When Is It Time To Consider Hospice Care Or To Transition From Palliative Care To Hospice Care?

Hospice care is usually considered when a person has a limited life expectancy, often estimated to be six months or less. The focus of hospice care is on providing comfort and support rather than pursuing curative treatments. It is usually appropriate when curative treatments are no longer effective or when your loved one decides to stop pursuing them.

Palliative care can be provided at any stage of a serious illness and is focused on relieving symptoms, managing pain, and improving the quality of life. It can be provided alongside curative treatments and is not limited to individuals with a life limiting prognosis.

The decision to choose hospice, or to transition from palliative care to hospice care is typically based on your loved one’s prognosis and the goals of care. Both palliative care and hospice care provide comfort and support to those coping with serious illnesses, but they differ in some key respects.

Here are some factors that may indicate it is time to consider hospice care or transitioning from palliative care to hospice care:

Prognosis: If your loved one’s life expectancy is estimated to be six months or less, then hospice care may be a good choice.

Ineffectiveness of treatments: Your loved one’s condition is deteriorating despite treatment and more treatment is not expected to provide significant benefits.

You are seeing a general decline: Your loved one’s mobility is getting worse as treatment progresses. They are losing weight and persistently tired. This could indicate the body is weakening.

Repeated infections: Persistent or recurrent infections may indicate a decline in your loved one’s overall health.

Their need of assistance is growing: They are becoming more and more dependent on others for daily activities. They need increasing amounts of help with daily tasks like sitting up, eating, or going to the bathroom.

They are saying that they’ve had enough: They say they’ve had enough treatments, or that they’re ‘ready’, or they just want to feel better, and nothing is helping. If they just want more good days than days spent struggling, it may be time for supportive comfort care.

Treatment Goals: If the primary goal of care is shifting from curative treatment to comfort and quality of life, hospice may be more appropriate.

Conversations with your loved one and the family about the wishes and goals of care are crucial. Understanding their preferences and values helps in making the right decision. It’s always important to include your primary care physician, and specialists in the decision-making process. You may be thinking, “but my doctor hasn’t mentioned hospice care, why not?”

Physicians are people too, and they may hesitate to discuss hospice care for a lot of reasons. Many don’t hesitate, and others may feel much more at ease if you approach the subject first. Some common reasons they may hesitate to have these discussions may be:

Communication challenges: Discussing end-of-life care can be emotionally challenging for both healthcare providers and patients. They often like their patients and have known them for years. Doctors may be hesitant to bring up hospice care because they’re concerned about how your loved one and the family will react.

Difficulty in broaching the subject: Discussing end-of-life care requires sensitivity and good communication skills. Some healthcare providers may feel uncomfortable or unprepared to have these discussions, leading to a delay in referring patients to hospice care.

Over Prognostication: Many doctors out of fondness for their patients view situations with optimism. Research shows that 63% of physicians overestimated survival by more than a factor of five. The longer a physician has known their patient, or the more recently they have seen their patient, the more optimistic their projections. It’s human nature, they like their patients.

Uncertainty Over Prognosis: Physicians refer to hospice when life expectancy is estimated to be six months or less, but that is frequently difficult to determine with certainty. If your loved one is coping with other illnesses in addition to their primary diagnosis, then that should be considered alongside the primary diagnosis. Ask to be evaluated by a hospice and palliative care provider like Ascend. As a provider of both palliative care and hospice, our teams can provide valuable consultation to your physician.

Fear of taking away hope: Some providers may worry that introducing hospice care could be interpreted by your loved one as giving up on treatment or losing hope. They might be concerned about the potential psychological impact on your loved one and the family. Let your physician know when your hope becomes to endure less suffering and to find more good days than bad days.

Lack of awareness or knowledge about hospice: Some healthcare professionals may not be well-versed in the services and benefits that hospice care can provide. This lack of knowledge might lead to hesitation in having this discussion.

Institutional factors: Certain healthcare institutions may not have established protocols or sufficient support systems for discussing and facilitating hospice referrals. This can contribute to delays in the decision process.

