Pathways Home Health and Hospice of San Francisco

A large part of hospice care is bereavement support for families and friends. Pathways provides phone calls, newsletters, workshops, counseling, support groups, and remembrance events for families after a death.

Not usually. Some diseases cause the patient to be less alert. If pain is severe, pain medicine may make a patient sleepier than usual for two or three days, then they will be as alert as the disease lets them be.

Yes. Your primary care doctor remains your doctor under hospice care. Your doctor gives us direction about your care.

In the United States, hospice is a kind of care, not a place. Hospice is provided wherever you live. It is specialized care for people whose doctors believe they probably have six months or less to live. People nearing the end of life often have many changes happening in a short period of time. There may be changes in medications, sleep habits, fatigue, diet, and family roles, to name just a few. It is the job of Pathways Hospice to address each of these changes as they occur, to make the quality of life the best it can be.

Supplies, like wound dressings, are paid for when they are ordered as part of your care. Equipment such as a wheelchair or walker is paid separately by Medicare. Medicare usually pays 80% of the amount they decide is appropriate. Pathways will arrange for an equipment company to bring items the doctor has ordered to your home.

Your doctor decides which kinds of care you need—possibly a nurse, a physical therapist, a speech pathologist, or a combination. Only if you have at least one of those three, your doctor may also order an occupational therapist, social worker or personal care aide, depending on your condition.

Yes. You can always go to the hospital. We ask that you call hospice first. We may be able to manage your crisis at home. If not, they can arrange transportation to the hospital. There are times that the hospice may ask the patient to go to the hospital for a short stay if there is a problem that can be managed better there.

Hospice nurses and other team members provide care during their visits, and they will teach you what you need to know to provide care at home.

Hospice is a benefit covered under Medicare, Medi-Cal, senior HMOs, regular HMOs and private insurance. Hospice pays for medications, medical equipment and supplies that are related to the life-threatening disease.

Pathways has certified wound and ostomy nurse specialists that oversee care for those with conditions such as wounds that won’t heal, infections in surgical incisions, and new ostomies.

A referral to either of these programs means nurses will provide intense training to patients and their families or caregivers on how to manage their condition. Education includes medication reviews, “red flags” to watch for, and the importance of follow-up visits. This can mean fewer trips to the hospital.

Palliative means comfort. Palliative care, whether in the hospital or at home, is to relieve pain and other symptoms—no matter what the cause is. Pathways Home Health has a Palliative Care team for people with advanced or serious illness and need help managing their symptoms. Patients may be getting curative therapies including chemotherapy, radiation, dialysis or surgery.

These are diseases that get worse slowly over many years. Examples of chronic diseases are emphysema (COPD), heart failure, dementia, diabetes and sometimes cancer. The goal of our chronic disease programs is to teach people to successfully manage their disease and to recognize warning signs. This can help avoid trips to the hospital.

Home Health is for people who are homebound, but this doesn’t mean you can’t leave home. It means that leaving home takes a great effort. It usually means that you need help from someone else and perhaps a wheelchair or walker to leave home. Patients may leave home for medical treatment, and occasionally for non-medical things (like attending religious services, attending a special event or getting a haircut) and still qualify for Home Health.

Many health care treatments that were once offered only in a hospital, a doctor’s office or a nursing facility can now be done at home—things like IV therapy, wound care and stroke rehabilitation. Home Health professionals such as nurses, physical therapists, occupational therapists, social workers and personal care aides provide services.

Physical, speech and occupational therapy are all available to patients at home. This kind of rehabilitation can mean shorter hospital stays and a safe transition from hospital to home.

Pathways has a team of IV (intravenous) certified nurses to deliver complex IV solutions and medications to patients in the comfort of their own homes.

Home Health is intended for short periods, such as a few weeks; it is not ongoing. Home Health is provided just long enough to stabilize your health and teach you about managing your condition independently.

If the patient has a skilled need and a nurse, speech pathologist or physical therapist is visiting, then the doctor may also order a home health aide to assist with personal care such as bathing, dressing, and shaving.  Needing only personal care does not qualify for Home Health.

The frequency of visits is based on the doctor’s order and the patient’s needs, and may vary from monthly to daily, but most commonly are one to two times a week. Visits are usually an hour or less.

Home Health services are intermittent. Services are provided with short visits from healthcare professionals.  No one comes to stay. Patients who need full-time nursing care do not qualify for Home Health.

Pathways Home Health has nurses available 24 hours a day, seven days a week for consultation or home visits if needed.

Pathways Home Health is very comprehensive and cares for people who need things such as wound care, physical rehabilitation after a stroke or surgery, intravenous (IV) medications, and help managing the symptoms of a life-threatening illness. Pathways also has programs for people with chronic diseases.

Often the doctor’s office will call Pathways. If you are a patient in the hospital, the hospital discharge planner may call. You may ask either the doctor or discharge planner about Home Health, or you can call us yourself; we will find out if your doctor would like to order Home Health for you.

