While Hospice care has been around for centuries it is only recently that it has become part of the traditional medical/healthcare landscape. Hospice, otherwise known as palliative or comfort care, is indicated when a person has been diagnosed with a terminal disease and has less than six months to live. It is generally funded by Medicare, Medicaid, HMO’s and personal health insurance. The majority of the 1.5 million plus hospice patients nationwide are funded by Medicare.
Upon referral, a representative from a local hospice agency will stop by and, through clinical assessment, determine whether patient meets criteria for intake. The hospice team is comprised of a medical director, nurses, certified nurse’s aides, chaplains, social workers and volunteers. Some agencies go further and provide a range of therapies including music, occupational, speech, massage and physical therapies.
The team takes a three hundred-and-sixty degree approach to palliative care that includes not only medical but psychological, social and spiritual care for the patient and his or her family including caregivers, relatives and anyone else who may have a vested interest or relationship with the patient. Hospice care, has until recently, not been a major part of what is seen as traditional medicine but, with the aging of America and so many people moving into the graying years, hospice has become an indispensable part of the healthcare industry.
The traditional medical model has, up until recently, been a strictly curative model. And while there is a palliative component built into it, its primary objective is to heal or resolve, not to comfort. Physicians well steeped in the traditional curative model occasionally need to be reminded of the importance of letting nature take its course and refrain from pursuing curative-based therapies that can be unduly pain-inductive.
Hospice and its palliative care emphasis is typically at its best in a home setting however it does follow patients wherever they may reside. While most patients spend their last days at home, others may find themselves in assisted living or nursing facilities.
Once a patient goes through the intake process, each member of the team meets with patient and vested interests alike and performs what is called a needs-assessment. Some of the best work hospice will do is not actually with a given patient but with family members who are struggling with the decline of a loved one. Each member of the team is a highly trained, appropriately licensed professional able to provide the kind of care that for some, means the difference between dying in pain or in relative peace and comfort. There are many families for example that report that the thing they dreaded most, caring for a dying loved one, ended up being a positive, even sacred experience and that the family was better for having gone through the process.
While palliative care differs from the traditional curative model, it is no less prepared to provide a quality, cutting-edge pain-therapy regimen that can help even the most problematic cases. Because of the range of cutting edge pharmaceuticals available people no longer have to die in pain. For those with profound pain where every wakeful moment is informed by same, there is the option to receive what is known as palliative sedation, a level of pain therapy that allows a patient to remain in a sleepfull, comfortable state until passing.
Many assume that hospice is about dying, but when properly understood, hospice/palliative care is about living and doing so comfortably. Yes, life ends in death, but as hospice is becoming more mainstream, death is less the fearful thing it once was.
By Matthew R. Fellows
Photo By Hefin Owen – Flickr License