Can we call hospice without telling Dad?

Originally published in the Lincoln Tribune, May 27, 2008

Q: Dad was diagnosed with heart failure about a year ago, and he is not doing well. We want to call hospice, but he will panic if we do. Can we get hospice involved without him knowing?

A: You can't hide hospice from your father, but you can help him understand it's no reason for panic. Hospice care can improve and even lengthen his life.

Nevertheless, if he is afraid of hospice, the conversation will be a difficult one to begin. I suggest you discuss the situation first with family members he trusts. A "united front" might help make your case—and ease the burden on you.

Here are a few pointers for the conversation:

● Address his fears. Why does calling hospice make him panic? Is he afraid you have given up on him? Reassure him that you are with him every step of the way, and you want him to be free from pain or symptoms. If his panic comes from believing the end is near, reassure him that is not the case, and not the reason you are asking. Explain that he and the family will be best served if hospice is involved for a long period of time. The hospice care team can often help the patient and caregivers for weeks or months before a serious crisis occurs.

● Explain the benefits. Heart failure patients tell us their number one benefit has been the reduced number of trips to the emergency room. By now, your whole family may know about that "revolving door" to the ER. Your dad may be fine one week and back in the hospital the next. At my hospice, specially trained nurses in cardiac might help him to stay home—where he wants to be—and out of the hospital.

● Emphasize quality of life. Your father may imagine the hospice staff beginning bedside vigils, not helping him enjoy his grandchildren's visits. But if he is able to breathe freely, he may spend more time doing the things he wants to do. Every day is precious, and hospice can help him enjoy more of them.

Above all, remain calm and allow him to make his own choice. If he refuses, I would encourage you to try again when you feel the moment is right. Remind him that you love him and do not want to see him struggle.

Please send me your questions to asklinda@pchcv.org. See you next week!