What is Hospice?
Why Choose Hospice? | Hospice Care Process | Do I Qualify?
The term 'Hospice' originated in medieval times when it was used to describe a place of shelter and rest for weary or sick travelers on long journeys. The modern hospice movement began in 1967 when Dr. Cicely Saunders, a British physician, established St. Christopher's Hospice near London. Her program included a team of professional care-givers for each patient, and was the first to combine compassionate care for the dying, which hospice had always offered, with modern pain and symptom control techniques.
Today hospice care is for the patient whose illness is no longer responding to aggressive curative therapies. When radiation and/or chemotherapy is no longer recommended or sought a hospice referral is appropriate. Hospice addresses all the symptoms of the disease with special emphasis on controlling the patient's pain and discomfort. Hospice also deals with the emotional, social and spiritual impact of the disease on the patient, the patient's family and significant others.
A hospice team consists of physicians, nurses, aides, social workers, spiritual care givers, counselors, therapists, and volunteers - all of whom are specially trained to provide pain and symptom management for the patient and support for the family. The patient and family are the core of the hospice team and are the center of all decision making.
The goal of all hospice programs is to improve the quality of the patient's last days and weeks of life by offering comfort and dignity. To do this, hospice conducts an evaluation of the patient's physical condition, pain, support system, and environment. Because each family's needs are unique, the hospice team works with the patient and family to develop a personlized care plan. The delivery of the plan by an interdisciplinary team distinguishes hospice care from ordinary homecare.
Hospice brings this caring team right to the patient's home, be it a house, apartment, nursing home, assisted living setting, or residential hospice. Family members are encouraged to participate in the care by visiting regularly, bringing favorite music or food, and by providing as much hands-on support as is comfortable, such as feeding, bathing, reading favorite books, or just being present. When care is delivered in the patient's house or apartment Hospice provides instruction, assistance and support for the family. When hospice care is delivered in a facility, much attention is paid to making the environment and care planning as patient-friendly as possible.
Always, the focus is on controlling pain, managing symptoms, and providing comfort, dignity and quality of life. We encourage independence and never push any of our services if the patient or family isn't ready. Hospice neither hastens nor postpones death, but strives to validate a life. We can't add days to our patient's life, but we can add life to their days.
- Hospice programs cared for 1,060,000 people in the United States in 2004 and the number grows annually. There are more than 3,650 hospice programs in all 50 states. In 2001 there were 104 hospices in Michigan and 100 of those were Medicare certified. These Michigan hospices served 33,300 patients and families with 2,231,100 days of care. In 2001, 9,000 volunteers statewide assisted and supported hospice programs
- In 2004 63% of Hospice programs were non-profit, 31% were for-profit, and 6% were government-run programs.
- Hospice puts the patient back as the focal point in treatment. In hospice we ask the patient how they feel and we pay attention to their answer. The first goal is to help the patient feel their best physically, emotionally and spiritually. When medical science can no longer add more days to life, hospice adds more life to every day.
- Hospice staff and volunteers assist with all the traditional physical care tasks, such as bathing, managing pain medications, arranging medical equipment and therapies, as well as to do things as simple as providing back rubs, assiting with household chores, helping put financial matters in order, talking openly about feelings, arranging transportation to doctors appointments, and helping family members cope.
- Care for the terminally ill in the home generally provides patients more privacy and control of their environment, such as when to eat, what to eat, when to bathe, when to have company, visit with pets, etc. It is also more convenient for family and friends to visit the patient at home.
- Data shows that care in the home is less costly than care in a hospital, and quality is high.
- Berevement care is provided to the hospice family for 14 months after the death.
- Caregivers are generally asked to provide a safe comfortable environment, help with feeding, bathing, turning, and giving medications. Caregivers are also advised to alert the hospice of any changes in the patient's condition.
The patient, family, and/or physician can initiate an information/referral call or visit as soon as a terminal disease is diagnosed, or at the time a patient decides to move from a treatment plan focused on curing the disease to a plan focused on providing comfort and pain relief.
Before providing care, the hospice staff, the patient's personal physician, and the hospice physician confer on the patient's disease history, current physical systems, and life expectancy.
Hospice then meets with the patient and family to discuss the hospice philosophy of care, services available, pain and comfort levels, expectations, Advanced Directives, the support system available, financial and insurance resources, medications, and equipment needs. Patients are asked to sign an informed consent for care. From the information gathered a plan of care is developed. As the patient's condition changes, this plan is regularly reviewed and revised. The plan of care provides the hospice staff, the patient, and the family with details about what services and support they will recieve and what team member visits to expect, in addition to what medications, therapies, supplies, and equipment will be used. It also outlines what training the patient and family can expect and how they will participate in the care.
The patient's own attending physician follows and orders any medication or services changes. If a patient does not have a physician our medical director will follow them through hospice care. Patients are encouraged to have a primary caregiver but not required to. Our social workers and nurses work with patients who need additional care that family or friends cannot provide. Occassionaly this may mean the hiring of additional help, placement outside the home or transfer to another hospice in a locale where family lives.
A physician must write an order for hospice care and certify that the patient has a limited life expectancy. A physician order is always obtained when change in treatment is necessary. Hospice will never discontinue service to a terminal patient who outlives their prognosis if the attending physician and the hospice team feel the patient meets hospice criteria.
A patient may be admitted to Hospice if he or she:- has a terminal illness with a life expectancy of six months or less, which is confirmed by the attending physician or hospice medical director.
- is no longer receiving curative therapy and symptom management is now the primary goal.
- and the patient/family understands the hospice concept and accepts hospice care.