Hospice (Magill’s Medical Guide, Sixth Edition)
Hospice is a philosophy of care directed toward persons who are dying. Hospice care uses a family-oriented holistic approach to assist these individuals in making the transition from life to death in a manner that preserves their dignity and comfort. This approach, as Elisabeth Kübler-Ross would say, allows dying patients “to live until they die.” Hospice care encourages patients to participate fully in determining the type of care that is most appropriate for their comfort. By creating a secure and caring community sensitive to the needs of the dying and their families and by providing palliative care that relieves patients of the distressing symptoms of their disease, hospice care can aid the dying in preparing mentally as well as spiritually for their impending death.
Unlike traditional health care, where the patient is viewed as the client, hospice care, with its holistic emphasis, treats the family unit as the client. There are usually specific areas of stress for the families of the dying. In addition to the stress of caring for the physical needs of the dying, family members often feel tremendous pressure maintaining their own roles and responsibilities within the family itself. The conflict of caring for their own nuclear families while caring for dying relatives places a huge strain on everyone involved and can be a source of anxiety and guilt for the patient as well. Another area of stress experienced by family members...
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Principles (Magill’s Medical Guide, Sixth Edition)
Hospice care attempts to enhance the quality of dying patients’ final days by providing them with as much comfort as possible. It is predicated on the belief that death is a natural process with which humans should not interfere. The principles of hospice care, therefore, revolve around alleviating the anxieties and physical suffering that can be associated with the dying process, and not prolonging the dying process by using invasive medical techniques. Hospice care is also based on the assertion that dying patients have certain rights that must be respected. These rights include a right to absent themselves from social responsibilities and commitments, a right to be cared for, and the right to continued respect and status. The following seven principles are basic components of hospice care.
The first principle is highly personalized and holistic care of the dying, which includes treating dying patients emotionally and spiritually as well as physically. This interpersonal support, known as bonding, helps patients in their final days to live as fully and as comfortably as possible, while retaining their dignity, autonomy, and individual self-worth in a safe and secure environment. This one-on-one attention involves what can be called therapeutic communication. Knowing that someone has heard, that someone understands and is concerned, can be profoundly healing.
Another principle is treating pain aggressively. To this end,...
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History (Magill’s Medical Guide, Sixth Edition)
The term “hospice” comes from the Latin hospitia, meaning “places of welcome.” The earliest documented example of hospice care dates to the fourth century, when a Roman woman named Fabiola apparently used her own wealth to care for the sick and dying. In medieval times, the Catholic Church established inns for poor wayfarers and pilgrims traveling to religious shrines in search of miraculous cures for their illnesses. Such “rest homes,” usually run by religious orders, provided both lodging and nursing care, since the medieval view was that the sick, dying, and needy were all travelers on a journey. This attitude also reflects the medieval notion that true hospitality included care of the mind and spirit as well as of the body. During the Protestant Reformation, when monasteries were forcibly closed, the concepts of hospice and hospital became distinct. Care of the sick and dying was now considered a public duty rather than a religious or private one, and many former hospices were turned into state-run hospitals.
The first in-patient hospice establishment of modern times (specifically called “hospice”) was founded by Mary Aitkenhead and the Irish Sisters of Charity under her leadership in the 1870’s in Dublin, Ireland. Cicely Saunders, a physician at St. Joseph’s Hospice in London, which was founded by the English Sisters of Charity in 1908, began to adapt the ancient concept of hospice to modern...
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Cost (Magill’s Medical Guide, Sixth Edition)
Because of hospice care’s reliance on heavily trained volunteers and contributions, and because death is seen as a natural process that should not be prolonged by invasive and expensive medical techniques, hospice care is much less costly than traditional acute care facilities. Because hospice care is a philosophy of care rather than a specific facility, though, legislation to provide monetary support for hospice patients took a great deal of time to be approved. In 1982, the U.S. Congress finally added hospice care as a Medicare benefit. In 1986, it was made a permanent benefit. Medicare requires, however, that there be a prognosis of six months or less for the patient to live. Hospice care is also reimbursable by many private insurance companies.
The National Hospice Organization (NHO) originated in 1977 in the United States as a resource for the many groups across the country who needed assistance in establishing hospice programs in their own communities. The purpose of this organization is to provide information about hospice care to the public, to establish conduits so that information may be exchanged between hospice groups, and to maintain agreed-upon standards for developing hospices around the country. The NHO publishes Guide to the Nation’s Hospices on an annual basis.
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Buckingham, Robert W. The Handbook of Hospice Care. New York: Prometheus Books, 1996. Covers the history and philosophy of hospice care while providing practical information as to its cost, how to find hospice programs in your own community, and how to manage grief. Focuses on two target populations for hospice care: children and AIDS victims.
