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The Hospice Experience

What to Expect on the Hospice Care Journey

We understand that this is an overwhelming season of life, and we are here to provide care that supports the patient, caregiver and family so that you can concentrate on your moments together. Please note that we recommend that you call us as soon as you or your loved one is eligible for hospice care (when doctors have given a life expectancy prognosis of 6 months or less). 

Anyone can request care by calling 866-466-9734 or REQUEST CARE online. If hospice care has been recommended by your medical provider, they may also refer you. If they have not mentioned Four Seasons, you can ask for us by name. It’s always your choice.

When you call you will be connected to our Care Access team who will gather your information and help schedule an evaluation. If you request care online, they will call you or email you if you have indicated you would rather be contacted by email. They can answer questions and make sure we have what we need to get started.

Four Seasons makes every effort to get you enrolled the same day you contact us. After you have spoken to the Care Access team, an RN will visit with you to conduct a patient evaluation. 

Patient Evaluation

  • The Hospice RN will talk to the patient and family and assess the eligibility of the patient for Hospice Care. 
  • During this visit the RN will also review the medical history, current medications, and comfort levels.
  • The RN will ask  “What’s most important to you?” She will listen to  understand your goals for comfort and symptom management as well as your priorities and things you would like to do during this season of life. Our goal is to help enhance your quality of life so that you can spend time truly living.
  • The RN will confirm eligibility with the Hospice Physician and/or referring physician. If you or your loved one are not eligible you may be a good fit for our Palliative Care services and the RN can help facilitate that enrollment.

Admissions Paperwork

  • If eligibility is confirmed, the RN will explain admissions forms, consent forms, and the rules of the Hospice Benefit.
  • The patient or legal decision-maker will sign the paperwork.

Ordering Durable Medical Equipment

  • At this visit the RN will also order any equipment you might need including a hospital bed, oxygen, or mobility aids.
  • They will also have comfort medications and hygiene supplies delivered to the home.
 

Helpful Documents to Have on Hand for the Visit (not required but helpful)

We understand this is a challenging time. If you are able to get these documents together before the visit, it will help facilitate the enrollment. If not, we will help you!
  • Advance Directives: Copies of the Living Will or Healthcare Power of Attorney (POA) if you have one.
  • Resuscitation Orders: A Do Not Resuscitate (DNR) order or Physician Orders for Life-Sustaining Treatment (POLST) form, if already completed. This must be an ORIGINAL copy – they will not take duplicates. If you do not have this, we can assist.
  • Identification: The patient’s State ID or Driver’s License.
  • Insurance Cards: All relevant Medicare, Medicaid, or private insurance cards. 

At Four Seasons, your Hospice Care Team includes specially trained professionals who each have an important role in providing patient-centered care. Our care not only focuses on relieving symptoms and providing comfort but also on emotional and spiritual counseling, as well as helping the caregiver with logistics, filing paperwork, emotional support, and more. 

Your Care Team will schedule visits with you but does not move in with you. We schedule visits regularly and then visit more often as needed. Read more about these team members below:

A hospice care professional with short dark hair wearing a white lab coat and stethoscope, set against a light blue circular background.

Hospice Physician

A Four Seasons physician monitors the patient’s condition, prescribes medications, and coordinates care with the team. Depending on the patient's condition, providers typically visit every 6-8 weeks or as needed. 100% of our Hospice Physicians are certified in Palliative and Hospice Care.

A hospice care team member wearing glasses, blue scrubs, and a stethoscope stands with arms crossed against a light circular background.

Hospice Nurse

Your Hospice nurse provides hands-on care, including symptom assessment and management, while also listening to and collaborating with the patient, caregiver, and family. Depending on needs, nurses typically visit 1-3 times per week. Also, there is a nurse available by phone 24/7 to manage your needs and answer questions.

A person with short hair in a navy shirt holds a closed blue folder, representing a hospice care team member, set against a light blue circular background.

Hospice Aide

Your Hospice Aide is a Certified Nurse Assistant who provides personal care, including bathing, dressing, and oral care, easing the burden on families. Aides often visit 2-3 times weekly to ensure comfort and dignity.

A person with short hair and glasses, wearing a red top with a white collar, representing a member of the hospice care team on a light blue circular background.

Hospice Social Worker

Your Hospice Social Worker emotionally supports the patient and family and helps with logistics, including help navigating payment options, Medicare, and insurance. Social workers typically visit as needed, based on family needs.

