Question

End-of-Life and Hospice

• What is hospice? What is the philosophy of hospice? Complete a very brief search: what end-of-life services are available to persons living in your area?
• Consider that death and dying are part of life and are not a sign of failure; within the context of health and wellness, and successful aging, what role does end-of-life care play?

Answer 1

Hospice is like a home designed to give supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life, rather than cure.

A philosophy of care about providing support to patients with a terminal illness and their families.

The philosophy behind the hospice is to promote comfort and use compassion, interest, and genuine concern to allow the patient to live a better lifestyle during the dying process and to provide support for the patient's emotional, social, and spiritual needs as well as medical symptoms as part of treating the whole person.

The goal is to enable patients to be comfortable and free of pain so that they live each day as fully as possible. Aggressive methods of pain control may be used. Hospice programs generally are home-based, but they sometimes provide services away from home in freestanding facilities, in nursing homes, or within hospitals.

Hospice care emphasizes quality and not the quantity of life. When active, curative treatment is no longer effective and supportive measures are necessary to assist the terminally ill patient through the dying process.

Criteria must be met to be admitted into hospice:

1. Attending physician has to certify that the patient's illness is terminal and the patient has a prognosis of 6 months or less to live.
2. For Medicare/Medicaid, 2 physicians are required to state dying patient's prognosis
3. It is mandatory that the patient desires the services. The patient has to be willing to forgo any further curative treatment and be willing to seek only palliative care.
4. Patient and caregiver are required to understand and agree that hospice staff will plan the care according to comfort and that they will not necessarily perform life support measures.
5. The patient and caregiver are required to understand the prognosis and be willing to participate in the planning of care.

Home care aides offer help with hygienic needs, and a nurse is available to coordinate and manage symptom relief. Nurses providing hospice care use therapeutic communication, offer psychosocial care and expert symptom management, promote patient dignity and self-esteem, maintain a comfortable and peaceful environment, provide spiritual comfort and hope, protect against abandonment or isolation, offer family support, help with ethical decision making, and facilitating mourning.

Hospice team members offer 24-hour accessibility and coordinate care between the home and inpatient setting. A patient receiving home hospice care may enter an inpatient hospice unit for stabilization of symptoms or caregiver respite. As a patient's death comes closer, the hospice team provides intensive support to the patient and family.

* Older people need to know what their end-of-life care options are and state their preferences to their caregivers in advance. If an older person wants to die at home, receiving end-of-life care for pain and other symptoms, and makes this known to healthcare providers and family, it is less likely he or she will die in a hospital receiving unwanted treatments.

Hospice provides comprehensive comfort care as well as support for the family, but, in hospice, attempts to cure the person's illness are stopped. Hospice is provided for a person with a terminal illness whose doctor believes he or she has 6 months or less to live if the illness runs its natural course.

Hospice is an approach to care, so it is not tied to a specific place. It can be offered in two types of settings at home or in a facility such as a nursing home, hospital, or even in a separate hospice center.

Although hospice provides a lot of support, the day-to-day care of a person dying at home is provided by family and friends. The hospice team coaches family members on how to care for the dying person and even provides respite care when caregivers need a break. Respite care can be for as short as a few hours or for as long as several weeks.