Hospice Care Treatment
Hospice Facts
1. Hospice care is a service, which may be provided at home, in a hospital, a nursing home, or in a facility specifically designated for such service.
2. Hospice does not hasten or prolong death.
3. Hospice care may be recommended for patients with a usually less than six-month life expectancy and an incurable illness for whom the focus of care is primarily comfort.
4. The goal of hospice is to provide comfort, reduce suffering, and preserve patient dignity.
5. A team consisting of doctors, nurses, social workers, clerics, volunteers, and therapists participate in the care of hospice patients.
6. Medicare, Medicaid, and most private insurance carriers provide hospice benefits
What is Hospice Care?
Hospice is a field of medicine that focuses on the comprehensive care of patients with terminal illnesses. Hospice need not be a place but rather a service that offers support, resources, and assistance to terminally ill patients and their families.
The main goal of hospice is to provide a peaceful, symptom-free, and dignified transition to death for patients whose diseases are advanced beyond a cure. The hope for a cure shifts to hope for a life free of suffering. The focus becomes quality of life rather than its length.
Hospice care is patient-centered medical care. A host of valuable services are offered to address every aspect of the patient's care as a whole. This is achieved by considering each individual's goals, values, beliefs, and rituals.
Why is hospice care important?
In many chronic and progressive conditions such as cancer, heart disease, or dementia, the natural disease process can ultimately reach an end stage. Most of the time, as a disease progresses to an advanced stage, its symptoms become more intolerable and difficult to control. As a result, an end-stage condition can significantly impair a person's functional status and quality of life.
At this point, often there is no further cure or treatment to control the progression of the disease. Furthermore, aggressive treatment may only offer little benefit while posing significant risk and jeopardizing the patient's quality of life.
In such late stages of diseases, hospice can offer help for patients and families. The use of the term "nothing left to do," is generally to be avoided by health care professionals. There may be nothing with curative potential to do, but there is always something to do that helps with symptoms or improves quality of life. There are many aspects of a patient's well-being that can be addressed. Hospice can play a key role in managing physical symptoms of a disease (palliative care) and supporting patients and families emotionally and spiritually.
Hospice care promotes open discussions about "the big picture" with patients and their loved ones. The disease process, prognosis, and realities are often important parts of these discussions. More importantly, the patient's wishes, values, and beliefs are taken into account and become the cornerstone of the hospice plan of care.
Hospice and palliative care philosophy encourages these type of discussions with treating physicians early on in the course of a terminal disease. Patients can outline their preferences before they become too ill and incapable, thereby relieving some of the decision-making burden from family members. Advance care directives can be discussed and their completion facilitated in this setting.
What is the history of Hospice Care?
Toward the end of the 19th century, hospices became designated places for the care of terminal patients in Ireland and England. The modern concept of hospice was later developed in England in 1967 by Dr. Cicely Saunders.
St. Christopher's hospice was the first hospice under the direction of Dr. Saunders. The philosophy of end-of-life care and the practice of hospice have since spread to many other countries around the world.
In the United States, hospice was originally run by volunteers who cared for dying patients. In the 1980s, Medicare authorized formal hospice care and Medicare hospice benefits became part of Medicare Part A. State-run insurances or Medicaid also offer hospice benefits, as do most private insurances.
Currently in the United States alone there are several thousands of hospice agencies. This branch of the medical field continues to grow as more people live longer with their chronic conditions. As a result, hospice can become a reasonable option for more patients during the disease progression.
In the early 1990s, hospice became an official medical subspecialty and physicians involved in the care of hospice patients could become board certified in hospice and palliative medicin
What are the main goals of Hospice Care?
The end-of-life period is a sensitive part of everyone's life cycle. Psychosocial, financial, interpersonal, medical, and spiritual conflicts are all intertwined.
The main goal of hospice care is to reduce potentially unavoidable physical, emotional, psychosocial, and spiritual suffering encountered by patients during the dying process.