Patient or family preferences: Sometimes, doctors may perceive that the patient or their family may be resistant to the idea of hospice care. This may lead them to try to respect the wishes of the family rather than initiate a difficult conversation intended to advise them of their options.

It's essential for your loved one and the family to openly communicate with healthcare providers about their preferences for end-of-life care. Open and honest dialogue is the only way to guarantee your family gets the care it needs. It takes courage and it can be difficult for everyone involved, including your physician.

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Coping With Dementia: 10 steps to gain more cooperation with simple tasks

August 28, 2025

How can we increase the level of cooperation we get from a loved one coping with dementia? A loved one with dementia may resist simple routines that we, as caregivers, need for them to complete so they can maintain proper hygiene or enable us to run a household. It may be a simple task, like taking a shower or getting dressed - or brushing their teeth before they go to bed. A good way to start is to recognize that we are about to face a challenge . Like any challenge we face, it’s best to get ready before we begin. Be prepared! Gather everything that will be needed to complete the task and arrange those things in the order that they’ll be needed. Be sure to have everything at hand that will be needed when the task is completed. For instance, are we brushing our teeth in the morning? Have the bathing set up as the next task or be ready to dress and go to the dining table. Have patience, remember that this will take longer than normal. Budgeting more time will reduce your own stress, and that is key in reducing theirs. Remember, they are cognitively disabled . It’s frequently not that they’re resisting your instructions, it’s simply that they are having difficulty processing them - it will take them longer to understand and cooperate than normal. One of our biggest goals is to avoid making them feel pressured, rushed or agitated . Maintaining this level of structure will be comforting to your loved one and will decrease confusion and stress. It will also reduce distractions that might be inadvertently introduced by being less than organized. We may be doing something simple, but it’s no longer simple to a loved one suffering from dementia. Have you ever assembled a piece of furniture from IKEA? Keep that in mind – you needed step by step instructions. Did they always make sense as you progressed? Nope. Did you ever get frustrated? You bet. This is the same thing. Give them simple steps, one step at a time . Think from a new perspective. “Let’s go brush our teeth,” doesn’t really lead them to beginning or completion. How about: 1 - let’s go to the bathroom 2 - can you stand in front of the sink? 3 - let’s rinse your toothbrush - we need to make sure it’s clean! 4 - perhaps try doing your own side by side as an example 5 - can you open the toothpaste now? 6 - squeeze a line of toothpaste onto your brush, like this, see? 7 - now, put the toothbrush into your mouth, brush like I’m doing 8 - top now - left side, center, now on the right - inside, like this 9 - bottom now - left side, center, now on the right - inside, like this 10 - now, we’re almost done. Take your brush and rinse it 11 - put the brush back into the holder 12 - put some water in the cup 13 - now just rinse your mouth 14 - spit the water back into the sink Try to let them do as much on their own as possible. It will build confidence and reduce their stress, step in and help as needed. You’ll see for yourself how deeply you need to break down tasks and learn from their responses when to help, praise or comfort. Try not to take over and do steps for them when they may be able to complete the step themselves. If they are able, that may convey impatience. We’re trying to encourage a sense of competency and autonomy - even if a step is not taken perfectly. To learn more about dementia and Alzheimer’s disease follow these links. 1 - https://www.ascendhealth.com/coping-with-alzheimers-anxiety-and-depression 2 - https://www.ascendhealth.com/alzheimers-caregiving-7-signs-its-time-for-extra-support 3 - creating dementia-friendly documents https://bit.ly/3H9g6WD Our teams offer specialized care for those living with end-stage dementia and Alzheimer’s. Our supportive team focuses on improving quality of life and easing the distressing burdens of Alzheimer’s and related dementias. Learn more about how we can help bring comfort and support by reaching out to a member of our compassionate team.

