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End of Life

Hospice Care Explained

Reviewed by: MySeniorCare Staff
Last Updated: 4/15/2011 1:33:01 PM

Hospice is defined as "a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments." More than 4,700 local hospice programs across the United States serve 1.4 million patients per year, along with their caregivers.

As a result, hospice is a familiar term to many people who face their final weeks and days of life, along with their caregiving loved ones. Still, the Hospice Foundation of America sees fit to combat myths about the purposes and practices of hospice care.

The Myths of Hospice Care

Does adoption of hospice care imply that the family caregivers have "given up" on the loved one because there is "nothing more to be done?" To the contrary, supporters reply that hospice is "something more" rather than "nothing more," a philosophy of comfort-oriented terminal care. Patients who enter hospice care are found to live just as long, on average, as patients who do not enter hospice care. This is not a matter of caregivers "pulling the plug." Beyond that, if a patient diagnosed as terminal makes a stunning (and extremely rare) recovery, removal from hospice care always is an option.

Shouldn't family members, especially children, be isolated from a dying loved one, for their own good? Children actually can learn lifelong lessons through hospice care that can help them counteract fears of mortality.

Isn't hospice care more expensive? Indeed, since a team of medical professionals is involved, but the Hospice Society of America reports that 90 percent of day-to-day patient care typically is provided by caregivers who include immediate family, relatives, friends and volunteers. Also, there often is less reliance on technology and families get to keep their own doctors. Hospice is coverage available through Medicare, and through Medicaid in most states, and through most private insurers.

Caregivers Involved in Hospice Care

Hospice care begins with a doctor's referral, along with a diagnosis that the patient has no more than six months to live. Advocates of hospice care, in fact, lament that too many families wait until the final weeks for hospice care rather than starting sooner.

Hospice services may be provided in a hospital, in nursing care or similar long-term facilities, or in a family home. In cases when a patient is returned from a hospital or from nursing care to live their final days back at home, hospice can play a key role.

Local hospice staff conducts an initial meeting with the patient's own doctor and with a specially trained hospice physician, starting with a discussion of the patient's medical history and current symptoms.

Next, a second meeting involves both the patient (except in rare exceptions involving medical condition) and immediate family members. Topics include the philosophy of hospice and the services that are offered. Participants review such issues as pain and comfort levels, medications, needed equipment, and available financial resources that include insurance.

This pair of meetings launches a plan of care that is constantly reviewed and revised, based on the patient's condition. Plans and support become even more intensive when imminent death becomes a matter of hours.

Hospice does not end with the patient's final breath, because hospice care is also intended to support family members. Counseling and bereavement services remain available for a full year.

History of Hospice Care, Ancient & Modern

The Latin word "hospitium" means "guest house," and often was used in relation to people who were returning from difficult religious pilgrimages. In modern English, we speak of "hospitality." The modern practice of organized hospice care started during the 1960s through the efforts of a British physician, Dr. Cicely Saunders, who established St. Christopher's Hospice near London. The first hospice in the United States was launched in 1974 in New Haven, Connecticut.

Dr. Saunders explained, "You matter because of who you are. You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but also to live until you die."

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