A man with gray hair, beard, and mustache wearing a dark suit, representing a hospice care team member, set against a light gray circular background.

Hospice Chaplain

Your Chaplain provides guidance and comfort, addresses spiritual questions, and honors religious and cultural traditions. They are highly educated and trained in administering spiritual counseling for multiple religions and worldviews. Your Chaplain will visit as needed.

A person with long, wavy brown hair in a white turtleneck stands against a light blue circle, symbolizing compassionate hospice care support. The face is featureless.

Music Therapist

Your Board Certified Music Therapist uses a combination of music and therapy to offer emotional, physical, and spiritual support to patients and families, helping create moments of peace. Music therapy is a proven method of therapy that may help with trouble breathing, pain management, anxiety and other symptoms. It also creates opportunities for connection with the patient and family.

A woman with short white hair and a green top represents a hospice team on a light blue circular background.

Volunteer

Your Hospice Volunteer provides companionship and assistance, offering a caring presence to lighten the load for patients and families.

Caregiver Training & Resources

After the initial visits, your Hospice Care Team will continue to visit regularly to care for the patient and will also provide training and resources to help the Caregiver and Family have confidence in providing daily care. They will continue to provide training and help you understand what is happening throughout the hospice journey.

Our Hospice Education Guide, and our Online version with videos are excellent resources and references for dealing with issues like trouble breathing, eating, oxygen safety, dealing with anxiety, planning for what’s next, and more. You will receive a guide when you enroll but you can access it via PDF and flipping book as well.

 

Caregiver Support

Hospice Aide & Volunteer

The Hospice Aide comes out 2-3 times a week and helps with bathing, dressing, mobilizing the patient. They provide support for the caregiver and may help with some light housekeeping or other needs.
 
Volunteers can support the caregiver and patient in many ways. They can visit to provide socialization and interaction for the patient. They can help with transportation to visits and so many other things that give the caregiver a little time to catch their breath.

Respite Care

One of the most important things you need to do as a Caregiver, is take care of yourself. The Centers for Medicare and Medicaid Services have realized the importance Caregiver mental health and actually include a 5 Day Respite Care benefit to give caregivers a much-needed break. You can talk to your Nurse or Social Worker to see about scheduling a stay at Elizabeth House (based on availability) or another CMS certified facility. You can schedule 5 days in a row or just a few days.

Advance Care Planning

Preparing for what’s next is a huge weight off the shoulders of a caregiver. Our Healthcare Social workers can talk with the Caregiver and Patient about their wishes. They will guide you in what is needed to name a Healthcare Power of Attorney, create a list of goals for your end-of-life care including filling out the MOST form and a DNR if desired. They can direct you to resources for making wills and when the time comes, plan for funeral services.

At Four Seasons, Hospice is about LIVING. We focus on sunrises and the potential for quality of life that each day brings. 

It is our priority to make sure that if you or your loved one have plans to travel, go to a wedding, have a fishing trip or see a big ballgame, write a memoir, worship, or spend time with family, you are supported. In our first meeting with you we will ask what’s most important to you, and this includes your priorities for things you would like to do at the end of life if you are able. We will provide care and advice to help you along the way and can also help coordinate with another hospice if you are traveling. To us, Hospice is about Living! Please do note that in order to support you or your loved one fully, we advise that you enroll in Hospice Care as soon as your doctor gives a prognosis or a life expectancy of 6 months or less. This gives us time to set up plans and get support in place, even if it is not yet necessary on a daily basis.

Some of the ways our patients have lived their lives to their fullest include:

  • Prioritizing faith and attending worship.
  • Attending a granddaughter’s wedding.
  • Going to a baseball game.
  • Traveling to the coast with family.
  • Writing a book (actually one patient wrote 3!).
  • Journaling or creating legacy videos.
  • Mending relationships.
  • Learning a new skill.
  • Visiting with grandchildren as often as possible.
  • Finding spiritual peace.
  • So many others…

Our team will continue to visit, manage symptoms, and provide medication or treatment as needed. We will also be carefully monitoring the progression of you or your loved one’s condition. 

