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A Brief Overview of Hospice Care

The hospice movement has revolutionized care for the dying in this country since the first hospice opened in Connecticut in 1963. Hospice philosophy views death as a natural part of the human experience, and hospice workers strive to make that experience unique to each patient and family. Even though the focus is on making the end of life as peaceful and comfortable as possible, hospice care can be as pro-active and aggressive as curative care. Nurses and physicians utilize the latest research in pain and symptom management to continue to provide high-quality care for the patient. Hospice care does not mean giving up hope — instead, the focus of that hope shifts. The dying person and family hope now for support, dignity and quality of life. Hospice works hard to provide this care.

One of the most important features of hospice care is that the patient and the family (in whatever way family is be defined by the patient) are considered to be the unit of care. Hospice provides education and resources to assist the family of the dying person, helping them to care for the patient, and for themselves, as well. Other precepts of hospice care include:

Use of an interdisciplinary team to address the physical, emotional, and spiritual needs of the patient and family; the team mainly consists of, but is not limited to: the physician, nurse, social worker, spiritual counselor, bereavement services and the family.

Provision of medical treatment for pain and other distressing symptoms of the life-limiting disease process, emphasizing relief instead of a cure or prolonging life.

An overall plan of care, developed by the interdisciplinary team along with the patient and family, to coordinate supportive resources needed to maintain the comfort of the patient.

The use of volunteer services from the community to assist in the care of the patient.

The patient’s home or primary place of residence is the primary site for hospice care.

Comfort, dignity, and quality of life are emphasized throughout the journey of dying, death and bereavement; and
The patient and family are empowered through education and support to maintain as much control over their lives as possible. (Core Curriculum for the Generalist Hospice and Palliative Nurse, 2002).

Hospice care is funded mainly through the Medicare Hospice Benefit, which provides nursing care, medical social services, counseling, physician services, physical therapy, occupational therapy, volunteers, home health aids, and homemaker services. Medications, medical equipment and supplies are also provided under the Medicare Hospice Benefit, but only if related to the terminal diagnosis. Brief hospitalizations for acute symptom management and inpatient respite care in healthcare facilities are options, and bereavement services are available for the family for up to thirteen months following the death of the patient. Most private insurances have hospice care benefits that can be accessed as well and are usually modeled after the Medicare Hospice Benefit.

Contrary to popular belief, a patient does not have to sign a do-not-resuscitate order to access hospice care, although resuscitative efforts are not covered under the hospice benefit. Advanced directives are discussed and encouraged, and hospice strives to educate the patient and family to help them make informed choices.

As you can see, hospice provides comprehensive and crucial care to the dying and their families. When the physician or nurse is answering questions about options in the face of advanced disease, hospice care is an option that should be offered.