It started for Martin Jones with a diagnosis of squamous cell carcinoma, skin cancer. Not usually fatal, they told him. A state-of-the-art surgery called Mohs allows the surgeon to microscopically remove the cancerous tissue.

It's day surgery, not a big deal, and it should take care of the problem. And it did - for a while. Martin withstood several Mohs procedures and all seemed well. Then the day came when another lesion raised itself on Martin's ear and the new diagnosis was an aggressive version of the cancer that required the skill of a face-and-neck surgeon and weeks of radiation following surgery.

"He's 92, can we just leave it alone?" his wife, Millie, pleaded.

"Can't do it," the doctor said. "This one would be fatal and the end would not be pretty."

So the team of doctors was assembled: surgeon, oncologist, radiologist.

"We have to determine whether the cancer has spread into the lymph nodes," they told Martin and Millie.

They ordered a CT scan, then a PET scan, which confirmed that the shadows on the CT revealed cancer in the lymph nodes in Martin's chest - a whole new ballgame.

"He's not up to surgery or radiation," the oncologist lamented. "He's going to need full-time nursing care, then hospice."

"Hospice? What is hospice?"

Martin looked at Millie, as if waiting for her to explain.

"I think I've heard of it. But I'm not sure how it works," Millie said.

What is hospice?

Hospice is a compassionate way of caring for the terminally ill and their families. Hospice uses an interdisciplinary team that assists the patient to spend the last days of life in dignity and comfort, either at home or in a homelike setting.

Hospice care has been shown to be generally less expensive than conventional care during the last six months of life. And hospice care is covered by most private health insurance carriers, nationwide by Medicare and in Texas by Medicaid.

The hospice program focuses on palliative care rather than cure, meaning the emphasis is on providing comfort and freedom from pain. When the patient chooses hospice care, Medicare will not pay for treatment to try to cure the illness. However, the program will pay for drugs that control symptoms and pain, and the caring application and monitoring of those drugs.

The hospice philosophy affirms life but egards dying as a natural part of life. Hospice neither hastens death nor delays the process of dying. Hospice emphasizes the quality of the patient's life up to the point of death.

The patient, who has been certified by his or her doctor as terminally ill with the probability of no more than six months to live, opts for hospice care instead of routine treatment when that treatment is no longer beneficial. Medicare, under Part A (Hospital Insurance) will pay for the following services:

? Doctor services

? Nursing care

? Medical equipment (such as wheelchairs and walkers

? Medical supplies (such as bandages and catheters)

? Drugs for symptom control and pain relief

? Short-term care in the hospital

? Home health aide and homemaker services

? Physical and occupational therapy

? Speech therapy

? Social worker services

? Dietary counseling

? Counseling to help the patient and family cope with grief and loss.

The patient often can receive these services in the comfort of home from a Medicare-approved and funded hospice program. Depending on the patient's condition, hospice care can instead be provided in a Medicare-approved hospice facility, hospital or nursing home. The doctor/hospice team works with the family to establish a plan of care that meets their needs.

Along with the professional support provided, trained volunteers help with everyday tasks, such as shopping and personal care, like bathing and dressing. A family member or other caregiver stays with the patient every day, with members of the hospice team making regular visits.

A nurse and doctor are on call 24/7 for care when needed. Should the terminally ill person need hospitalization during the term, the hospice team arranges for this stay.

If preferred, a patient one may continue care from his or her regular physician, not part of the hospice team. In this case, the hospice doctor will work closely with the regular doctor to provide the needed care.

How long can a patient receive hospice care?

Hospice care becomes available when the patient's doctor certifies that the patient is terminally ill and probably has less than six months to live. Under Medicare, the hospice patient is entitled to two 90-day periods of care, followed by an unlimited number of 60 day periods of care.

The practical effect is that the doctor must re-certify at the end of each of the two 90-day periods, then every 60 day period thereafter.

What is respite care?

Frequently, the hospice patient relies upon one person, such as a family member, for their day-to-day care. That person may need a period of time away to take care of other things or to obtain a needed respite from the care-giving duties. The hospice patient can then receive respite care at a Medicare-approved facility during that time.

More information concerning a hospice plan of care in Texas can be obtained by contacting the Texas and New Mexico Hospice Organization online at: or by phone at 800-580-9270 or 512-454-1247.