Gene Hackman’s Final Lesson: A Wake-Up Call for Caregivers and Families

June 30, 2025

A few months ago, beloved actor Gene Hackman and his wife, Betsy Arakawa, were found deceased in their New Mexico home. Investigators believe Arakawa passed away first—possibly up to a week before Hackman. Shortly before her death, she had reached out to a local clinic . Later, Hackman’s pacemaker data helped confirm the timeline of his own passing. The medical examiner determined that Arakawa died from hantavirus pulmonary syndrome , a rare and dangerous respiratory illness transmitted by rodents. Hackman died from advanced heart disease , with Alzheimer’s disease contributing to his decline. Experts suggest that his cognitive impairment likely prevented him from recognizing Arakawa’s death—or, if he did realize it, he may have experienced confusion, heartbreak, and helplessness before ultimately passing away himself. We may consider Gene Hackman’s last role to be his final lesson, a wake-up call for caregivers and families. It’s a profoundly tragic story—one that reflects a reality many families quietly face. As our loved ones age, especially when one becomes the caregiver, a sudden health crisis can leave the other stranded in a dangerous situation. What Can We Learn? This heartbreaking story offers more than grief—it offers perspective. It’s a reminder to be proactive, observant, and involved in the lives of aging loved ones. Here’s ways we can help. 1. Know the Conditions Affecting Your Loved Ones In Hackman’s case, the central health challenges were heart disease and Alzheimer’s. Recognizing the signs of heart trouble—chest pain, fatigue, breathlessness—and understanding how dementia can mask or confuse those symptoms is critical. 2. Caregivers Need Care Too When the caregiver goes down, the one who relies on them is suddenly exposed. Arakawa’s sudden illness likely left Hackman alone, disoriented, and unable to seek help. Caregivers often suffer in silence, pushing past their limits. Regular check-ins and support for them are just as essential. 3. A Simple Visit Can Save a Life A timely visit from a friend or relative might have changed the outcome. Subtle signs—rodent activity, spoiled food, confusion, hygiene issues—could have triggered help before it was too late. Don’t underestimate the power of simply showing up. What to Watch For: A Family Checklist If you have aging parents, relatives, or friends, here are some key areas to keep an eye on: Physical Health • Sudden weight loss or gain • Bruises, burns, or signs of falls • Unkempt appearance or body odor • Difficulty walking or standing Cognitive & Emotional Well-being • Memory loss or repeating questions • Depression, anxiety, or social withdrawal • Unsafe behavior such as leaving appliances on • Unusual mail or phone activity Home Conditions • Spoiled food, pest presence, or clutter • Safety hazards (dim lighting, loose rugs) • Appliances or plumbing not working Nutrition & Kitchen Safety • Expired food or low food supply • Dirty or neglected kitchen tools • Avoiding cooking altogether Medication Compliance • Confused about medications or missed doses • Expired or improperly labeled prescriptions Social Interaction • Isolation or reluctance to leave the house • Loss of interest in hobbies or community involvement Financial Awareness • Unpaid bills or unopened mail • Signs of financial exploitation or scams Tech & Communication • Can they use a phone in an emergency? • Are they responsive to calls or messages? What To Do If You Notice a Problem If you see red flags, don’t panic—but don’t ignore them either. Start with an honest, caring conversation. Explain that your concern comes from love, not judgment. Then, consider next steps: • Schedule a check-up with their doctor • Bring in help, even part-time support • Assess whether the home needs modifications • Explore new living arrangements if necessary Whether it’s weekly dinners, video chats, or simple texts—stay involved–consistent contact keeps you in tune with your loved ones’ needs and builds a safety net they may not even know they need. Final Thought If Gene Hackman’s last role is to serve as a final lesson, it’s a wake-up call for caregivers and families. Gene Hackman’s final days are a sobering reminder: Don’t wait until something goes wrong. Aging can be beautiful—but it also comes with risk, especially in solitude. Let this story motivate you to reconnect, check in, and truly see how your loved ones are doing. Additional Resources: Learn more about Congestive Heart Failure: https://www.ascendhealth.com/caring-for-a-loved-one-with-chf-this-summer https://www.ascendhealth.com/caring-for-a-loved-one-with-chf Learn more about dementia and Alzheimer’s disease: https://www.ascendhealth.com/alzheimers-caregiving-7-signs-its-time-for-extra-support https://www.ascendhealth.com/coping-with-alzheimers-anxiety-and-depression Need a health or safety assessment for a loved one? Contact Us or call today.