The term “hospice,” with its Latin root shared with “hospitality” raises mental images of caring and comfort. That is precisely what hospice care is designed to offer. The National Hospice and Palliative Care Organization (NHPCO) notes that hospice is in the business of caring.
Hospice is for persons who are facing the end of life. When an elderly loved one with an incurable disease undergoes aggressive or even heroic medical measures, caregivers may be faced with the question of whether or not they should let go and let nature take its course. At this point they may want to consider hospice, a sympathetic and humane alternative.
Here are a few background facts about hospice.
- The idea of hospice was introduced in the U.S. at Yale when Dame Cicely Saunders, a British physician and the founder of the first hospice, delivered a seminal 1963 address.
- The hospice movement was also strongly influenced by the work of Elisabeth Kübler-Ross. Kübler-Ross was born in Switzerland (1926 – 2004). From her study of end of life issues, she wrote a landmark book On Death and Dying. She is most famous for depicting five stages of grief. A recipient of twenty honorary degrees and a lecturer on Harvard, Kübler-Ross pioneered exploration of the frontier between life and death.
- According to the NHPCO, hospice has burgeoned from one program in the U.S. in 1974 to 5,800 programs in 2013.
- The number of patients served by hospice has swelled from 25,000 served in 1982 to 1,542,000 served in 2013.
Should You Consider Hospice Care?
In the twentieth century, modern medicine advanced so that it could prolong life seemingly indefinitely. Heroic measures like Cardio-Pulmonary Resuscitation, which could be used to good effect in a young person whose heart had stopped due to, say, an accident, began to be used in older people too. However, CPR may cause fractures of the sternum or ribs (which causes months of pain) in the elderly, whose bones are fragile.Ventilators, which mechanically inflate and deflate the lungs, are extremely uncomfortable for a patient, who often must be sedated in order to bear the pain of a tube inserted down the throat, and restrained to keep from plucking it out. Catheters, IV tubes, and drainage bags all carry a risk of infection at the insertion site.
Are these measures appropriate when a person is at the end of life? The hospice philosophy says this is no way to live–or die.
According to the American Cancer Society, hospice emphasizes quality, not quantity, of life. Hospice treats the whole person rather than the person’s disease, and this includes allowing for peace and time to interact with beloved family members in the all-important last days of life, uninterrupted by invasive and ultimately futile medical procedures.
Entering a loved one into hospice is a difficult decision. The best barometer is what is best for the patient. Sometimes we opt to keep family members alive as long as possible for our benefit rather than for theirs. We cannot bear to let them go or, as sometimes happens, family members can’t agree. Yet is the person enjoying any quality of life? Is he or she happy like this–or are the aggressive or heroic measures only adding to his or her discomfort?
Hospice puts the patient’s comfort first. Pain medication is administered carefully to allow the patient to be alert but free of pain.
Considering all this and the patient’s wishes as expressed in a living will or verbally, relatives may very well decide to opt for the comforts of hospice.
Could You Consider Hospice Care?
Many people wonder if they can afford hospice. Medicare pays for hospice, as does Medicaid, VA programs, some private programs, and insurance. To enter hospice paid for by Medicare, a person must have a diagnosis of six months or less to live.
Because complex treatments are suspended, caregivers can often administer hospice care at home with the help of a support team. Depending on the level of care needed for basics like the bathroom, cleanliness, and feeding, hospice at home may be a feasible alternative.
On the other hand, hospice centers offer great convenience and comfort for all members of the family. They are designed to be home-like. Lighting is soft, and noise is kept to a minimum. Some hospice centers are arranged so that the patient can look out windows at gardens or groves. Sofas, tables, and chairs, make the hospice center comfortable and homey for all. Chaplains are on hand for counseling both before and after death.
Hospice in a hospital is another possible option. This offers the advantage of easily switching back to regular medical care. However, since this rarely happens with a hospice patient, families may prefer the more comfortable and comforting environment of the home or a hospice center with 24/7 personnel support.
When Should You Consider Hospice Care?
Some family members have expressed that their only regret about putting their loved one is hospice was that they wish they had done it sooner. Families report high satisfaction with the hospice experience. NHPCO reports that about 75% to 86% of family members rate hospice care as “excellent.” They also come in at majorities (64%) who feel that their loved ones were physically comfortable in hospice.
The majority of patients die in hospice within a very short time of being there. Quite often, hospice is used as a last measure, giving the person and their family insufficient time to reap the full benefits of hospice. The majority of hospice patients stay in it less than 20 days.
If, when, and how hospice should be instituted for a loved one depends on a complex of factors, including and especially the loved one’s own expressed wishes. In general, hospice seems to provide great relief to patients and their caregivers as all come together to make the end of life as natural, comfortable, and peaceful as possible.
More for family caregivers on SeniorsMatter.com:
National Hospice and Palliative Care Organization. Available online at http://www.nhpco.org/sites/default/files/public/Statistics_Research/ProviderGrowth.pdf and http://www.nhpco.org/sites/default/files/public/Statistics_Research/Patients_Served.pdf.
National Hospice and Palliative Care Organization. NHPCO’s Facts and Figures, Hospice Care in America 2014 Edition. Available online at http://www.nhpco.org/sites/default/files/public/Statistics_Research/2014_Facts_Figures.pdf.
National Hospice and Palliative Care Organization. History of Hospice Care. Available online at http://www.nhpco.org/history-hospice-care.