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Benefits of Hospice for the Caregivers

Why Choose Cleveland Clinic Hospice at Home? Coordinated and compassionate care.

We'll work with each patient's physicians and specialists to continue their care and keep them updated on the patient's progress. If a patient needs additional medical services, we can arrange them with other Cleveland Clinic providers.

Dedicated physicians. While other hospice programs may have "contracted" physicians, we have board-certified palliative or hospice Cleveland Clinic physicians who are solely dedicated to our program. The strength of our physician support and leadership sets us apart.

• Accredited and trusted. Our hospice is Joint Commission accredited and a member of:
o National Association for Home Care & Hospice
o National Hospice and Palliative Care Organization
o Midwest Care Alliance
o Ohio Council for Home Care and Hospice

Listen as the experts from Cleveland Clinic give you the most up to date information on why you should choose Cleveland Clinic Hospice for your loved one.

We're Talking About Your Health with Cleveland Clinic!
Benefits of Hospice for the Caregivers
Featured Speaker:
Terence Gutgsell, MD, Cleveland Clinic Hospice and Palliative Care Specialist
Terence Gutgsell, MD, is Director of Education of the Harry R. Horvitz Center for Palliative Medicine at Cleveland Clinic, in Cleveland, Ohio. He served as Medical Director and Chief Medical Officer at Hospice of the Bluegrass, and Medical Director of the Hospice Care Center at St. Joseph Hospital in Lexington, Ky., from 1996-2007. From 1999-2007, he was Medical Director of the Palliative Care Center of the Bluegrass and Medical Director of the Palliative Care Unit at Central Baptist Hospital. His work with Hospice of the Bluegrass and local hospitals in Lexington led to designation of the Palliative Care Center of the Bluegrass as one of six nationally recognized Robert Wood Johnson Palliative Care Leadership Centers (PCLC). These centers are charged with teaching other hospitals and hospices how to initiate, grow and sustain hospital-based palliative care consultation programs.

Harry R. Horvitz Center for Palliative Medicine at Cleveland Clinic

Melanie Cole (Host): Having a loved one in hospice is never easy, but there is help. My guest is Dr. Terence Gutgsell. He's the Chief Medical Officer of Hospice of Cleveland Clinic and Homebased Palliative Care. Welcome to the show, Dr. Gutgsell. Tell us a little bit about hospice care versus palliative care. I think people don't understand that there's a big difference between the two.

Dr. Terence Gutgsell (Guest): Sure. And folks or not alone. Even among physicians and nurses, sometimes there's some big confusion about that. Palliative care is a big umbrella, basically. It's care designed to help people who have advanced illness, serious illness, and the goal of palliative care is to provide a release from suffering—whether that's physical, mental, emotional, spiritual—and can be delivered at the same time that patients are getting life prolonging, life-saving treatment. So consequently, we can see patients actually quite early in their course and, in fact, see some patients who may have the opportunity to be cured of their illness. Whereas hospice is palliative care, but it's specific to patients who have a very limited life expectancy. Hospice is actually a program that was devised by the US government through Congress, an act of Congress back in the mid '80s. And basically, there were criteria set up that stated a patient had to have a life expectancy of six months if the disease runs its usual course and had to be willing to forego life-prolonging, life-saving kinds of treatments. So consequently, hospice really is a benefit of Medicare, primarily, but also private insurances and through the VA system that provides a very profound support for patients and families who are going to the place where they will not have much life left.

Melanie: And sometimes, Dr. Gutgsell, palliative care and hospice medicine go together at the same time, don't they?

Dr. Gutgsell: Sure. Palliative care, again, can be provided anywhere in the continuum of a patient's illness. As long as the patient has a suffering of some sort or another, they're a candidate for palliative care. But that care will be compensated through the usual fee-for-service type of payment system. Hospice, on the other hand, if you qualify for hospice, there is a specific hospice benefit, which provides funding for the physician, the nurse, the social worker, for medications, for supplies, which is a profound benefit that palliative care really does not cover. So it's a much more vigorous form of care for patients approaching the end of their lives.

Melanie: So hospice care can take place, Dr. Gutgsell, in the home or in the hospital. As far as caregivers and people caring for loved ones going through whether it's palliative or hospice care, this is a difficult time. Are there certain advantages to hospice care at home? And what benefits can they find from your help at Cleveland Clinic that will help them deal with it at home?

Dr. Gutgsell: If you lived in England or in other countries, hospice may be really a place where people would go, sort of like a hospital, in a way. In the United States, our system of care has become one where hospice is primarily given in the patient's home. Let's say 90 percent of patients die in their home with the support of hospice care. So there are in-patient facilities for patients whose symptoms are very difficult to control, but for the most part, the cares provided by a physician, a nurse, a social worker, a spiritual care provider, a nursing assistant, all making home visits when and if needed. At the very least, a nurse is seeing a patient on a weekly basis. Medicines for the terminal illness are provided by the hospice program, meaning they are purchased and monitored by the program. So there's no out-of-pocket cost for the patient and her family regarding the medications. Any supplies that they need, any medical equipment they need, such as oxygen, such as a hospital bed, a walker, whatever is needed to support that patient and family in the home, hospice provides that. So again, I want to emphasize, it's a very strong support mechanism for the patients and the families. And in fact, hospice sees their unit of care as being the patient and the family.

Melanie: And this is a multidisciplinary care that is so critical at this time of life for both the caregivers and the patient. Tell us a little bit about that care. There's nutritionists involved, pain management, symptom control. All of these different things come together.

Dr. Gutgsell: The founding person of the hospice movement was Cicely Saunders in England back in the 1960s, and she had this concept of total pain. Total pain, she stated, was a combination of physical distress, emotional suffering, spiritual suffering, and social suffering, and that if we ignore any one of those components, the person and the family can suffer needlessly. So with that concept in mind, hospice has always been multidisciplinary. It has been provided for a by a physician who is expert in pain and symptom management. It's provided for by a nurse who's had special training in the care of terminally ill patients, social workers who can help families navigate some of the emotional and practical issues that come about because of the serious illness, and then spiritual care providers, chaplains who can meet the patient and family where they are. In no way are the spiritual care providers trying to put their idea of what is spiritually appropriate at this time but meeting the patient and family where they are and helping them guide through this difficult time. So, multidisciplinary support is very, very much part of the concept of hospice. And I failed to mention one other very crucial individual, and that's the nursing assistant. Hospice, for patients who need it, will provide a nursing assistant that comes into the home. It can be a daily basis for about an hour to help with some daily care needs, whether that's bathing, dressing, wound care, et cetera.

Melanie: So what sets Cleveland Clinic Hospice at Home really apart for us, Dr. Gutgsell?

Dr. Gutgsell: Sure. Well, all of our physicians are, first of all, board-certified in hospice and palliative care. Each and every one of these physicians has come through our own fellowship program, so we can vouch for the quality of care that they provide. Secondly, we are, in the hospice program and home-based palliative care program through connected care, are connected with the palliative medicine program at the main campus, which was the very first palliative care program in the United States and has a very, very strong academic mission. And we're also integrated with other components of the connected care program, meaning occasionally a patient will do better than we anticipate and may be discharged from hospice, in which case we can transition them to a home care program seamlessly, which is really wonderful. We also have access to physical therapists, occupational therapists, speech and language therapists, nutritionists who can provide a consultation for hospice patients—again, in a seamless and well-integrated manner.

Melanie: Thank you so much, Dr. Terence Gutgsell. You are listening to Talking About Your Health with Cleveland Clinic. For more information, you can go to That's  Find out more about hospice care at home for your loved one. This is Melanie Cole. Thanks for listening.