As a result, medical care during this period is very delicate and needs to be individually tailored. End-of-life care requires detailed attention to each person's wishes, beliefs, values, social situation, and personal characteristics.
The complex care of hospice patients may include the following:
1. Managing evolving medical issues (infections, medication management, pressure ulcers, hydration, nutrition, physical stages of dying).
2. Treating physical symptoms (pain, shortness of breath, anxiety, nausea, vomiting, constipation, confusion, etc).
3. Counseling about the anxiety, uncertainty, grief, and fear associated with end of life and dying.
4. Rendering support to the patient, their families, and caregivers with the overwhelming physical and psychological stresses of a terminal illness.
5. Guiding patients and families through the difficult interpersonal and psychosocial issues and helping them with finding closure.
6. Paying attention to personal, religious, spiritual, and cultural values.
7. Assisting patients and families making their wishes known and also reaching financial closures (living will, trust, advance directive, funeral arrangements).
8. Providing bereavement counseling to the mourning loved ones after the death of the patient.
What are some misconceptions about Hospice Care?
Many misconceptions about hospice care still exist in the mind of the public and health care professionals. For example, it is perceived that hospice is a physical location and it only treats pain in cancer patients.
The following are some of the true facts about hospice to clarify these misconceptions.
What kinds of services does Hospice Care Provide?
Services provided under hospice depend on the patient's needs and medical condition. General services provided by hospice include
Additional personnel, including dieticians, pharmacists, home health aids, and other therapists, can also be involved in the care of a patient under hospice.
Contribution from these team members is dictated by the needs and goals of the patient.
In regards to medications, hospice typically supplies medications that help with managing and controlling the symptoms of the underlying condition.
In addition, durable medical equipment and medical supplies are routinely provided and covered under hospice benefits. Wheelchairs, hospital beds, wound care supplies, oxygen tanks, nutritional supplements, diapers, and urinary catheters are examples of some of the equipment often provided to patients by hospice.
Can hospice care be offered at Home?
Yes, because hospice is a service which can be provided in many different settings. Its location to deliver care is based on each individual's preference. In fact, the majority of patients on hospice stay at their home or their usual residence (nursing homes or long-term care facilities) as they did prior to going on hospice.
Hospice care can be offered where the patient lives as long as the environment is safe, and the intensity of care does not overwhelm the patient and caregivers. Occasionally, a patient may need to be moved to a nursing facility or another health care setting if their home care becomes unachievable. This situation usually arises because of a need for higher level of personal care or uncontrolled symptoms requiring close monitoring by trained staff.
Who is part of the Hospice Team?
At the very core of every hospice there are four required components: medical doctors, nurses, social workers, and chaplains.
In addition to these core components, essentially all hospices benefit from involvement of other support staff who make irreplaceable contributions to patient care and are vital to survival of hospice organizations. Contributions of these team members vary between hospices and depend on the plan of care of the patients.
Hospice volunteers are an integral part of the hospice team. They assist patients with meal preparation, running errands, companionship, basic needs around the house, and other projects to help the patient and the family. Certified home health aides are another important part of hospice care. Home aides are usually employed by hospice and help patients and families with personal care such as assistance with bathing, feeding, and other basic needs.
Hospices often utilize other ancillary staff including:
Less commonly, some hospices may utilize the expertise of acupuncturists, music therapists, massage therapists, psychologists, or art therapists if these services are thought to improve the patient's symptoms or overall quality of life.
Hospice patients are always (24 hours a day, seven days a week) under the care of the hospice medical directors through nurses and other hospice team members.
An essential component of hospice care is the interdisciplinary team (or IDT) meeting which takes place every two weeks. During the IDT, each patient's progress, active issues, and overall plan of care are thoroughly reviewed by the hospice medical directors, nurses, social workers, volunteers, chaplain, and other ancillary staff who are involved in the patient's care.
Because hospice care is centered around the patient as a whole, the recommendations and input from each team member in IDT contribute meaningfully to the overall plan of care.
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