How Respite Care Helps Patients by Helping Caregivers
Demands of Caregiving
Caregiving for someone who is ill can be stressful, but when that someone is in the final stages of life, caregiving takes on different challenges. Care requirements are often escalated, and the patient may require more frequent medication, special wound care and assistance with feeding and toileting. The uncertainty of when death will occur also puts emotional pressure on the caregiver.
All of this can cause caregivers to lose sleep and live in isolation and worry, which can result in depression, fatigue and anxiety, also referred to as “caregiver burnout.”¹ Some caregivers facing especially intense burnout may consider quitting, a decision that could require the patient to be placed in a nursing home or other facility.
It is essential that those taking care of someone near the end of life also take care of themselves by getting plenty of rest and making time for themselves away from the demands of caregiving.
End-of-life patients receiving hospice services are eligible for “respite care,” defined and covered by the Medicare Part A hospice benefit. Hospice respite care allows a family caregiver to get a break of up to five consecutive days and nights from caregiving duties while the patient is cared for in a Medicare-certified inpatient facility.
These facilities are often nursing homes, but hospice providers have arrangements with a number of appropriate 24-hour long term care facilities that can provide respite care. Some hospices provide their own inpatient hospice units for occasional respite care.
What Is Respite Care?
Medicare defines respite care as, “… short-term inpatient care provided to the individual only when necessary to relieve the family members or the person caring for the individual at home.”²
Qualifying situations include:
- Caregivers who may be suffering from physical or emotional exhaustion from taking care of a patient around the clock
- Caregivers who would like to attend a family event such as a graduation, wedding, funeral, etc.
- Caregivers who become ill and cannot take care of the patient.
Who Receives Respite Care?
Members of the hospice care team, who are positioned to notice the symptoms of caregiver burnout, can ask the team physician to provide orders to admit a patient into a Medicare-approved facility. Caregivers themselves can also request respite care for their loved one in order to take a break. Some caregivers are reluctant to do so, but this is short-sighted.
Caregivers who take time for themselves return better able to resume their caregiver responsibilities. Respite care can be beneficial to the patient as well. The fact that their hospice team can call on a 24-hour facility to meet their needs gives some patients a sense of autonomy, and a renewed appreciation of their caregiver after the break.
To get the most from respite care, plan ahead. Depending on your hospice provider, there may be a slight cost, perhaps five percent of the cost of the care. Ask questions in advance. Then plan how you will use the respite time. The ARCH National Respite Network and Resource Center recommends that caregivers take regular and sufficient respite periods and make this a meaningful and purposeful break from the care routine.³
Under respite care, the hospice team continues to expedite the patient’s plan of care, while the facility staff provides the care that would have been given by the family caregiver. Respite care can be provided periodically, ensuring that the caregiver can relax and enjoy time away knowing that his or her loved one is in good hands.
Not every caregiver needs up to five days and nights to enjoy a break in caregiving duties. Relief can often be found in shorter breaks. While a hospice care team member or trusted friend is visiting a patient, the family caregiver may utilize that time to run errands, take a walk or meet with friends.
Respite Care Is One of Our Four Levels of Care
VITAS offers four broad types, or levels, of care as defined by the Medicare hospice benefit:
- Routine home care. This is how we provide hospice care most often: in patients’ homes, long-term care facilities and nursing homes.
- Continuous care (Intensive Comfort Care®). When medically necessary, acute symptom management is provided at home or in another facility by hospice staff in shifts of up to 24 hours/day so the patient can avoid hospitalization.
- Inpatient care. If a patient’s needs cannot be managed at home, VITAS inpatient hospice units and special arrangements at other local facilities provide hospice care around the clock until the patient can return home.
- Respite care. Limited to up to five consecutive days, respite care provides a brief “respite” for the patient’s primary caregiver by admitting the home care patient to an institutional setting without meeting the “inpatient” pain and symptom management criteria.
²National Palliative Care Organization. Level of Care Tip Sheet, 2012. www.nhpco.org/regulatory