Our Services
Answering Your Questions about Hospice Care
Following are the types of questions that patients, family members and referring providers frequently ask. For your easy reference, these questions are organized in the following sections:
- Getting Admitted to Hospice
- What If Conditions Change
- Family Dynamics
- About Hospice of The Gorge
- Hospice of The Gorge Care Guidelines
- Other Questions
- Definitions
Please do not hesitate to call if your questions are not answered here or elsewhere on this website.
Getting Admitted to Hospice
Q: Can I call Hospice of The Gorge if I don't have health insurance?
A: Many people don't realize that hospice care is guaranteed by Medicare. Even if you are not enrolled in Medicare, we welcome all patients regardless of their financial circumstance.
Q: Is hospice just for people with cancer?
A: Hospice can help anyone with a life-limiting illness. Slightly fewer than half of our patients have cancer; many have congestive heart failure, chronic obstructive pulmonary disease, renal failure or Alzheimer's disease.
Q: Is hospice just for the elderly?
A:Hospice can help anyone with a life-limiting illness. We create a unique care plan for each patient as an individual. For example, we might give special attention to the social and existential struggles of a young man who is terminally ill, and special bereavement-related attention to his family.
Q: Do I really have to have less than six months to live?
A: You have to have a terminal diagnosis with a probability of six or fewer months to live in order to receive hospice services. However, you are not obligated to die within that time period. Some patients are recertified after six months, and occasionally a patient “graduates” because his/her condition improves.
Q: How can Hospice of The Gorge help if I'm not ready to go on hospice yet?
A: Hospice staff can explain your options, explore other resources and prepare documents so that if you decide later to sign up for hospice care, we will be ready for you. Our medical directors can determine if you are medically eligible for hospice. Our nurses and social workers can make a hospice presentation in your home (or other convenient location) in which they describe our services. Your primary physician can request a “palliative care consultation,” at which one of our medical directors will meet you and recommend comfort measures and symptom-improvement, regardless of whether you are interested in hospice.
Q: What happens if I don’t have any insurance … or if my insurance doesn’t cover hospice?
A: We are proud to say that Hospice of The Gorge has never refused to serve a patient because of his/her financial circumstances. Our community has generously donated funds over the years to cover costs associated with uninsured patients, and we are careful stewards of our resources.
Q: How far away can patients live? What if they are Washington residents?
A: Hospice of The Gorge serves both Oregon and Washington patients in eight mid-Columbia counties (Hood River, Wasco, Sherman, Gilliam, Morrow, Wheeler, Skamania and Klickitat). We supported the development of Klickitat Valley Hospice in Goldendale but still accept patients in that area if they choose our agency. Though we must always consider our resources, we willingly see patients in remote, rural settings if we are needed there.
Q: Can Hospice of The Gorge see patients in nursing homes and other facilities?
A: At any given time, 30 to 50 percent of our patients live in facilities. We have excellent collaborative relationships—and staff liaisons—with all residential care, adult foster care, assisted living and skilled nursing facilities in the area.
Q: Can a patient be admitted on the weekend?
A: Yes. Because of support-staffing limitations, admissions are generally easier, quicker and more satisfying for both referring physician and patient if they are non-urgent and if they are launched on a weekday. But Hospice of The Gorge recognizes that the need for—or patient acceptance of—end-of-life care sometimes arises quickly, and we will always “stretch” to accommodate such needs.
Q: Can Hospice of The Gorge serve patients and families who speak Spanish?
A: Yes. We regard this as an absolute necessity for assisting our community. Hospice of The Gorge Spanish-speakers include staff in medical directorship, nursing, chaplaincy and social work. We have an active program to reach out to the Hispanic population in the communities we serve, and we’ve demonstrated leadership on a national level in this regard.
What if Conditions Change
Q: What if I get better?
A: If your condition improves or you simply feel that hospice care is not for you, you may end your hospice services at any time.
Q: What if I want to travel?
A: You are welcome to temporarily come off services with the option of transferring your care to another hospice while you are traveling.
Q: What if I have an after-hours emergency?
A: Hospice has on-call nursing staff available at all hours.
Q: What if I need to go into the hospital?
A: While it is always your right to choose hospitalization or emergency-room care, many hospice services actually prevent the need to go to the hospital. Sometimes hospitalization means going off hospice service for a while, but there are cases in which hospice care allows for hospitalization or an ER visit.
Family Dynamics
Q: I want to refer my father to Hospice, but my sister says it's not time. What should we do?
A: For many people, making the decision to elect Hospice care is not easy. However, the earlier you can establish a relationship with the Hospice care team, the better we can read your symptoms, know your family and generally provide better care. More often than not, people tell us, "I wish we had called Hospice sooner." And remember that you are not obligated to stay on hospice if it's not for you.
Q: My mother won't talk to me about her situation, and I'm afraid to ask what's going on. Do you have any advice?
A: It's usually difficult to bring up the subject of dying. It often seems easier to just pretend it isn't happening. She may be just as hesitant to bring it up as you are, yet she may desperately need to talk about it. You might try to initiate a conversation with open-ended inquiries like:
•Tell me how you're feeling.
•Are you worrying about your health?
•Is there anything that you're worrying about right now?
