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Hospice Care

As caregivers to someone who is terminally ill, we must eventually think about end-of-life care for our loved ones. We want them to die in familiar surroundings with us and with dignity, and not in a cold and sterile hospital setting. Hospice care can help.

The term hospice dates back to the Middle Ages in Europe. Then it was used to refer to places o charitable refuge offering rest and refreshment to weary travelers. These homes were usually run by monasteries; the most famous of which, St. Bernard, is still a shelter for those passing over the Alps. During World War II, the special needs of the dying were recognized and this led to the modern hospice movement.

The modern hospice movement was started by a British physician named Dr. Cicely Saunders who established St. Christopher’s hospice outside of London. This hospice combined modern symptom and pain control techniques with compassionate care for the dying. These same basic principles apply to today’s hospices as well. The first hospice in the U.S. was organized in 1974 in Connecticut.

Hospice is not necessarily a place though. It is a system of caring for someone who can no longer benefit from aggressive treatment for their disease. In fact, treatment has become futile. The emphasis in a hospice situation is on palliative (easing without curing) care and pain treatment. Most hospice care not only treats the loved one, it counsels the families and caregivers as well. All of this is done through an interdisciplinary team consisting of highly trained volunteers, home health aides, dieticians, social workers, clergy (if applicable), nurses, and doctors. In addition to providing nursing care, hospices may supply physical therapy, drugs, and medical equipment. Most of the care is provided in the loved one’s or the caregiver’s home, but hospice centers are available in many areas.

Simply put, the hospice team is a compassionate group of individuals who address the emotional, physical and spiritual needs of patients and families alike. There is often a spiritual/emotional healing that happens when the patient and family begin to focus on living peacefully and with dignity rather than focusing on the condition or disease.

The therapy that the team provides is designed to relieve symptoms, use pain medications effectively, improve the quality of life, and prepare the loved one and their caregiver(s) and family members for death. Nothing is done to speed death, but it is allowed to happen naturally. The benefits are an increase in patient satisfaction, a reduction in costs, and the mitigation of family anxiety.  

The decision to enter hospice is not an easy one. To some it feels like giving up, but it really comes down to accepting one part of the natural cycle of life. For many, dying at home peacefully is a better alternative than fighting in a hospital until their last breath. It is not for everyone, and, as much as possible, your loved one should decide for themselves.

One must qualify for hospice care. In most cases, a doctor must have diagnosed the patient as having a terminal illness that is most likely to cause death within six months. The patient can leave at any time. An example of this would be an improvement in the person’s condition to the point where they might want to start treating it again. Most insurance plans, including Medicare and Medicaid, pay for hospice care. Many times even those without insurance are still eligible. Costs are covered mostly through donations.

The immediate goal of the hospice team is to develop a “plan of care” for the patient. Before this can happen, the team meets with the patient’s personal doctor(s) and the hospice physician to discuss the patient’s history, current symptoms, and life expectancy. The team then meets with patient and family members. Available services, the philosophy of hospice, and expectations are considered here. Other topics at this meeting might include comfort and pain levels, equipment and medication needs, support systems, and financial and insurance resources. From these meetings a care plan tailored to meet the patient’s specific needs is developed. This plan is reviewed and revised regularly as a patient’s condition changes. Typically, counseling and bereavement services are available to family members for a year after their loved one’s death. 
    
According to hospice Foundation of America, the following questions should be asked when selecting a hospice: 

Does the hospice serve your area?
Is the hospice licensed (where applicable) and Medicare/Medicaid certified?
Does the hospice provide the services you want/need?
What does the hospice expect from you and your caregiver support system?
Will your insurance plan work with the hospice?
Does the hospice have a support program for caregivers?
Where is needed inpatient or respite care provided?
Is the hospice’s position on resuscitation, hydration and antibiotics consistent with yours?
What out of pocket expenses should you anticipate?
Is there a sliding scale payment plan for services not covered by insurance?

If your loved one is diagnosed with a terminal illness, this might be a good alternative for you. Your loved one’s comfort will be a priority, and they can pass on peacefully, surrounded by the people they have cherished most. Not only that, the whole family can benefit from the hospice experience through their bereavement counseling. You may learn a little more about death, and, in so doing, learn a little bit more about life.
 

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