How to Know it’s Time for Hospice

Hospice care can be an overwhelming decision to make.

If you’re like most people in this circumstance, you’re loved one is extremely ill, worsening in discomfort, distress and daily life and most likely hospitalized. It’s too difficult for you to handle his or her care on your own, so you decide to make the call for hospice. But hospice can be beneficial even sooner – in the last six months of life.

Meet Jerez-Marte, MD who was recently appointed the new medical director for Suncoast Hospice, the only nonprofit hospice serving Pinellas County for more than 40 years. She came on board in 2015 and has worked with two home teams, the care centers and as interim medical director. Her prior work was in geriatric-focused primary care.

In this Q&A, Dr. Jerez-Marte discusses the signs someone may be ready for hospice, conversations physicians may have with patients, comfort and support for patients and families and our excellence in care.

Q&A: Suncoast Hospice Medical Director Dr. Jasmin Jerez-Marte

1. What do you do in your new role?

I oversee all Suncoast Hospice physicians and ARNPs (advanced registered nurse practitioners), who are an extension of this position. I’m the one who signs off on treatment for our hospice patients.

2. When is a good time to seek a hospice referral?

There’s no need to wait until the very last days of a patient’s life to initiate a hospice referral. A family member can call and request a referral or it may be done through a physician’s office or hospital. The earlier the better. There are so many benefits to getting hospice services early on. Our interdisciplinary teams can help care for patients and support the families.

3. What are the signs that a person might be ready for hospice?

Someone who has had a noticeable decline within the last six-month period, been chronically ill with more need for hospitalizations (either because of infection or worsening of symptoms with the disease) or had a trend of more sick days than good days. All of those types of patients should be considered for a hospice referral.

Some specific examples include:

• Patients with COPD (chronic obstructive pulmonary disease) who use oxygen, aren’t really ambulatory (able to walk) or have more visits to doctors or hospitalizations. Their symptoms may get really bad for a few days and then get better after treated, and then go back into that same cycle. The same thing can happen with patients with congestive heart failure, who may spend days without sitting in bed, have shortness of breath with any minimal exertion, be unable to walk, need care from providers or hospitals or have no significant improvement with treatment.

• Alzheimer’s patients are prevalent in our population. It’s quite a challenge for caregivers. The amount of support hospice can bring to these families is significant. These patients may be chair or bedbound, have stopped using their words, not eating well, losing weight or getting easily agitated, restless and difficult to care for because they resist care. They should have an early referral to hospice so at the end stages of the disease, the burden isn’t so hard on caregivers. This can help keep patients out of the hospital so it’s not a detriment to their well-being and quality of life.

With patients with cancer, the disease will naturally evolve. The cancer may leave the primary site and spread into their organs or bones, but with treatment the disease still progresses. These patients should get into hospice immediately as opposed to the last few days so there can be improvement in the quality of life. Starting symptom management can help control pain.

• Patients who are aging might see a 10-percent weight loss without any reason or less ability to eat, walk or take care for themselves without extra support.

4. How might physicians talk with patients about hospice?

A provider may talk with a family member about the patient’s disease progressing and not a cure, to be able to maintain comfort. When it comes to hospice and palliative care, the main goal is to meet patients’ and families’ needs and to understand their goals of care. A physician may first educate the patient and family where they stand at this point, what will be the normal trajectory of this disease and how there may be treatment that can be offered that’s futile because it might not bring improvement.

The goal may be a more palliative approach to what they’re seeking, which may be the comfort of less pain, anxiety and suffering as well as enjoying more days at home and better quality of life. That’s a starting point of how either palliative or hospice services can become really helpful, if we approach the patient that we’re changing course of the treatment because the disease has changed its course. We focus on treating pain and not the disease.

5. What types of support do we provide for patients and families?

We play a great role in educating patients and families regarding the disease. Perhaps their journey in health care has concentrated mostly on treatment and aggressive procedures. We can educate about the process of the natural progression of the disease.

Overall, we provide excellent support. Our counselors and social workers help navigate what resources are available for the care of loved ones and we offer education on nursing care that the family needs. Families are able to pick up the phone and get answers to concerns with symptom management for the patient through collaboration between doctors and nurses.

6. What do you feel stands out about Suncoast Hospice?

Our vision of bringing compassionate care above and beyond what others may offer. We pride ourselves in putting the patients first and meeting patients where their needs are as opposed to imposing any kind of care. We recently received additional certification from the Joint Commission, in which were deemed for our excellence in care, proper symptom management, clean conditions of facilities and team collaboration.

We’re definitely ahead of the game. Our institution’s measuring outcomes of our patients to be able to provide more evidence-based treatment and ensure we’re targeting their needs. We’re well into an advanced kind of hospice care that has evolved from providing extraordinary comfort and support to being a well-rounded institution with regard to having the right tools necessary to provide the right kind of care.

Don’t Wait, Make the Call

If it seems your loved one’s experiencing signs for hospice care, please talk with us to get the help you need. Call us any time at (727) 467-7423 or visit our website.