ARTICLES / General / Hospice
Share This Article
by Peter Ganther
As caregivers to someone who is
terminally ill, we must eventually think about
end-of-life care for our loved ones. We want them to die
in familiar surroundings with us and with dignity, and
not in a cold and sterile hospital setting. Hospice care
The term hospice dates back to the Middle Ages in
Europe. Then it was used to refer to places o charitable
refuge offering rest and refreshment to weary travelers.
These homes were usually run by monasteries; the most
famous of which, St. Bernard, is still a shelter for
those passing over the Alps. During World War II, the
special needs of the dying were recognized and this led
to the modern hospice movement.
The modern hospice movement was started by a British
physician named Dr. Cicely Saunders who established St.
Christopherís hospice outside of London. This hospice
combined modern symptom and pain control techniques with
compassionate care for the dying. These same basic
principles apply to todayís hospices as well. The first
hospice in the U.S. was organized in 1974 in
Hospice is not necessarily a place though. It is a
system of caring for someone who can no longer benefit
from aggressive treatment for their disease. In fact,
treatment has become futile. The emphasis in a hospice
situation is on palliative (easing without curing) care
and pain treatment. Most hospice care not only treats
the loved one, it counsels the families and caregivers
as well. All of this is done through an
interdisciplinary team consisting of highly trained
volunteers, home health aides, dieticians, social
workers, clergy (if applicable), nurses, and doctors. In
addition to providing nursing care, hospices may supply
physical therapy, drugs, and medical equipment. Most of
the care is provided in the loved oneís or the
caregiverís home, but hospice centers are available in
Simply put, the hospice team is a compassionate group of
individuals who address the emotional, physical and
spiritual needs of patients and families alike. There is
often a spiritual/emotional healing that happens when
the patient and family begin to focus on living
peacefully and with dignity rather than focusing on the
condition or disease.
The therapy that the team provides is designed to
relieve symptoms, use pain medications effectively,
improve the quality of life, and prepare the loved one
and their caregiver(s) and family members for death.
Nothing is done to speed death, but it is allowed to
happen naturally. The benefits are an increase in
patient satisfaction, a reduction in costs, and the
mitigation of family anxiety.
The decision to enter hospice is not an easy one. To
some it feels like giving up, but it really comes down
to accepting one part of the natural cycle of life. For
many, dying at home peacefully is a better alternative
than fighting in a hospital until their last breath. It
is not for everyone, and, as much as possible, your
loved one should decide for themselves.
One must qualify for hospice care. In most cases, a
doctor must have diagnosed the patient as having a
terminal illness that is most likely to cause death
within six months. The patient can leave at any time. An
example of this would be an improvement in the personís
condition to the point where they might want to start
treating it again. Most insurance plans, including
Medicare and Medicaid, pay for hospice care. Many times
even those without insurance are still eligible. Costs
are covered mostly through donations.
The immediate goal of the hospice team is to develop a
ďplan of careĒ for the patient. Before this can happen,
the team meets with the patientís personal doctor(s) and
the hospice physician to discuss the patientís history,
current symptoms, and life expectancy. The team then
meets with patient and family members. Available
services, the philosophy of hospice, and expectations
are considered here. Other topics at this meeting might
include comfort and pain levels, equipment and
medication needs, support systems, and financial and
insurance resources. From these meetings a care plan
tailored to meet the patientís specific needs is
developed. This plan is reviewed and revised regularly
as a patientís condition changes. Typically, counseling
and bereavement services are available to family members
for a year after their loved oneís death.
According to hospice Foundation of America, the
following questions should be asked when selecting a
Does the hospice serve your area?
Is the hospice licensed (where applicable) and
Does the hospice provide the services you want/need?
What does the hospice expect from you and your caregiver
Will your insurance plan work with the hospice?
Does the hospice have a support program for caregivers?
Where is needed inpatient or respite care provided?
Is the hospiceís position on resuscitation, hydration
and antibiotics consistent with yours?
What out of pocket expenses should you anticipate?
Is there a sliding scale payment plan for services not
covered by insurance?
If your loved one is diagnosed with a terminal illness,
this might be a good alternative for you. Your loved
oneís comfort will be a priority, and they can pass on
peacefully, surrounded by the people they have cherished
most. Not only that, the whole family can benefit from
the hospice experience through their bereavement
counseling. You may learn a little more about death,
and, in so doing, learn a little bit more about life.