The Hospice Philosophy

Joyce Remy

When a person has a limited life expectancy, the focus of treatment often turns from cure to care. Hospice care is an interdisciplinary approach designed to meet the needs physical, psychological, and spiritual of a person at the end of life.

What is Hospice?

The word "hospice" comes from the same root as "hospital," "hospitality" and "hotel" all referring to caring for a person's comfort and needs. "Hospice care" means care provided to persons who are terminally ill. Some hospices are specialized, inpatient facilities where terminally ill patients come to stay. Hospice services may also be provided in long term care facilities or hospitals. The most common providers of hospice care are home health agencies and in-home hospice services, which support persons who wish to be cared for at home. Some hospice facilities also provide respite care, where patients can receive care on an in-patient basis.

But hospice is more than a place or agency. Hospice is a philosophy of healthcare for people at the end of life, which seeks not to prolong life unnaturally, but to ensure that in the time left to the dying person, his or her life is as full and comfortable as possible. Hospice seeks to enhance the dying person's quality of life and to provide support for family and other caregivers.

The goal of hospice care providers is to give supportive nursing care without aggressive medical treatment designed to prolong life. Such care includes...

• Palliative care aimed at relieving pain and other symptoms, such as dry or sore mouth, dizziness, or nausea. There are many ways to effectively manage pain; the hospice team works with the patient to provide the best possible symptom control.
  
  
• Other nursing care, such as blood work, mouth care, wound care, placing and maintaining catheters.
  
  
• Personal care, such as bathing, grooming, shaving, and changing bed linens.
  
  
• Social, psychological and spiritual support for the person who is at the end of life needs which are just as important as physical care.
  
  
• Support for family and other caregivers who are dealing with stress, grief, and other emotions encountered in caring for a person in late-stage terminal illness.

Hospice staff can guide family through daily tasks, both practical and emotional. They can provide or refer respite care. Bereavement counseling and financial guidance are also available.

Who is on the Hospice Team?

An interdisciplinary team works with the patient and family.

Nurses perform medical care procedures such as placing and maintaining catheters, wound care and blood draws. Nurses also instruct caregivers in skills needed to care for their loved one, such as routine dressing changes, administering medication, providing comfort care, and so forth. Nurses consult with the patient's physician about treatment, and commonly serve as the care team leader.

Social workers work closely with patients, families and caregivers to create and maintain a supportive care setting. They are available to help patients and families deal with personal, financial, emotional and care planning issues that arise. The social worker may:

• Identify community resources and provide referrals.
• Help with confusing paperwork for assistance programs and insurance.
• Help with the emotional side of the dying process.

Occupational therapists and other therapy services help maximize the independence, quality of life and safety of patient and family. The occupational therapist can:

• Visit the home to evaluate the need for medical equipment and assistive devices, such as walkers, handheld showers, portable commodes or hospital beds.
• Help the patient and caregiver learn to safely transfer from bed to wheelchair, and demonstrate positioning in bed to prevent problems caused by immobility.

Speech therapists can help the patient to communicate, even if he or she cannot speak.

Home health aides are trained nursing assistants who provide personal care to the patient. They help the patient and family with activities of daily living, such as grooming, bathing, changing bed linens and skin care. Aides work closely with nurses and other hospice team members.

Chaplains and other counselors are available to help with the spiritual concerns of both patient and family, who may be struggling with end of life issues and concerns. They also offer bereavement counseling.

Volunteers from a variety of backgrounds provide many indispensable services for hospices. Volunteers may:

• Stay with the patient so the family can take a break (respite care).
• Provide transportation to appointments or run errands.
• Help with household tasks.
• Provide one-to-one companionship.

For more information about hospice:

The National Hospice and Palliative Care Organization website (www.nhpco.org) offers consumer information and a directory. The affiliated National Hospice Foundation website offers more resources and information. 

The Hospice Foundation of America website contains information about many end of life issues, and resources for persons with terminal illness, their families and caregivers. 

2006 Caresource Healthcare Communications