Hospice Care/Cardiac Hospice


My 94 year old father has severe aortic valve stenosis which makes him extremely short of breath and unable to walk very far, even across a room. He is in early heart failure. The doctors want him to have a valve replacement, but he is not sure he wants to do this. Can you tell me how hospice would be able to make him more comfortable, specifically with the shortness of breath? Would Medicare pay for hospice? Thank you.

Dear Marina--

Thank you for writing me and trusting me to share my thoughts about your Dad's situation.

First, consider that 94 is not a diagnosis.  Some 94 year olds are just barely hanging on, and others are out kicking up their heels.  You might consider what your Dad's health and activity level would be, except for the valve stenosis.  I'd suggest talking with your Dad about his worries.  Pain is managed much, much better than it used to be, and cardiac rehab can bring very high functioning. If your Dad is still living in his own home and has little other health concerns, if the surgeon (and I'd get a second opinion) thinks he is a good risk, there is a lot to be said for treating the valve issue.

However, the decision is of course his.  If he refuses, even after having a good understanding of how pain management, rehab and the quality of life he can expect have been clearly and thoroughly explained, then one must honor that.  

Medicare pays for hospice.  Some hospices do charge for the 20 percent copay, which would be covered by his supplemental (probably) if he has that.  Hospice nurses can teach your Dad and the family how to use positioning, diet and fluid management, medication and ways of moving about to conserve energy, which can help to increase the quality of his life.  Later when breathlessness makes him anxious, there will be medications which can relieve the anxiety.  It is also thought that morphine, which is an amazing way of managing pain, can make breathing better, though I am not entirely clear on how it does that.

Hospice would not begin until a physician believes, based on symptoms and the results of tests and assessments, that your Dad has six months or less to live, and only if your Dad no longer wishes to try to cure or treat his condition.

I hope this has been helpful.  Do seek out information locally, both about his condition, the treatments that might help, and talk to a couple of local hospices.  Be specific with your questions and push for good answers.  Don't let anyone stop short of providing you with every bit of info it takes for you to completely understand.

I wish you and your Dad and family well.  I'm glad you wrote and I hope that you will write again if I can help.  God bless you all....


Hospice Care

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Christine Johnson


I can give suggestions, encouragement and direction on what hospice is and is not, when it is appropriate, and how to go about getting it. I am familiar with Medicaid and Medicare hospice benefits. I can answer general questions about disease process, what dying looks like, how hospice handles pain and other symptoms, what to expect from a hospice when end of life nears. I can provide support, direction and encouragement related to spiritual matters and psychological matters related to death and dying.


I am a certified hospice and palliative care nurse, and have been the director of nurses for three hospice centers, under two different companies. I have also worked as a contract hospice nurse for a large American hospice company. On a personal level, my father died without benefit of hospice (it was not popular then). I have taken care of dying patients in hospitals and recognize that for most of us, it is preferable to die at home (or in our residence, wherever that may be), comfortably and without anxiety. Also I had no support when my father died; hospice clients are the whole family (however that is defined by the "patient"), and support is provided at least a year after the patient passes. These are the sorts of things (and probably others) that I can help with.

HPNA (Hospice and Palliative Nurses Association)

none yet

Registered Nurse (TX), Licensed Marriage and Family Therapist (TX) ADN Nursing, Excelsior College, Albany, New York (2004) 4.0 GPA BA, Psychology (minor Social Work), Oklahoma University, Norman, OK (1986) 3.67 GPA MHR (MA) Human Relations, Oklahoma University, Norman, OK (1988) 3.5 GPA

Awards and Honors
Phi Beta Kappa (and others)

Past/Present Clients
Unable to name as this would violate their privacy (and HIPAA....)

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