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hospice

hospice Hospice Programs; A Dignified Death In the Middle Ages, hospice was a place where sick or weary travelers would stay while a long journey. Today hospice services are available to people who can no longer benefit from curative treatments. As the health care environment is changing at pace that few could have predicted, hospice is very much part of that change (Stair, 1998). For many years our society and the media has placed an image of death in our heads, of a painful experience, one that is feared by everyone. Although death can be emotionally draining, also can be an uplifting experience. Providing comfort and love and the assurance that life will continue, is truly the biggest gift. Hospices are designated to provide sensitive support for people in the final phase of terminal illness. ). The typical hospice patient has a life expectancy of six months or less. Hospice care works to help the patient and family members to carry on an alter, pain-free life to manage other symptoms so that their last days may be spent with dignity and quality at home or in a home-like setting (http:/www.cmcric.org/homecare.html, 2000) Hospice should be viewed as specialty and is focused on palliative care principles. Medical care is geared towards symptoms management, not curative treatment (Homecare and Hospices Resources, 2000). It is focus on living rather than dying, and a way to make the end of life as comfortable and meaningful as possible. The purpose of hospice is not to limit what health care is available to the patient, but enhance their life by controlling symptoms and providing support for everyone involved. Hospice programs offer patients different levels of care and professional services that include; Nursing, Social Work, Chaplain, Medical Director, Bereavement Staff and Therapists. Effective prescription and non-prescription medications are provided to palliate symptoms related to the terminal illness. Medical equipment and supplies are provided to assist the patient at home. Under the guidance of the hospice team, family members or friends are often the primary care givers. About 90% of hospice services are delivered in the patient’s home. Respite for the caregiver is provided and patients can be placed up for medication and symptom management. Patients that are able to visit relatives out of town and still be covered under what the program call “courtesy coverage”. Patients are also assigned to hospice programs depending on their illness, the type of cancer, and any other chronic conditions and they provide treatments needed (Byrock, 1998). Care also can be provided in the place that the person chooses to call home whether that is their home or a friend or family member’s home. Insurance’s including Medicare and Medicaid, cover hospice 100%, which mean the patient and/or family members does not have out-of-pocket expense, providing a sense of security and relief. The hospice program has an average cost of $200 per day and covers all the services provided to the patient. How do we know a hospice care is needed for a patient? When physicians after exhausting all available treatments and the patient is considered terminally ill, is when hospice care is suggested is the best option. The physician certifies that a patient is appropriate for hospice care, and the patient is then assigned to a hospice team, which is supportive of both the family and the person who is dying. The team provides nursing care, companionship, spiritual care, emotional support, and home health aide care. The family doesn’t have to take all the services, but they are there if needed as well as counseling. As needed this services make a great difference in people’s lives, today hospice programs are facing a financial risk. A primary concern that hospices face is the realization that reimbursement will not continue to rise at the current rate, and even perhaps even fall. More than half of the nation’s hospices including the vast majority of rural hospices, had their per diem payments reduced, effective October 1, 1997, under a new hospice wage index (Stair, 1998). About 53 percent of hospices were affected negatively during 1998-2000 (National Hospice Organization, 2000). In order to develop a palliative care strategy and maintain the different services provided by hospice programs in the United States, a palliative care program include the following strategies: * Hospice programs need to clearly define their guidelines for care of patients. * Guidelines and procedures for a palliative care model should be developed by hospice programs, that in collaboration with those agencies that care for the terminally ill can implement the plan of care needed by terminally ill patients. * The program needs to set realistic objectives for measuring outcomes such as patient comfort and level of pain at the end of life. * All patients in hospice care need to be reevaluated on monthly basis to determine the appropriateness of their care setting. * Communication and documentation procedures need to be standardizing to reduce paperwork and streamline reporting. * Treatment protocols need to be implemented to ensure that pain and other symptoms are treated consistently and logically. Why hospice care is so important? The greatest gift that any individual can give to a terminally ill patient is a dignified death surrounded by love, comfort and care. Since the beginning of time such death were common. The person dying stayed at home and was cared for by family members, but with the advances in technology care for the dying has changed. During the 1960’s hospitals became the place terminally ill people went to die (National Hospice Organization, 1999). This concept changed family involvement in the care of their own. In 1980’s the tide starting to change, and terminally ill patients were allow to stay home to die when their families and have the opportunity to care for the loved one. Hospice gives this opportunity for those patients and family members giving them a way to minimize the stress, anguish, and trauma at the end of life. It is not geared to heal people physically, but to make the end of life as comfortable, meaningful and dignified as possible. My own personal experience with hospice care has been a great one. When my mother was diagnosed with liver cancer, the hospice care service was offered to us as the best option. After carefully consulting with the family we decided it was the best decision to take our mother home and receive hospice care. It gave us some respite moments during her illness and provide excellent care 24 hours a day, giving at our disposition all the services available. The supportive services, the provision of medications delivered at home, medical supplies and equipment, and most important their caring attitude give us a sense of peace and satisfaction. My mother's apprehension as well as ours about dying with such a traumatic condition, was greatly alleviated with the close coordination, care and supervision of the hospice care services staff. An increasing number of people are reclaiming the final chapter of their lives as a transition to be made among family members and friends, at home or in a homelike setting, away from the bright lights of hospital and the humming of machines. Hospice brings crucial elements of medical and nursing care to the person’s bedside at home and offers practical and emotional support for patients and their families. This program helps many patients to be alert, comfortable, and most important free of pain as they live their final days in a familiar place surrounded by people they know and love. Therefore, giving them a dignified death. Stair, J. (1998). Understanding the Challenges for Hospice: Fundamental for the Future. Oncology Issues [Online]. 13(2): pages 22-25. *http://ehostweb6.Epnet.com: (2000, October 13). Home Health Care Hospice Services. *http://www.cmcric.org/homecare.html. (2000, October 13) National Hospice Organization. Operations Manual. (1999). [Online]. *http://oncology.mescape.com (2000, October 13). Byrock, I. (1995) The Changing Face of Hospice [Online] 14, pages 7-11. *http://oncology.medscape.com (2000, October 13) Homecare and Hospice Resources (2000). [Online]. http://herald-journal.com Bibliography:

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