Hospice care is a specialized model of support for individuals facing a life-limiting illness. This care focuses entirely on comfort and quality of life, rather than pursuing curative treatments. While hospice manages symptoms of the primary condition, patients may still experience acute illnesses, such as pneumonia. The sudden onset of an infection requires careful consideration within the hospice philosophy. This article explores how hospice teams approach the management of acute events like pneumonia while maintaining the patient’s established goals of care.
Understanding the Goals of Hospice Care
Hospice care centers on providing comfort and dignity during the final phase of life. It is an option for individuals who have received a medical prognosis of six months or less if their illness runs its typical course. The focus shifts away from aggressive medical interventions aimed at life extension or curing the terminal diagnosis.
The primary goal is comprehensive symptom management, ensuring the person is comfortable and free from suffering. This includes physical, emotional, and spiritual support for both the patient and their family. The care plan is highly personalized, reflecting the patient’s values and wishes for their remaining time. This focus on comfort provides the context for all subsequent medical decisions, including how to handle an acute infection.
Acute Illness Management within Hospice
Hospice care does not automatically mean that all treatment for pneumonia is withheld; instead, the intent of the treatment is carefully evaluated. The hospice team and family engage in a detailed discussion to determine if treatment aligns with the patient’s comfort-focused goals. A physician may prescribe an antibiotic, often oral, if the goal is palliative—to alleviate distress, such as reducing fever or cough.
This approach differs significantly from curative intent, which seeks to aggressively reverse the infection to extend life. Aggressive interventions, such as complex intravenous antibiotics, repeated blood tests, or a prolonged hospital stay, are considered curative and may conflict with the hospice plan. The decision is always guided by the patient’s preference and the potential burden of the treatment versus the benefit to their comfort. For a patient nearing the end of life, avoiding the distress of hospitalization or invasive procedures often takes precedence over aggressively eradicating the infection.
Palliative Interventions for Respiratory Symptoms
When managing pneumonia with a comfort focus, the hospice team employs specific palliative interventions to address respiratory distress. Shortness of breath, or dyspnea, is commonly managed using low-dose opioid medications, such as morphine. These medications reduce the sensation of air hunger and ease labored breathing, and are titrated carefully to relieve discomfort without causing excessive sedation.
Supplemental oxygen delivered via a nasal cannula helps ease breathlessness, even if saturation levels are not severely low. Non-pharmacological measures, like directing a small fan toward the patient’s face, also provide significant relief by stimulating sensory nerves. Other comfort measures include nebulized treatments to open airways and reduce congestion, and anxiolytics to calm the anxiety often associated with the feeling of not getting enough air. The goal of all these measures is to control the symptoms of the infection and maintain the patient’s peace.
Maintaining Hospice Eligibility
Choosing aggressive, curative treatment for an acute illness may affect a patient’s eligibility for the hospice benefit. Hospice coverage, particularly through Medicare, requires the patient to forgo treatment aimed at curing the terminal illness. If a patient pursues aggressive measures, such as a lengthy hospitalization specifically for intensive IV antibiotic therapy aimed at completely reversing the infection, the goals of care are considered curative.
In this situation, the patient must formally revoke their hospice benefit or be temporarily discharged from the program. This action allows the patient to receive high-intensity, curative care. They can generally be readmitted to hospice later if their condition declines and they re-elect comfort-focused goals of care. This administrative requirement ensures the care provided aligns with the palliative focus mandated by the insurance benefit.