Nobody looks forward to arranging hospice care. Emotions run high as caregivers look for the best solution for their loved one’s final chapter. Yet, individuals in rural communities often face additional challenges in finding hospice care.
Not only are options generally fewer in rural communities but the need for hospice is often greater, as rural regions are often composed of an older and sicker population. A 2019 report showed the number of rural hospices in the country has decreased, even while the percentage of rural Medicare beneficiaries who used hospice services has increased.
Furthermore, the geographic distance to care often creates transportation issues for rural residents that may hinder many rural seniors from receiving at-home hospice care. For states with a high proportion of rural residents, more than 10% of the population lives further than 60 minutes of driving time from a hospice.
Kinds of hospice care
Hospice care can look vastly different, so it’s important to discuss with your loved one’s care providers about what kind of hospice is best. Hospice care can be delivered at a freestanding facility or through a hospital or health care system, via home health agencies or in a nursing home. Because complex treatments are suspended once an individual enters hospice, caregivers can often administer hospice care at home with the help of a support team, whereas hospice centers offer convenience and comfort for individuals with a higher level of care needed. Caregivers, however, should also consider their physical and emotional toll of administering hospice care at home.
Every Medicare-certified hospice provider must provide each of the four levels of care:
- Hospice care at home to provide routine visits from a home hospice care team
- Continuous hospice care, which provides 24/7 care to manage patients’ acute symptoms and avoid hospitalization until routine services can resume
- Inpatient hospice care for 24/7 support for symptoms that cannot be managed at home
- Respite care hospice support, which allows patients to spend a short time in a Medicare-certified inpatient hospice setting so their primary caregiver can take a break and avoid burnout
Though the decision to begin hospice is tough, the large majority of caregivers are overwhelmingly satisfied with the care provided in hospice. A 2016 study compared the quality of hospice care between rural and urban residents, which found that rural participants reported higher overall satisfaction and a high ranking of pain/symptom management. The study found that, regardless of geographic location, satisfaction scores were higher when patients were informed and emotionally supported, with no difference in hospice satisfaction ratings between patients and families.
Choosing hospice providers in rural communities
In many cases, hospice is the most dignified choice for your loved one’s end-of-life care. However, many rural residents are accustomed to the scarcity of medical resources and may assume hospice care is not available in their area—or only seek hospice care too late in the dying process. Hospice experts urge it’s never too early to learn if hospice care is appropriate for someone you care about.
The National Hospice and Palliative Care Organization (NHPCO) offers a handy tool to find nearby hospice providers. After confirming with your loved one’s physicians on the most appropriate kind of hospice, consider the following questions when choosing a hospice provider:
- Can individuals closest to the patient easily access the hospice facility?
- What services are provided?
- What support is given to the individual’s family?
- How will hospice interact with the individual’s physician?
- How are services provided after hours?
- How long does it take hospice to enroll someone once the request for services is made?
- What are the restrictions and rules for visitors?
The decision to enter hospice is ultimately a medical decision but one that can provide comfort-focused, end-of-life care, and allow your loved one to enjoy their final days in the comfort of their own home or in a facility with trained staff and round-the-clock services. Hospice care can provide relief to patients and caregivers to create comfortable, peaceful end days, no matter where you live.