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When does a patient qualify for hospice? You might be surprised to know that hospice is not just for the elderly, for patients with cancer, or for patients that only have days to live. Many times, one could be eligible for hospice long before the conversation is started. Over the next weeks, we are going to talk about individual illnesses that might qualify a patient for hospice.

Most often, primary caregivers of terminally ill loved ones are spouses, adult children, or other family members. When a family member is unavailable, a neighbor or a close friend may take responsibility for this care. Years ago, the Journal of the American Geriatrics Society published a report stating that many caregivers and seriously ill older persons have an unmet desire for increased communication and knowledge. In another study conducted by The Center for Gerontology and Healthcare Research, it was suggested that involving family members/primary caregivers in the decision-making and preparing them for what to expect improves bereavement and may offset increased mortality risks associated with caring for a terminally ill loved one. This information may also help you know when it might be time to initiate a hospice referral discussion with your physician.

Today, we will focus on COPD. According to the American Lung Association, COPD (Chronic Obstructive Pulmonary Disease) is the 3rd leading cause of death worldwide. COPD is not curable but can be managed for many years by treating symptoms.

COPD can be treated with medicines, oxygen, and pulmonary therapy. If the patient diagnosed with COPD is a smoker, it can help delay the progression to stop smoking. COPD causes the lungs to lose their natural elasticity, which impairs the ability to inhale and exhale fully. It’s important to know that COPD develops gradually over time, often resulting from a combination of risk factors:

• tobacco exposure from active smoking or passive exposure to second-hand smoke
• occupational exposure to dust, fumes, or chemicals; indoor air pollution: biomass fuel (wood, animal dung, crop residue) or coal is frequently used for cooking and heating in low- and middle-income countries with high levels of smoke exposure
• early life events such as poor growth in utero, prematurity, and frequent or severe respiratory infections in childhood that prevent maximum lung growth
• asthma in childhood
• a rare genetic condition called alpha-1 antitrypsin deficiency, which can cause COPD at a young age.

According to the World Health Association, the most common symptoms of COPD are difficulty breathing, chronic cough (sometimes with phlegm), and feeling tired.

People with COPD also have a higher risk for other health problems. These include:

• lung infections, like the flu or pneumonia
• lung cancer
• heart problems
• weak muscles and brittle bones
• depression and anxiety

As COPD worsens, a person may pick up repeated lung infections and have trouble walking and breathing. They may find themselves calling the doctor more often and have increased emergency room visits and hospital stays. As time passes, there may also be low levels of oxygen or high levels of carbon dioxide in the blood and often right-sided heart failure related to COPD. Caregivers may notice depression/sadness and increased anxiety/ nervousness. Also, as time goes on, a person with advanced COPD may find they are experiencing more pain, nausea, fatigue, decreased appetite, weight loss, more shortness of breath, and needing increased oxygen.

When a person tires of continued doctor visits, emergency room visits, and increased hospital stays, it may be time to initiate a conversation with their physician about hospice care. In the comfort of their own home, under the direction of their physician and the hospice medical director, hospice can help alleviate and manage all of these symptoms.

The criteria to be admitted to hospice with a diagnosis of COPD is: Disabling dyspnea (difficult, painful breathing or shortness of breath) at rest, poor response to bronchodilators (types of medication like albuterol that make breathing easier), signs or symptoms of right heart failure (swelling of feet/ankles, shortness of breath when lying flat, and feeling tired all the time) 02 sat on room air of less than 88 percent, PC02 (partial pressure of carbon dioxide is the measure of carbon dioxide with arterial or venous blood) less than 50, unintentional weight loss, and increased medical visits.

If you have questions about the benefits of hospice care, please consult your physician or call the hospice of your choice.

“The best thing a human being can do is to help another human being know more.” ~ Charlie Munger

— Vickie C. Wacaster is a Patient and Hospice Advocate with Aveanna Hospice (formerly Comfort Care Hospice).