Hospice care provides medications as a central part of the care plan. The goal is to offer comfort and maintain quality of life for individuals facing a life-limiting illness. Medications focus on managing symptoms like pain, anxiety, and shortness of breath, rather than curing the underlying disease. This transition shifts the medical focus from prolonging life to maximizing comfort.
The Guiding Principle of Hospice Medication
The philosophy governing medication decisions in hospice care is palliative treatment, meaning treating symptoms to relieve suffering. This differs from curative treatment, which aims to halt or reverse the disease process. Hospice is designed for individuals who choose to forego life-prolonging treatments, as the burdens often outweigh the benefits.
The primary objective is maintaining the patient’s quality of life and dignity, ensuring they are comfortable and alert. Medications serving a life-prolonging purpose are typically discontinued as they no longer align with the goal of comfort.
The Medicare Hospice Benefit and most private insurance plans cover medications specifically related to pain and symptom management for the terminal diagnosis. This coverage manages the financial burden of comfort-focused drugs, allowing the hospice team to prioritize immediate relief. The hospice is responsible for all drugs connected to the terminal illness and its symptoms.
Medications for Symptom Management
Hospice medications address the most common and distressing symptoms experienced at the end of life. Pain is managed aggressively using opioids like morphine or fentanyl for severe acute and chronic pain. Morphine also alleviates shortness of breath by altering the central nervous system’s response to breathing difficulty.
Anxiety and agitation are treated with benzodiazepines, such as lorazepam, to calm the patient and reduce restlessness. Nausea and vomiting are addressed with anti-emetics like prochlorperazine or haloperidol. These help prevent discomfort and maintain the patient’s ability to take other medications.
The hospice team adjusts the dosage of comfort medications frequently based on the patient’s needs and response. Medications are often administered using fast-acting routes, such as sublingual liquid formulations or suppositories. These methods ensure rapid absorption and quicker symptom relief compared to standard oral pills, which is important for quickly worsening symptoms.
Reviewing Existing Prescriptions
Upon admission, medication reconciliation reviews every drug the patient is currently taking. The hospice team, often including a pharmacist, evaluates each medication against the patient’s new goals of care. This review leads to “deprescribing,” where medications that no longer offer a net benefit are systematically discontinued.
Preventative medications are often stopped first because their benefits take too long to materialize, making them irrelevant given a short life expectancy. Examples include statins, blood pressure medications, and aspirin. Stopping these drugs reduces the “pill burden,” minimizing daily doses and lowering the risk of harmful interactions and side effects.
Deprescribing improves comfort by reducing unnecessary pharmaceutical interventions. The focus shifts to maximizing well-being, meaning removing any medication that might cause side effects without offering immediate relief. Patients and families are included to ensure they understand why certain long-term medications are being discontinued.
Medication Administration and Logistics
Hospice care includes an organized system for managing comfort medications. The hospice provider works with a designated pharmacy network to manage the supply of drugs related to the terminal diagnosis. Medications are often delivered directly to the patient’s home, ensuring a continuous supply.
A small, sealed supply of emergency comfort medications, called a “comfort kit” or “E-kit,” is kept in the patient’s residence. This kit contains fast-acting medications for sudden, severe symptoms like breakthrough pain, acute anxiety, or uncontrolled nausea. Immediate availability prevents delays, ensuring symptoms are managed without waiting for a pharmacy to open.
The hospice nurse teaches family caregivers how and when to use these as-needed (PRN) comfort kit medications. Caregivers are instructed to contact the hospice team before administering any drug from the kit for the first time. The cost of these medications is typically covered under the hospice benefit.