Your doctor decides and is the one to give Pathways an order for Home Health. You must remain under the care of your doctor during the period you have Home Health.

Medicare, Medi-Cal and many insurance plans cover Home Health visits when ordered by your doctor. We will work with your insurance provider to check your coverage for Home Health.

Your doctor orders Home Health and must be willing to continue to manage your care. You must have a problem that requires the services of a registered nurse, speech pathologist or physical therapist (sometimes called a “skilled need”), and you must be homebound.

Examples are people who need treatment for wounds, who need IV therapy, who must have rehabilitation after a knee or hip is replaced, or someone whose chronic illness has not been completely stable.

The goal is to improve your health and for you to become independent in managing your health.

Sometimes with the extra care from hospice a patient’s health improves. They may start eating more and be more active. If they improve to the point that it appears they will live more than six months, we must discontinue hospice care. The patient can return to hospice in the future when needed.

Yes. Any patient can go off hospice at any time. You can also come back on hospice if circumstances change.

Hospice must periodically recertify that the patient has a prognosis of six months or less. If at each of these dates it appears that the patient has six months or less to live, then the patient can stay on hospice. If the course of the disease is slow, some people may be on longer than six months.

You and your doctor are always in control of your care. Hospice will make suggestions about your care, but you will always be in control.

You do. Your doctor authorizes care, but you decide if you want this care or not. Sometimes the doctor calls hospice and asks us to contact you about hospice. Some families call hospice and have us call the doctor to ask for authorization. Pathways will send someone, free of charge, to make an information visit if you need this.

No. Hospice care is only related to health insurance. Because of the special nature of hospice care, we do make spiritual care counselors available to patients and families. They can also help to link you to someone in your own faith community.

You can let your doctor know that you would like hospice care when it becomes appropriate. You are entitled to six months of care, but some doctors hesitate to talk about hospice for fear you will think they are “giving up.” Hospice is not giving up. Just like you, we hope you do well. Hospice is a way to be sure of the best care, no matter how things turn out.

Nursing homes are experts in long-term care. Hospice nurses are experts in symptom management and end-of-life care. Hospice nurses are best equipped to deal quickly with urgent problems that arise. Other benefits of hospice include more frequent personal care, volunteer visitors, paid medications and supplies, and bereavement follow-up for family members.

If you feel you can’t care for the patient at home, the hospice social worker can help you find a skilled nursing facility or residential care facility.

You can have a volunteer if you like. Volunteers can help you with practical matters such as shopping, or they can stay with your loved one while you go out.

Hospice does not do treatments to shorten or lengthen life. Hospice tries to improve the quality of life. Research shows that with the extra care from hospice people who go on hospice usually live longer than those who do not.

Hospice usually treats pain aggressively. We know that pain interferes with eating, sleeping, visiting and general quality of life. Uncontrolled pain can also shorten life. The patient and family are always in control of their care and can decide how they want to treat pain.

No. Hospice will pay for your medications that are related to the terminal diagnosis. If there are medications that hospice does not cover, you can continue to get them and take them as you always have.

Hospice does not usually provide shift care or 24-hour care. Team members make visits. But a nurse is available by telephone 24-hours a day and can come at any time if a visit is necessary.

Hospice care is provided by a team. Each patient has a nurse case manager. You can decide if you would also like a hospice aide to give personal care, a spiritual care counselor to talk to, a social worker to assist with arranging practical matters, or a volunteer to run errands or keep the patient company.

It’s for anyone. In fact, most people on hospice don’t have cancer. They may have emphysema, Alzheimer’s, heart failure, kidney disease, COPD, Parkinson’s, or any other disease that is life-limiting.

Hospice is a benefit covered under Medicare, Medi-Cal, senior HMOs, regular HMOs and private insurance. Hospice pays for medications, medical equipment and supplies that are related to the life-threatening disease.

You do. Your doctor authorizes care, but you decide if you want this care or not. Sometimes the doctor calls hospice and asks us to contact you about hospice. Some families call hospice and have us call the doctor to ask for authorization. Pathways will send someone, free of charge, to make an information visit if you need this.

In the United States, hospice is a kind of care, not a place. Hospice is provided wherever you live. It is specialized care for people whose doctors believe they probably have six months or less to live. People nearing the end of life often have many changes happening in a short period of time. There may be changes in medications, sleep habits, fatigue, diet, and family roles, to name just a few. It is the job of Pathways Hospice to address each of these changes as they occur, to make the quality of life the best it can be.

Medicare, Medi-Cal and many insurance plans cover Home Health visits when ordered by your doctor. We will work with your insurance provider to check your coverage for Home Health.

Your doctor decides and is the one to give Pathways an order for Home Health. You must remain under the care of your doctor during the period you have Home Health.

The goal is to improve your health and for you to become independent in managing your health.

Most of us have little first-hand knowledge of home health care and services. You may need more facts to make the best possible health care decisions. Here we’ll tell you about home healthcare, and answer some of the common questions that people ask.

Thank you for asking! You can talk to someone 24/7 at 888-755-7855.