Solo Agers Interest Group
of Orange County
April 22, 2026

Objectives

• Discuss the benefits of hospice for timely, quality end-of-life care for patients/families.
• Overview of Hospice vs. Palliative Care
• Specifics of Hospice Care
• Levels of Hospice Care, Myths about Hospice and HOCK Family Pavilion
• Discuss transition to comfort focused hospice care from disease directed

DHCH Service Lines

• Duke Home Infusion
  • Covers three states NC, SC & VA
• Duke Home Health
  • Provides SN, PT, OT, ST, SW and HHA services to patients in their home
  • Specialty programs such as Telemonitoring, Bridge & Wound Care Support
• Duke Hospice
  • Wherever a patient calls home, long term care facilities, Inpatient
• Duke Hospice Bereavement Services
  • Hospice and the Community
• Duke Hospice Volunteers
  • Patient/Family Support, Administrative, Pet/Music Therapy, Veteran’s Recognition
• Duke Hospice Inpatient Care
  • HOCK Family Pavilion is a 12-bed unit on Roxboro
• Duke Caregiver Support
  • Within and outside the Duke Health system

Myth or Fact

31% of deaths occur
at home

More than 80% of Americans
would prefer to die at home

What is palliative care?

• Treatment that enhances comfort and improves the quality of an individual’s life who is facing a serious illness but may not qualify for hospice care.
• The expected outcome is relief from distressing symptoms, the easing of pain, and/or enhancing the quality of life.

Hospice vs. Palliative Care

• Palliative Care
  • Palliative care focuses on improving a patient's quality of life by managing pain and other distressing symptoms of a serious illness. Palliative care should be provided along with other medical treatments.
• Hospice Care
  • Hospice is palliative care for patients in their last year of life. It is for patients who have chosen to pursue treatment focused on symptom relief and comfort, and who are no longer pursuing treatments focused on cure. Hospice care can be provided in patients' homes, hospice centers, hospitals, long-term care facilities, or wherever a patient resides.

American Academy of Hospice and Palliative Medicine

Hospice Care

• Provides support and care for those in the last phases of life-limiting illness.
• Recognizes dying as part of the normal process of living.
• Affirms life and neither hastens nor postpones death.
• Focuses on quality of life for individuals and their family caregivers.

Hospice Admission Criteria

• Life-limiting illness, prognosis is 6 months or less if the disease takes normal course
• Live in the hospice coverage area
• Consent to accept services
• Forgo other curative medical interventions for the terminal illness-will discuss this.

Where is Hospice Provided?

• Home – the patient’s or loved one’s home
• Nursing Facility
• Assisted Living Facility
• Family Care Home
• Hospital
• Hospice residence or unit
• Correctional setting, homeless shelter – wherever the person is located

Hospice Team

• Personal physician
• Hospice physician (medical director)
• Nurses
• Home health aides
• Social workers
• Clergy or other counselors
• Trained volunteers

The Hospice Team

• Develops the plan of care
• Manages pain and symptoms
• Attends to the emotional, psychosocial and spiritual aspects of dying and caregiving
• Teaches the family how to provide care
• Advocates for the patient and family
• Provides bereavement care and counseling

Hospice Care

• Patient/family focused
• Interdisciplinary team care
• Provides a range of services:
• Interdisciplinary case management
• Pharmaceuticals
• Durable medical equipment
• Supplies
• Volunteers
• Grief support

Who pays?

• Medicare
• Medicaid
• Insurance and HMOs
• Private pay
• Sometimes a combination of these…

Levels of Hospice Care

• Routine Hospice
• >90% of patients on hospice are receiving this level
• Typically delivered in place of residence- home, ALF, SNF
• Nurse, aide, social work, chaplain, volunteer services
• Medications, DME 100% covered
• NP/MD visits for certification and as needed
• Can include parenteral treatments- home PCA, Macy rectal catheter

GIP (General Inpatient)

• GIP (General Inpatient)
• Available when symptoms cannot reasonably be managed at home
• Typically for patients in symptomatic crisis or at end of life
• Offered at HOCK Family Pavilion and at three Duke hospitals
• Most hospice patients do not transition through GIP care

HOCK Pavillion

• 12 bed inpatient unit
• Prioritize community patients
• Must qualify for GIP care

Myths about Hospice

• They “stop everything” when enrolled with hospice
• Many comfort-sustaining treatments can continue
• Tube feeding
• Chest/pleural/abdominal tubes/drains
• Anticoagulants
• Trilogies
• Everything is available for discussion - our mission is to provide maximum relief driven by patient-centered goals

Myths about Hospice

• I can no longer see my oncologist when I enroll with hospice


• IV fluids, blood transfusions, and other more invasive procedures are not allowed on hospice


• Hospice enrollment means rapid progression to death
• Goal of hospice is to relieve symptoms and provide comfort as disease process follows its natural course
• Opioid utilization following practice guidelines does not hasten death
• Earlier referral and longer lengths of stay in hospice add to patient/family satisfaction

Other Benefits of Hospice

• Team-based approach
• Comfort of being at home
• 100% Medicare benefit
• Caregiver/family support
• Bereavement services for 13 months
• Access to HOCK Family Pavilion
• Meet our team, take a tour, learn about our services

Main Number 919-620-3853

additional information for Solo Agers