Guest editorial: Hospice expert offers advice
November 10, 2015
Hospice and Palliative Care are terms that resonate with fear and foreboding for many. Understandably, these and other terms, like ‘terminal illness’, ‘cancer’, ‘advance directive’, remind us that we are, indeed, mortal. More importantly, hospice has become synonymous with ‘giving up hope’ and being resigned to retire to bed, awaiting death to occur. It is this notion of "giving up hope " I wish to consider in a slightly differently light.
First, let me clarify the terms ‘hospice’ and ‘palliative’ care. Palliative care is comprised of an array of services dedicated to the person’s definition of quality of his/her life within the boundaries of health care services. Someone does not have to have a projected limit of six months to elect Palliative Care nor do they have to forego all treatment. Many folks with significant chronic, debilitating illnesses may choose this care option. Hospice care does require a projected lifespan of six months if the terminal condition runs its normal trajectory. To be eligible for hospice care, the individual has elected to forego aggressive therapy/treatment for the ‘terminal’ condition and instead focus on the care and services designed to enhance comfort and optimal wellbeing.
Arbitrarily, Medicare has defined eligibility for hospice care to be a life expectancy of six months. It was intended to do no more than bracket the hospice benefit. None of us, including doctors, nurses, chaplains, are able to predict someone’s mortality. What happens is that those of us in the health care professions base our rough projections on historical data and experience and each of us know and have seen, again and again, that people defy the predictions. Therefore, it is not uncommon that someone elects hospice care and improves enough to require discharge from hospice, albeit temporary, because their "terminal" condition has improved sufficiently to "disqualify" them.
Hospice care is oriented to work with the individual, the family and other caregivers to live as pain and symptom free as possible and for as long as possible. The emphasis of hospice and palliative care is shifting focus from longevity at any cost to quality of life -creating memories and experiences that bring richness to whatever time remains.
Toward this goal, a hospice agency brings a team of professionals to work with the individual and all involved in the caregiving to identify the priorities and develop a plan of action to fulfill on those priorities. The services provided reach far beyond the management of pain and other unpleasant symptoms, they reach into the lives of people in an effort to facilitate completion of relationships and reconciliation with one’s life, all of which allows someone to die peacefully. Unfortunately, the decision to accept hospice care is often made when death is imminent within days. This does not afford the person and family to work through the myriad of decisions nor the inevitable grief that precedes someone’s passing. The benefit of a knowledgeable hospice team available in the home cannot be overstated.
While each of us has to walk this path, some very fast, others very slowly, equipping yourself and your loved ones with accurate information and available resources when the time comes is invaluable.
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