In my work, I have been personally told by facility staff that their administration does not want them recommending outside hospice services because hospice in westminster that means that money leaves the building. Or, as the research mentions, if there is no family requiring support, hospice is not recommended and is instead provided by their own staff, lacking hospice background. In these cases, offering hospice becomes a territorial issue founded by concerns over money and staffing. How can family members trust health care providers when the concern for money and self interest overrides the care needs of their family members at an especially critical time of life? This choice should not be a decision made by facility staff but the decision of the individual or family member involved.

“Additionally, timing of hospice referrals is often delayed because staff members believe that hospice is appropriate only for the very end of life. There was often a discrepancy of weeks or months between when staff reported recognizing terminal decline and when referral to hospice occurred.” It is clear that training needs exist for staff relative to recognizing declines and understanding the benefits of hospice services. In defense of facility staff, I have experienced instances where fear of breaking rules or regulations or chastisement by a superior prevents staff from doing the right thing. However in these cases mysteriously a phone call or recommendation is made and I become involved to help families navigate the situation.

Until the level of palliative and hospice care education catches up with the need, family members will have a greater level of responsibility navigating the care of loved ones experiencing declines in health. It’s never too early to ask about palliative or hospice care; however it can be too late. Too late is when a loved one is days away from passing and has already likely experienced a high degree of pain and discomfort. In the instance you ask and it is not quite time for palliative or hospice care, at least you have been proactive in your own education and when the time does come you’ll be more prepared and less reliant on others to recognize the signs or request assistance.

Welch, Lisa C. Ph.D. et. al. Referral and Timing of Referral to Hospice Care in Nursing Homes: The Significant Role of Staff Members. The Gerontologist. Vol 48, No. 4, 477-484.