What is Hospice?

“Hospice is a philosophy of neither shortening life nor prolonging life, but rather letting the terminal illness take its natural course with care and comfort of symptoms to provide the goal of a peaceful death with dignity.” - Barbara Roberts

When is a Hospice Referral Appropriate:

More supportive care could help relieve distress.

The client and/or loved ones are ready to discontinue curative     treatment.

The needs of the client are not being adequately met by
    the current treatment routine.

The assumption has been that hospice care is only for the very end
of life. In fact, anyone with a life-threatening or chronic illness can
be referred to hospice- the earlier, the better. A hospice worker will
assess the patient, and contact the patient’s doctor if hospice care is appropriate.

Patient Comfort is Priority

The basic tenet of hospice is facing death rather than denying its inevitability. The first priority of any hospice care is to alleviate
physical, emotional and spiritual distress. Also, to provide durable medical equipment and medications, both for comfort and related
to the primary diagnosis. Criteria for admittance to hospice care
have become broader, and include failure to thrive, uncontrolled
pain, and other causes of suffering that may not be tied so directly
to a predictable time frame of approaching death.

“Death is a natural part of life, which we all surely
have to face sooner or later. To my mind, there are
two ways we can deal with it while we are alive. We
can either choose to ignore it or we can confront the
prospect of our own death and, by thinking clearly
about it, try to minimize the suffering that it can
bring. However, in neither of these ways can we
actually overcome it.”
The 14th Dalai Lama

The focus of modern hospice is pain and symptom control. Oral medications are used to prevent pain vs. injections to stop pain. The spiritual and psychological needs of the dying person are addressed. The importance of family and friends is recognized, as well as the need for a caring interdisciplinary team, which may include physician, nurse, social worker, caregivers, spiritual counselor, harpists, etc.

Hospice Issues to Consider

All who are coping with dying are still alive and have unfinished business which they may want to address.

We cannot be effective providers of care unless we listen actively to those who are coping with dying and understand their needs.

Many people feel it is wrong to “give up”, that is, to stop aggressive medical intervention even when there is no chance of a cure. A lot of unnecessary suffering results from this attitude

The assumption that hospice care is only for the very end of life. In fact, there are many ways in which patients may qualify for hospice care, such as frequent hospitalizations or infections, or "failure to thrive." Caregivers can be very influential in advocating for hospice care to improve the quality of life of their clients.

The belief that going on hospice always hastens death. In fact, a significant percentage of people improve with the extra care of hospice, and may even be discharged from hospice.

It is important to complete Advance Directives. Writing down your preferences in end-of-life care early, when you are healthy,
can save your loved ones a lot of unnecessary guilt or suffering in trying to make these decisions without knowing your wishes. You can change your mind at any time, as long as you are competent and able to express your wishes.

Suzanne Cerddeu, RN
©Copyright 2007 Suzanne Cerddeu
   May not be reproduced or altered without permission