Byock, Ira, ed. Dying Well: Peace and Possibilities at the End of Life. New York: Riverhead Books, 1998. President of the American Academy of Hospice and Palliative Medicine at the time he wrote this book, Byock uses the personal stories of his patients to show the best ways to die. Provides information for the families of the dying who wish to make their loved ones’ final days as comfortable and meaningful as possible.
Connor, Stephen R. Hospice: Practice, Pitfalls, and Promise. Washington, D.C.: Taylor & Francis, 1998. This book provides a useful outline of the history, structure, and function of hospice programs in the United States, with understandably less emphasis on medical issues. There is clear evidence of wide experience and consideration of the real world of hospice care, not secondhand distillation from the literature.
Corr, Charles A., Clyde M. Nabe, and Donna M. Corr. Death and Dying, Life and Living. 6th ed. Belmont, Calif.: Wadsworth/Cengage Learning, 2009. This book provides perspective on common issues...
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Introduction (Psychology and Mental Health)
Hospice programs are designed for those who are dying or who have no reasonable hope of benefit from cure-oriented interventions. Hospice care typically starts when life expectancy is six months or less if the illness runs its normal course, but this type of care can continue longer than six months with physician certification. Hospice services can include home care, inpatient care, consultation, and bereavement follow-up. With a mission of palliative rather than curative care, hospice programs neither prolong life nor hasten death. The goal is to prolong the quality of life.
Hospice programs deal with whole individual, including the physical, emotional, social, and spiritual impact of the disease on the patient and the patient’s friends and family. Hospice staff and volunteers offer specialized knowledge of medical care, including pain management. Most hospice care, about 75 percent, takes place within the dying person’s home, the home or a friend or relative, a nursing home, or an assisted living facility. Other locations include residential hospice facilities or hospice units within hospitals.
Hospice care involves a multidisciplinary team, including physicians, nurses, pharmacists, social workers, physical and occupational therapists, and clergy. The team also includes family members and trained volunteers, who help with household chores and give family caregivers respite time. The team approach provides...
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History and Status (Psychology and Mental Health)
Hospice programs trace their roots to age-old customs of hospitality and medieval religious institutions offering rest and support for weary travelers. In England, the modern hospice movement began in 1967 when Dame Cicely Saunders founded St. Christopher’s Hospice in southeast London. In the United States, hospice care began in 1974 with a community-based home care program in New Haven, Connecticut.
From these roots, the hospice movement has grown tremendously. In 2006, the National Hospice and Palliative Care Organization (NHPCO) estimated that the United States had more than forty-five hundred hospices, including ones in all states and territories. These hospices served 1.3 million people in 2006, approximately 36 percent of all Americans who died that year. Of these patients, 56 percent were women, 64 percent were over the age of seventy-five, and 81 percent were white. The three diseases with the highest utilization rates were malignancies, nephritis or kidney disease, and Alzheimer’s disease. In 2006, the average length of hospice service was fifty-nine days; the median, which represents what the most people actually experienced, was twenty-one days.
Funding for hospice services is strong. The U.S. Congress enacted the Medicare Hospice Benefit in 1982, so most hospice programs are covered underMedicare. In addition, most states offer Medicaid coverage, and many private healthinsurance policies and health...
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Sources for Further Study (Psychology and Mental Health)
American College of Physicians. http://www.acponline.org. Clinical practice guidelines on medical interventions that have been shown to relieve pain, breathing problems, and depression at the end of life.
Armstrong-Dailey, Ann, and Sarah Zarbock. Hospice Care for Children. 2d ed. London: Oxford University Press, 2001. Practical, highly readable information on end-of-life issues, focusing on children. Intended for a diverse audience of professionals and volunteers involved in hospice services.
Cairns, Moira, Marney Thompson, and Wendy Wainwright. Transitions in Dying and Bereavement: A Psychosocial Guide for Hospice and Palliative Care. Baltimore: Health Professions Press, 2003. Practical information about the needs of dying people and their families.
Forman, Walter B., Judith A. Kitzes, Robert B. Anderson, and Denice K. Sheehan, eds. Hospice and Palliative Care: Concepts and Practice. 2d ed. Sudbury, Mass.: Jones and Bartlett, 2003. Informative chapters on the history of hospice, the interdisciplinary team, reimbursement, settings, assessment, communication, ethics and legalities, spiritual issues, physical problems, cultural issues, and grief.
Marrelli, Tina M. Hospice and Palliative Care Handbook: Quality, Compliance and Reimbursement. St. Louis, Mo.: Mosby, 2004. Medical-surgical guidelines, practical advice regarding documentation, and sample forms for...
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