Hospice is used when a physician has noted that an individual’s illness is terminal and the prognosis for life could be six months or less. The physician will discuss comfort care with the patient and/or the family and a decision is made to either continue various treatments such as blood transfusions, chemotherapy etc. or to choose comfort care. This involves the patient remaining at their place of residence wherein a team will come to them directly to provide treatment and care that address their physical, emotional and spiritual comfort until the individual naturally passes away.
There are also many cases in which an individual or the family speaks to the physician first and asks if hospice is now appropriate – this occurs often when a person with an end stage disease has been declining for several months to years with no noticeable improvement, multiple trips to the hospital have become exhausting, and/or the person’s quality of life has deteriorated profoundly.
The interdisciplinary hospice team consists of a Physician, Registered Nurse, Social Worker, Chaplain, and Certified Nurse’s Aids. The interdisciplinary team provides individualized care based on each of their specialty. Visits from each of these disciplines will vary depending on the symptoms and discomfort the patient is experiencing; therefore, changes in the care plan will always be adjusted and flexible to allow visits as often as needed by each team member. In certain cases of crisis, according to Medicare guidelines, patients may receive up to 24 hour nursing assistance at the bedside to continually monitor, provide, and adjust medications to ensure patient’s comfort.
A physician directs the care team and the care team develops a care plan that will best provide comfort to the patient which includes medication changes as well as spiritual, emotional support, counseling, and physical care; in addition, the patient, primary caregiver, or other designated caregivers will be directly involved in the plan of care and can request changes or refuse care at any time. This individual may request to be contacted upon each visit for an update of patient care, symptoms, management, changes, and will be provided support as needed.
Hospice is designed to assist and provide support to not only the patient but the family as well. Death and dying is not an easy experience for families to be a part of; therefore, hospice is always available to the family to provide support, counseling, education, and resources at any time.
The ultimate goal of hospice: the patient is always treated with dignity and respect, and he or she will pass from this life in a comfortable/peaceful manner and that the family will be able to process their grief, anxiety, and concerns with hospice staff so that at the time of passing they are also at a place of comfort and acceptance.
Families often express concerns about medications used to treat and prevent pain and discomfort because they feel as if medications will hasten the patient’s death. Because of these concerns it is also the goal of hospice to educate the family on any concerns they may have on medications used. There is a wide range of symptoms that can cause pain or discomfort at various levels from psychiatric to physical and each patient’s pain tolerance also varies. Hospice physicians and nurses are skilled in pain management and each patient’s pain treatment is individualized and monitored for effectiveness.
