Hospice Patients Alliance: Consumer Advocacy

Occupational, Physical, and Speech-Language Therapy

The hospice benefit specifically provides occupational therapy services, physical therapy services, and speech-language therapy services for those hospice patients that would benefit from such therapy. Simply having a terminal illness does not mean that we have to "give up" and lay down in bed and immediately die, as some may erroneously believe. Those patients who make the most of their remaining time usually experience the highest quality of life. Hospice is about improving the quality of life and providing comfort care, even if a "cure" for the disease cannot be made. What benefit would these therapies have for your loved one? Many. First of all, these therapists are highly trained specialists in their field and can determine what interventions can help improve your loved one's quality of life!

Occupational Therapy

An Occupational Therapist can evaluate the ability of your loved one to accomplish his activities of daily living ... to do the normal everyday tasks that are commonly performed, such as bathing, getting dressed, brushing his teeth, and feeding himself, etc. If there are difficulties in performing these types of tasks, the therapist can devise alternative ways of accomplishing these tasks which allow the patient to remain more independent (and less dependent upon others) which can often help tremendously with the patient's self-esteem and attitude.

Sometimes different adaptive or assistive devices are used to help patients accomplish these tasks. The therapist can explain how your loved one can conserve his energy by doing things in an easier manner. Helping your loved one continue to do as much as possible (if he or she wishes to do so) can dramatically improve his quality of life.

Physical Therapy

The physical therapist can evaluate your loved one's ability to move around safely in the home or facility. The therapist will determine what problems your loved one may be experiencing in getting around: walking (if applicable), in and out of bed, transfer from chair to bed, into the bathroom, to and from a car or wheelchair. The therapist can assess the patient's level of pain and provide physical therapies which can help to reduce pain. Strengthening exercises may be given if your loved one would benefit from these, and the therapist can evaluate all the equipment or layout of your loved one's living situation to make it safe and easily accessible.

Speech-Language Therapy

The speech language therapist is especially trained in helping your loved one who might be experiencing difficulties in swallowing food, speaking or communicating in any way. The therapist can help the patient to better communicate and determine what types of foods or food textures are best. For example, some patients who have difficulty swallowing can safely swallow soft or blended foods or foods cooked in different ways. Making sure that your loved one is able to overcome swallowing problems could help your loved one live longer and would certainly improve his quality of life! If your loved one had difficulty speaking or could no longer speak at all, the therapist can help create alternative ways of communicating. Communication between the family members and the hospice patient is so important at the end of life. Unfinished family "business" (relationship issues) can be resolved and your love can be expressed and shared.

Warning about Lack of Therapy Services

Ethical hospices will definitely provide these types of very important services to their patients. The RN case manager will make a referral to the therapists to come out and assess the patient's situation and to determine what therapy might be beneficial for your loved one. However, you should be aware that there are many hospices that do not properly inform the patient about these services and simply do not provide them, or actually misinform the patients and families by stating that these types of services are not part of the hospice benefit! We have gotten repeated complaints here at Hospice Patients Alliance, from families who reported having been told by hospice staff that these services were not available and not part of hospice. These therapy services are part of the hospice benefit!

Federal Law Requiring Provision of Therapy Services

The following is the exact language of the federal law governing hospice care at the Code of Federal Regulations, 42 CFR ch. iv. part 418:

Subpart E--Conditions of Participation: Other Services

Sec. 418.92 Condition of participation--Physical therapy, occupational therapy, and speech-language pathology.

(a) Physical therapy services, occupational therapy services, and speech-language pathology services must be available, and when provided, offered in a manner consistent with accepted standards of practice.????[emphasis added]

If you have difficulty obtaining these types of services for your loved one, simply print out this page and show it to your RN case manager. If they still refuse to provide therapy services, you can speak with the hospice director or file a complaint with your State licensing and certification department.

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