Written by Marquita Jacobs, LPN, Nurse Manager
According to the Merriam – Webster website, the word hospice is defined as; a program designed to provide palliative [symptom relief] care and emotional support to the terminally ill, in a home or homelike setting so that quality of life is maintained and family members may be active participants in care. Being a Licensed Practical Nurse (LPN) for the past 17 years, I have realized this definition is correct, but I’ve also learned that hospice care does far more!
The first modern hospice care was created in 1967 by Cicely Saunders, a registered nurse whose chronic health problems led her to pursue a career in medical social work. Cicely had developed a relationship with a dying Polish refugee, which helped her solidify the idea that terminally ill patients needed compassionate care to help address their fears and concerns, as well as palliative comfort for physical symptoms. In the 1970’s, the U.S. government began to view hospice care as a humane care option for the terminally ill. In 1982, Congress initiated the creation of the Medicare Hospice Benefit which became permanent in 1986. In 1993, President Clinton installed hospice as a guaranteed benefit and an accepted component of health care provisions. Hospice is the only Medicare benefit that includes and provides medicine and medical equipment, support for loved ones following death, and 24 hours a day, seven days a week access to care.
When caring for an elderly, chronically, and/or terminally ill person, it can be a very stressful time, not only emotionally, but physically and sometimes financially for the individual and the person’s loved ones, who are the caregivers. As a person progresses through his/her illness and hope begins to disappear, hospice not only assists the person, but also provides support for the loved ones. Helping them cope during this difficult time.
Hospice provides an additional layer of care to a person’s care system – primary physician, specialists, nurses, etc. – at home or in a long-term care setting. Hospice does not replace the care that is already in place but adds extra support. Hospice care supports dying as a natural process. It does not hasten death nor does it prolong life. A person choosing hospice forgoes curative treatment in favor of palliative. It could be that the physical and/or emotional toll of aggressive treatment do not offer the longevity or quality of life the individual wants for him/herself, or because there is no cure.
With the fear of death and dying, hospice care systems have faced resistance based on various factors, including misinformation, miseducation, and/or professional or cultural taboos surrounding open communication about death. I have had many conversations with residents under my care about hospice services, and as soon as the word hospice is mentioned, some automatically associate it with death or dying. I help them understand that that’s not always the case.
When signing on to hospice one must have a six-month or less prognosis to qualify, but it is important for people to understand that a doctor evaluating the prognosis does not have a solid rubric to use. The doctor is simply stating in his/her best clinical judgment, if the disease process continues its normal course, it is possible the patient will pass within six-months.
However, I have seen many patients improve after registering for and receiving services from hospice care. Hospice care provides patients with access to experts in many fields. So, some patients have the opportunity to heal and prolong their lives and potentially no longer require assistance from hospice care. Registering for hospice does not mean giving up hope, but instead choosing a different path for care.
Printed in the Daily Local News on Wednesday, May 29, 2019.