More Information About Hospice

Description

Hospice care is palliative care given to individuals who are terminally ill, with an expected survival of six months or less. The focus of hospice care is on meeting the physical, emotional, and spiritual needs of the dying individual, while fostering the highest quality of life possible.

Hospice services provide palliative care to individuals with a life expectancy of six months or less. Most hospice care is provided in the home, but may take place in a hospice home or a hospice/palliative care area within a medical facility. Requesting hospice care may be the first time that individuals, or their families, acknowledge that their condition is not treatable. It may be the first time that they have to deal with their death as a reality taking place within a few months. The emotional journey to be able to deal with these issues may take a while, and therefore may delay the time when the person begins to receive hospice care.

The focus of hospice is not on treatment, but on pain and symptom management, comfort measures, acknowledging that the individual will die, supporting the family, and trying to provide the best quality of life for the time remaining. Hospice functions under the philosophy that although some terminally ill patients may no longer receive treatment, they still require and deserve care.

Hospice care is interdisciplinary in nature, providing the services of physicians, nurses, social workers, physical, speech, or occupational therapists, clergy or other spiritual guides, health care aides, and volunteers. Home hospice care relies on the family and friends of the patient to provide most of the daily care. Nursing and other services are provided daily or weekly, but with 24 hours, 7 days a week on-call access. Addressing the spiritual needs of the hospice client is a fundamental aspect of hospice care.

Hospice and Palliative Care Goals

More than a place, hospice care is a philosophy that is now called "palliative care." Dictionary.com defines a hospice as "A program that provides palliative care and attends to the emotional and spiritual needs of terminally ill patients at an inpatient facility or at the patient's home," and the Cancer Web Internet site defines a hospice as "An institution that provides a centralized program of palliative and supportive services to dying persons and their families, in the form of physical, psychological, social, and spiritual care; such services are provided by an interdisciplinary team of professionals and volunteers who are available at home and in specialized inpatient settings.

Palliative care neither aims to hasten death nor to postpone death. It is characterized by concern for symptom relief and promotion of general well-being and spiritual, psychological and social comfort for the person with a life-threatening or life-limiting illness. The need to maintain quality of life has become increasingly important, not just in the dying stages, but also in the weeks, months and years before death. As the worldwide increase in life expectancy has led to a corresponding increase in the incidence of age-related chronic illnesses and palliative care increasingly cares for patients with illnesses other than cancer such as motor neurone disease and heart failure. The patient and family are both the focus of palliative care, with emphasis placed upon the well-being of family caregivers as well as the patient. In addition, palliative care is no longer restricted to adults and many teams and hospices now exist for children of any age.

Palliative care has been described as "Intensive care without the hardware."

Hospice History

Hospices were originally places of rest for travelers in the 4th century CE. In the 19th century a religious order established hospices for the dying in Ireland and London. The modern hospice is a relatively recent concept that originated and gained momentum in the United Kingdom after the founding of St. Christopher's Hospice in 1967. Dr. Cicely Saunders is regarded as the founder of the hospice movement. Since its beginning, the hospice movement has grown dramatically.
In the UK in 2005 there were 200 hospices for adults and 33 for children, offering 3,411 beds. There were also 361 community palliative care teams, one third based in hospices, as well as 361 day centers and palliative care teams in nearly all larger hospitals. Funding varies from 100% funding by the National Health Service to almost 100% funding by charities, but the service is always free to patients. The first hospice in the United States was established in 1974. Relatively generous Medicare reimbursement for hospice treatment has greatly increased hospice usage in the United States. There are now roughly 3,300 Hospice in operation in the United States.

Palliative Care Practice

Palliative care most often occurs in the dying person's home. It is also provided in free-standing inpatient (hospice) units and within regular hospital units.

In most countries, hospice care is provided by an interdisciplinary team consisting of physicians, registered nurses, chaplains, social workers, physiotherapists, occupational therapists, complimentary therapists, volunteers and, most importantly, the family. The focus of the team is to optimize the patient's comfort. Additional members of the team are likely to include home health care aides, volunteers from the community, and housekeepers. In the UK palliative care services offer inpatient care, day care, day treatment and outpatients and work in close partnership with mainstream services. Hospices often house a full range of services and professionals.

In the US, a patient is usually admitted into a palliative care program if there is a reasonable expectation of death within 6 months. This does not mean, however, that if a patient is still living after six months in hospice, he or she will be discharged from the service. Such restrictions do not exist in other countries such as the UK. Opportunities for caregiver respite are some of the services hospices provide to promote caregiver well-being. Respite may be for several hours or up to several days (the latter being done usually by placing the patient in a nursing home or in-patient hospice unit for several days).

Because palliative care sees an increasingly wide range of conditions in patients at varying stages of their illness, it follows that palliative care teams offer a wide range of care. This may range from managing the physical symptoms in patients receiving active treatment for cancer, through treating depression in patients with advanced disease, to the care of patients in their last hours and days. Much of the work involves helping patients with complex or severe physical, psychological, social and spiritual problems. In the UK over half of patients are improved sufficiently to return home. If a patient dies, it is common for most hospice organizations to offer bereavement counseling to the patient's partner or family.

In the US, board certification for physicians in palliative care is through the American Board of Hospice and Palliative Medicine. In the UK, palliative care has been a full speciality of medicine since 1989 and training is governed by the same regulations through the Royal College of Physicians as with any other medical speciality. In the United States it is important to note that while in hospice care, a Medicare patient gives up his or her claims to reimbursement for any treatment of the terminal condition, with the exception of what the hospice considers palliative treatment. (Though a hospice patient may later opt out of hospice care.) Also, Medicare does not reimburse for what is considered custodial care. In the UK and many other countries all palliaitve care is offered free to the patient and their family, either through the National Health Service (as in the UK) or through charities working in partnership with the local health services.

Treatment of Distress

The key to effective palliative care is to provide a safe place for the individual to express their distress. This involves treating physical symptoms such as pain, nausea and breathlessness so that the patient is able to express any psychological and spiritual distress. These are then addressed in turn, all the while supporting the partner and family. Palliative care teams have become very skillful in prescribing drugs for physical symptoms, and have been instrumental in showing how drugs such as morphine can be used safely while maintaining a patient's full faculties and function.

Alternative medical treatments such as relaxation therapy, massage, music therapy, and acupuncture can relieve some cancer-related symptoms and other causes of pain. Treatment that integrates complementary therapies with conventional cancer care is integrative oncology.

Source:
"Palliative Care." Wikipedia. Wikipedia, 2005. Answers.com 04 Mar. 2006. http://www.answers.com/topic/palliative-care