includes information on the dying process as well as background on a wide range of spiritual beliefs. Many agencies involve local funeral homes in the training as well as spiritual advisors. The goal of the training is to provide each person with the knowledge they will need to confront a wide range of possibilities as a volunteer.
Once you complete the training, you have the option to become an active volunteer or opt to support the program in other ways if you are not ready for in-home care. Once you elect to provide in-home care, your agency will complete a background check. For more information on becoming a hospice volunteer in:
Contact John Campbell, Hospice Volunteer Coordinator at 802.770.1683
Contact Mary Pleasant, Hospice Volunteer Coordinator at 802.442.5502
How can I be sure my end of life care wishes are known?
Planning for end-of-life care before it becomes a worry is as important as all the other life plans you have made. Having a plan in place makes it easier for you, your doctor and your loved ones if you are unable to tell them your health care choices because of an injury or serious illness.
Every moment is precious – especially at the end-of-life. Starting the conversation early can ensure that your choices are heard. It also means that when time becomes short, it can be spent doing what you most enjoy and not making last minute decisions. Talk about your wishes while you are in good health so you will be prepared.
A health crisis can happen to anyone at any time. Don’t wait. Start the Conversation today. It’s a gift.
Make a care plan
What are advance directives?
“Advance directives” are legal documents that allow you to plan and make your own end-of- life wishes known in the event that you are unable to communicate. Advance directives describe your wishes regarding the medical care and treatments you would like to receive if you are faced with a life-limiting illness.
An advance directive can also name a person to make healthcare decisions for you in case you are unable to speak for yourself. This person is often referred to as a health care agent, or durable power of attorney for health care.
Important things to know:
- You have the right to consent to or refuse any medical treatment.
- You have the right to appoint an agent to make decisions for you.
- You may use an advance directive to share your wishes in advance.
- You do not need a lawyer to complete an advance directive.
What do I need to know about end-of-life decisions to prepare my advance directive?
Before beginning the discussion, learn about end-of- life care services available in your community. Become familiar with what each option offers so you can decide which ones meet your loved one or your own, end-of-life care needs and wants.
For example, if you are faced with a serious life-limiting condition, you may not want to prolong your life with life-sustaining treatment. Life-sustaining treatments are specific medical procedures that support the body and keep a person alive when the body is not able to function on its own..
How can I prepare my advance directive?
Vermont offers short and long versions of an advance directive form to help you with this process. You may fill out all parts of this advance directive form or just portions of it. For example, you can just appoint an agent and sign it along with your witness signatures. If you fill out any Part of this document, you must also fill out Part 5, as it provides signatures and witnesses to validate the Advance Directive.
You may use any advance directive form or format as long as it is properly signed and witnessed.
You can revoke or suspend your advance directive at any time unless you expressly waive your right to do so.
Updating your Advance Directive
It is very important that the information in your advance directive is always current. Review it once a year or when events in your life change. Consider the “5 D’s” as times when your advance directive might need to be changed or updated. The 5 D’s are: Decade birthday, Diagnosis, Deterioration, Divorce, or Death of somebody close to you or that affects you. All of these events may affect how you think about future health care decisions for yourself.
Whenever necessary, you should also update addresses and contact information for your agent and alternate agent and other people such as potential medical guardians whom you may have identified in your advance directive.
Share your advance directive
Keep your completed advance directive in an easily accessible place and give photocopies to your primary medical power of attorney and your secondary, alternate agent. This document stays in effect unless you cancel it or decide to complete a new one with changes.
Vermont also provides residents an advance directive registry, a secure, on-line data base where individuals can submit copies of their completed advance directive forms to be immediately accessed by health care facilities and providers when they are most needed.
Everyone could benefit from having an Advance Directive — not just those anticipating the end of their lives. Any of us could have an accident or suffer from an unexpected medical condition. Some of us live with a mental or physical illness that leaves us without capacity at times. With an advance directive, those making decisions for you will know what your wishes are. Completing an advance directive is a gift to your family and for yourself.
Register your advance directive
Vermont Advance Directive Registry
The Vermont Advance Directive Registry (VADR) is a secure database service that stores a scanned copy of your advance directive electronically so that it can be found immediately by any hospital or doctor who is treating you in an emergency.
Registering your advance directive can be accomplished in three easy steps:
Complete your advance directive form. It must be signed and properly witnessed.
Complete and sign the Registration Agreement. This gives the registry permission to send a copy of your advance directive and emergency contact information to those authorized to access them.
Mail or fax your completed advance directive, along with your signed Registration Agreement to:
Vermont Advance Directive Registry
523 Westfield Ave/PO Box 2789
Westfield, NJ 07091-2789
For more information on Advance Directives and the Vermont Advance Directive Registry visit http://healthvermont.gov/vadr/.