End–of–life planning is a conversation Jennifer Guardiola encourages people to have with older family and friends sooner rather than later. 

“First of all, people need to be clear and candid about what kind of care they want in case of a health crisis or hospitalization — before the crisis happens,” she says. 

Wishes may range from seeking rigorous rehabilitation after a stroke to requesting comfort care after a cancer diagnosis to just wanting household help and company as age and illness limit physical and cognitive abilities. 

“Then, wishes should be documented in an Advanced Health Directive,” Guardiola added. “And, [they should be] respected.”   

Guardiola is director of development for Cella Bella’s Senior Services & Hospice, serving Austin and surrounding communities. Its mission is to help clients maintain their independence by providing quality, non-medical home care options for daily living, including providing hospice services.  

Regarding end-of-life planning, Guardiola additionally advises people to seek out information about what end–of–life support and care options are available. This may include in-home care to assist with non-medical daily needs, assisted living, rehabilitation in a skilled nursing facility, or needing 24-hour nursing in a long-term acute care facility for someone who is critically ill and/or has a medically complex condition.  

Finally, she suggests developing an understanding of the person’s financial resources (private insurance, long-term insurance, Medicare and Medicaid) and what services the plans cover, including coverage for hospice.  

According to Guardiola, people often avoid discussing hospice because of the emotional implications of impending death, but it can play an important role in accessing quality care and in relieving significant concerns about costs.  

“Technically, hospice is available to people who have chosen palliative care over active treatment and have a doctor that will certify that they have a life expectancy of six months or less,” Guardiola says. “And, if they qualify for Medicare, most hospice care services are fully paid for.” 

“Realistically,” she added, “many people receiving hospice care live longer than six months with no reduction in coverage from Medicare.”  

Hospice coverage applies to non-medical in-home care services provided by organizations like Cella Bella’s, including nursing visits, personal assistance and light housekeeping, medication management, transportation to appointments, and even respite care to relieve caregivers. 

Hospice also covers medical devices like hospital beds and wheelchairs, and other routine expenses like incontinence supplies. Prescriptions, however, often do require a co-pay.   

“At Cella Bella’s, we believe hospice care is about living out the precious, final days of life feeling supported and being made comfortable,” explains Guardiola. “It helps patients bear life-limiting illnesses by attending to physical, emotional, and spiritual needs; it embraces the end-of-life journey as a natural progression of the human life cycle.”  

Guardiola is encouraged that more doctors are educating themselves about hospice and more hospitals are offering it as an option when people are discharged. However, she still encourages families to be proactive in asking about hospice if the medical conditions may qualify.    

She also emphasizes the need to understand what a loved one wants at the end of life and being willing to advocate for them and help them achieve that level of care. 

“Our staff members are happy to talk you through the considerations and the option,” she says. “Please call us if we can help with these important conversations.”