Four Levels of Hospice Care

  1. Routine Home Hospice Care: This is the most common level of care. It happens where the person lives, which can be a private home, skilled nursing facility, assisted living facility, or wherever they call home. Many patients do not need another level of care.
  2. Respite Care: This level is mainly to help the family or caregivers who are looking after the patient. The patient can stay at our Elizabeth House facility or other contracted facility for up to five days (based on availability) to give the family a break so they can rest or handle other responsibilities. 
  3. Continuous Home Hospice Care: This is sometimes called “Crisis Care.” If a patient has a sudden medical problem—like severe pain or trouble breathing—a nurse may stay in the home for a longer period of time (overnight if needed). The goal is to get the problem under control so the person can stay at home.
  4. General Inpatient Hospice Care: If a medical crisis cannot be managed at home, the patient may be admitted to our Elizabeth House inpatient facility, or another CMS certified facility closer to you, typically for a short time. There, they receive 24-hour nursing care until they are stable enough to return home.

Death is a process of physical, emotional, social, and spiritual changes. The end-of-life may approach rapidly or gradually over many days. Each person is unique and the transition towards death often reflects the person’s life and personality. The goal is to honor and respect these changes, and to comfort and support the family through this process. Four Seasons values life and does not hasten nor prolong the natural process of dying. 

As the patient progresses toward the end of life, here are signs that death may be near:

  • Increasing sleep, though night and day sleep may switch; eventual inability to wake up.
  • Increasing weakness, more time resting in bed or in a comfortable chair.
  • Time and usual routines become less important.
  • Withdrawal from activities such as visiting with people or watching TV.
  • Decreased eating and drinking; eventual inability to swallow.
  • Slower or irregular breathing with pauses between breaths (apnea).
  • Skin may be cool, become grey-blue, or be splotchy (mottled).
  • Skin may be very warm often due to low or high-grade fevers not caused by infection.
  • No control of emptying bowels or bladder.
  • Decrease in amounts of urine and urine that is dark in color.
  • Limited or no swallowing, causing drooling or noisy breathing because of pooled saliva in the back of the mouth/throat.
  • Visions, often of people who have died, are common and can be comforting to the patient.
  • Restlessness or agitation, such as reaching into the air, picking at blankets, or trying to climb out of bed.
 
During this time, our visits may increase, and nurses will just be a phone call away 24/7 as death nears.  While a Hospice Nurse is not at the bedside 24/7, their caregiver or family can call even at 2 am to tell the nurse their loved one’s breathing has changed or let them know about another sign that death may be near. The nurse will guide them or come to the home.
 
When death occurs, the caregiver/family should call their Hospice Nurse (not 911) who will come to the home to officially declare and document the time of death. This prevents the need for emergency sirens, police presence, or coroner interventions.
 

After death, your nurse will give the family time sit with their loved one, pray, cry or share stories before they begin any logistics.

If the family would like, the nurse can perform postmortem care, bathing, remove medical equipment (oxygen, catheters, or IVs) and preserve dignity.

When the family is ready, the nurse will then call the funeral home or mortuary to arrange for transportation. They will also contact other members of your Care Team as needed, inform the patient’s medical provider, arrange for medical equipment to be picked up, and properly destroy medications. Four Seasons also honors your family and your religious or cultural traditions and will help facilitate the patient’s wishes as indicated.

The year following a loss can be the most difficult for many.  During this time,  bereaved families served by Four Seasons Hospice Care will receive quarterly mailings and phone calls to remind you of grief support services that you can take advantage of when you are ready.  You may choose to decline these calls and mailings, but remember that you can reach out to us for grief support at any time. 

Our professionally trained counseling staff provides time-limited individual counseling for the purpose of addressing grief related to the death of a loved one. They also offer groups that promote discussions, use creative means to express grief, and provide connection with others who have recently experienced a death. In addition, we offer child and adolescent grief services through our Compass Program.

For more information and to access our services, email us or call us at 828.692.6178 and ask for Grief Services.

We are honored to serve your family. We want you to take time to grieve and heal.

A year or more after your loved one has died, you may be ready to find something that will fulfill your sense of purpose. Many of our families have found that by volunteering with Four Seasons, they are able to be a part of co-creating the care experience. Our staff, volunteers, donors and community who are a part of Four Seasons have a motto, “Care Begins with Me.” 

There are many ways to volunteer, including spending time with patients, becoming an ambassador, volunteering with the Foundation at events or with the Home Stores, putting your sewing talents to use in our Keepsake sewing program, and so many other opportunities. 

If you are interested, we are glad to discuss this with you when you are ready. 

Find out more about volunteering

 

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