About Hospice of The Gorge
Q: Is Hospice of The Gorge a for-profit hospice? Is it owned by another organization?
A: Hospice of The Gorge is a free-standing, nonprofit, public-benefit agency. We are supported by gifts from the community and various grant monies, including the United Way.
Q: How long has Hospice of The Gorge served the mid-Columbia?
A: Hospice of The Gorge has been helping communities in the Gorge since 1981. We served more than 2,300 patients and their families through April 2007.
Hospice of The Gorge Care Guidelines
Q: How often do Hospice of The Gorge staff members visit their patients?
A: As often as needed! Nurses visit at least once weekly, and commonly more often—even daily if a patient needs it. Home health aides are usually in the home two or three times per week, but more frequently as indicated. Homemakers, social workers, chaplains and volunteers all visit on schedules that make sense for the patient and caregivers. In a crisis, we can sometimes arrange for nurses and home health aides to be in the home for several hours per day until a situation stabilizes.
Q: Could a Hospice of The Gorge medical director write orders or do a home visit for the patients primary physician?
A: Yes, definitely. Our philosophy is to support the continuing relationship between the primary physician and the hospice patient, but we are also happy to have our physicians or nurse practitioner assist physicians in these matters at their request. We can provide medical director home visits, assessments of eligibility for hospice, palliative care consultations on symptom management, and medical orders related to the hospice diagnosis. When a symptom such as pain is rapidly changing, it’s sometimes helpful to the referring provider if a hospice medical director writes the new orders needed. Please feel free to ask us about these possibilities.
Q: How skilled are Hospice of The Gorge nurses?
A: Our orientation, training, and professional development programs are well developed. Our Quality Assurance/Performance Improvement program includes various metrics that allow for continuous assessment of our nurses’ competencies and outcomes. Just as important, our nurses bring big doses of compassion, tenderness, and loving care to the bedside.
Q: Does Hospice of The Gorge provide any “special services” not already mentioned?
A: It’s hard to know where to begin. Examples include speech, physical and occupational therapy; dietician consultation; psychotherapy and counseling; extensive bereavement support; coordination with area clergy; music and massage therapy; acupuncture; respite care and inpatient care; and travel packs. A committed donor base and grants allow us to occasionally provide unusual extras—a gift that can enhance quality of life; travel stipend for a family member; a special food, a pair of slippers, an inspirational picture or piece of music. Such ideas are limited only by the imaginations of our staff and volunteers, who “think big” and care deeply.
Q: What happens after hours? Is someone on call?
A: Hospice of The Gorge ensures that there are two nurses, one nurse manager and at least one medical director on call at all times—24/7, 365 days per year.
Q: I already have my own church/spiritual support/beliefs. Will that be honored by the Hospice chaplain?
A: Visits from Hospice chaplains are available by request but are not required. Our chaplains honor all spiritual and/or religious faiths; they do not represent a particular point of view. Our chaplains can work in conjunction with your own spiritual advisor to lend their expertise in those spiritual areas that are unique at the end of life.
Q: Do I need to forego all medical treatments if I elect hospice care?
A: While you have discontinued treatments aimed at curing your terminal illness, you may continue or initiate palliative (comfort) treatments, which focus on symptom control and quality of life. So, for example, a person who has a terminal cancer diagnosis may still receive radiation therapy to shrink tumors that are causing pain, or receive arthritis treatment.
Other Questions
Q: What should I do with illness-related items when I no longer need them?
A: Equipment, such as a wheelchair or scooter, and certain medical supplies that a patient purchased or received as a Medicare benefit, can be liquidated as any other personal belonging, including being donated to Hospice of The Gorge. Medications cannot be donated. Donations to Hospice of The Gorge are tax-deductible.
Definitions
Q: What is palliative care?
A: Hospice provides "palliative" care, often called "comfort" care, which includes medical treatments that reduce and manage the symptoms of an illness, rather than provide a cure. It also includes counseling and grief support, and practical end-of-life support such as an advance directive. Palliative care is not "giving up;" it provides dignity and control over life's inevitable end.
Q: What is an advance directive?
A: An advance directive describes what kind of care you would like to have if you become unable to make medical decisions (if you are in a coma, for example), and allows you to designate a personal health care representative to speak on your behalf. Living will, durable power of attorney and Do Not Resuscitate documents are types of advance directives.
Q: What is a living will?
A: A living will describes the kind of medical or life-sustaining treatments you would want if you were seriously or terminally ill. It does not provide a means of designating another person to make decisions for you.
Q: What is a durable power of attorney?
A: A durable power of attorney (DPA) for health care states whom you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions. A DPA is generally more useful than a living will, but may not be a good choice if you don't have another person you trust to make these decisions for you.
Q: What is a DNR?
A: Unless instructed otherwise, medical personnel are required try to resuscitate anyone whose heart or breathing has stopped. A Do Not Resuscitate order (DNR) is a request to not have cardiopulmonary resuscitation (CPR).
Q: What is a POLST?
A: Physician Orders for Life-Sustaining Treatment (POLST) is a form designed to help health care professionals honor the end-of-life treatment directives of their patients. Unlike an advance directive, which expresses wishes but is not an official medical document, the POLST delineates actual physician orders. Ask your primary care physician to provide the form, and then post it in a prominent place, such as on your refrigerator.
