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Show B3 Castle Valley Review, April 2009 HEALTH Hospice Care Helps Patients Cope with Final Challenges in Life Jed Olsen Hospice, in the earliest days, was a concept rooted in the centuriesold idea of offering a place of shelter and rest, or “hospitality” to weary and sick travelers on a long journey. In 1967, Dame Cicely Saunders at St Christopher’s Hospice in London first applied the term “hospice” to specialized care for dying patients. Today, hospice care provides humane and compassionate care for people in the last phases of incurable disease so that they may live as fully and comfortably as possible. Hospice is a philosophy of care. The hospice philosophy or viewpoint accepts death as the final stage of life. The goal of hospice is to enable patients to continue an alert, less painful life and to manage other symptoms so that their last days may be spent with dignity and quality, surrounded by their loved ones. Hospice affirms life and does not hasten or postpone death. Hospice care treats the person rather than the disease and focuses on the quality of life, rather than the length of life. It provides family-centered care and involves the patient and the family in making decisions. Care for the patient is available to provide care or support 24 hours a day, seven days a week. In the United States most of hospice care is typically provided in the patient’s home, with a family member or members serving as the main caregiver. Hospice care is suitable when a person is receiving maximal treatment for the diagnosis, and their physician determines the patient as “terminal.” “Terminal” means that based on the current condition and treatment, death would be expected to occur within a 6-month period of time. Hospice provides treatment to help relieve disease related symptoms, but not cure the disease; its main purpose is to improve your quality of life. You, your doctor, your family should decide when hospice care should begin. One of the greatest challenges with hospice care is that it is often not started soon enough. Sometimes the care provider, family and patient will resist hospice because they feel it is an admission that there is no hope for their loved one. This is not true. If you get better or the disease goes into remission, you can be discharged from the hospice program. You may even go back to hospice care if needed later in your life. The hope that hospice brings is the hope of a quality life, making the best of each day during the last stages of advanced illness, and providing the patient and family the support needed to deal with the challenges being faced. Many home health care agencies offer hospice services. While a doctor, nurse and other professional manage a home hospice program, the primary caregiver is the key team leader. The primary caregiver is usually a family member or friend who is responsible for around-the-clock supervision of the patient. This person is with the patient most of the time and is trained by the nurse to provide much of the hands on care. It is important to know that hospice may require that someone be home with you at all times, as your health declines. This may be a problem if you live alone or if your partner or adult children have full time jobs. But creative scheduling and teamwork among your friends and loved ones can overcome this problem. Members of the hospice staff will visit regularly to check on you and your family and give needed care and services. Care begins when you are admitted to the program, which generally means that a hospice team member visits the home to learn about your situation and needs. Return visits are set up so your needs can be reevaluated regularly. To handle around the clock needs or crisis, hospice programs have an on call nurse who answers phone calls 24 hours a day. There are many things about hospice that set it apart form other types of home care: Interdisciplinary Team In most cases, an interdisciplinary health care team manages hospice care. This means that many interacting disciplines work together to care for the patient. Your own primary care physician, nurses, social workers, counselors, home health aides, clergy, therapist, and trained volunteers care for you and offer support based on their special areas of expertise. Typically, they meet bi-weekly to discuss and promote ways of assisting the hospice client to the fullest potential. Together, they provide complete palliative care aimed at relieving symptoms and giving social, emotional, and spiritual support. All services are covered 100 percent by Medicare, when ordered by your physician. Most often, private insurances also cover hospice care at 80-100 percent. Pain and Symptom Control The goal of pain and symptom control is to help you to achieve comfort while allowing you to stay in control of your life. This means that side effects are managed to make sure that you are as free of pain, nausea, and anxiety and associated symptoms as possible, yet still alert enough to make important decisions. You and your family are involved in decisions regarding level of medication use preferred. Spiritual Care Hospice care also tends to the spiritual needs of you and your family. Since people differ in their spiritual needs and religious beliefs, spiritual care is set up to meet your and your family’s specific Community Nursing Service’s Certified Nurse’s Aide, Jennifer Burdis, checks her patient, Ann Timothy, as part of her visit. needs. Spiritual support can be very worthwhile during this time. It may include helping you to look at what death might mean to you, to say goodbye or to perform a certain religious ceremony of ritual. Respite Care At some point during hospice care, your family and caregivers may need some time away from the intense care giving. Hospice service offers a break through respite care, which can be done in up to five day periods. During this time you will be cared for either in the hospice facility or nursing homes close to where you live. Family can plan a small vacation, go to special events, or even get much needed rest at home while you are cared for in a skilled nursing facility. Nurses can also provide inhome care while family and caregivers leave the home to provide for their own, individual care in certain situations. Family Conferences Through family meetings, often led by the hospice nurse or social worker, family members can stay informed about your condition and learn what to expect. Family conferences also give everyone a chance to share feelings, talk about expectations and learn about death. Family members can find great support and stress relief through these family conferences. Bereavement Care Bereavement is the time of mourning after a loss. The hospice care team works with surviving family members to help them through the grieving process. A trained volunteer, clergy member, or professional counselor provides support to survivors through visits, phone calls and/or letter contact, as well as through support groups. The hospice team can refer family members and care giving friends to other medical or professional care if needed. Bereavement services are often provided for about a year after the patient’s death, depending on family needs and request. Volunteers Hospice volunteers play an important role in planning and giving hospice care in the United States. Volunteers may be health professionals, or lay people who provide services that may range from reading a patient a favorite book, listening or running a needed errand. Volunteers are the heart of any home health hospice program. For more information on home health or hospice services contact Community Nursing Services Home Health and Hospice toll free 1877-613-8887,or locally at 613-8887 or 381-2044 (Jed Olsen works with Community Nursing Services.) |