There from the Start: A Hospice Nurse Looks Back
Although not talked about often or placed in the limelight as some other aspects of medicine, few people realize how important hospice care is. What we’ve come to know as modern hospice was first introduced to the world by Dame Cicely Saunders in the 1950’s, in the form of St. Christophers in London, England. A trained nurse, social worker and physician she came to see the importance of palliative care and hospice after losing someone she cared about.
What is Hospice?
Hospice the period at the end of a disease where no further medical intervention will make a difference in the course of the disease. The patients that are usually placed in hospice are terminal patients who have begun deteriorating. The focus of hospice care rather than the length is the quality. The aim of the hospice team is to make the patient as comfortable as possible for the length of time they have remaining by managing symptoms, while accepting that death is the final stage of life. While care is family centred, A hospice team for a patient not only includes the patient and family, but doctors, nurses, pharmacists and social workers. Hospice is usually used when the patient is expected to live no longer than six month, although some patients do live longer than that, if they choose that may still remain in hospice.
At Home Hospice
Most hospice care takes place in the patients home with a family member in attendance, there are care facilities as well, and some patients may need to go to a hospital at the end. Teamwork to provide the patient with as much dignity and quality of life as possible is the main aim of hospice, as such meetings between all members of the team to keep everyone up to date on the status of the patient should be scheduled. These meetings will also give everyone a chance to share what they feel about the process, their feelings, talk about treatment as well as to talk about what to expect once the patient dies. They will also give family members a chance to plan out services for the patient and make other end of life arrangements. The team is available twenty-four hours a day and makes sure that everyone will have the information that they should have.
The start of hospice care usually coincides with a visit from a member of the hospice team to the home of the patient after they’ve been admitted to the care program. The team member is there to evaluate the patient and learn more about their specific needs. This will be the first or many visits as continued reevaluation is necessary as the patient's needs will change as their condition declines. For emergencies that can happen at any time hospice services generally have a twenty-four hour on call nurse available who will if needed, dispatch emergency personnel to the patient's home.
Hospital or Facility Hospice
The families of some hospice patients may choose to have hospice care at a hospital or in a care facility. This is done if the patient's needs are too great for the family to handle. The patient may also choose this form of hospice if they feel like the don’t want to be a burden on family members of if the patient has no family. May hospitals have either a hospice unit or a hospice team that visits patients in the advanced stages of disease of any ward. The upside to hospice in a hospital setting is that medical professionals are always on hand should any emergency situation arise. It also gives the patient round the clock support and easy access to many support services.
Facility care hospices can either be independently owned hospice facilities or hospice units that are attached to nursing homes. Hospice units that are attached to nursing homes usually service the senior population that they already house and usually have a nurse that is a specially trained hospice nurse. This is a good option for elderly hospice patients who would rather not do hospice at home out of fear of being a burden on family members. This is a good setting as a nursing home will still be a professional setting without the sterility of a hospital.
Many cities have dedicated hospice facilities that cater to patients of all ages. It’s a good option for people that may not have families to care for them, but would like to avoid a hospital environment.
Who Pays For Hospice Care
Hospice at home is the most inexpensive of all the hospice services. Hospital hospice is the most expensive but in the United states it is usually covered by Medicare, Medicaid, Department of Veterans Affairs and most private insurances and other managed care. Additionally most hospice services out of nursing homes or independent ones, can often offer free hospice services to patients that can’t afford to pay as they’re funded through donations, grants and various contributions, others charge based on what the patient can afford to pay.
How To Choose a Hospice Program
Choosing the best hospice program takes a fair bit of research, but is important to finding the one that suits the needs of the patient best. The best course of action is to involve the physician of care in the discussion, they may be familiar with programs that have been used by other patients and their families. The decision and discussion should be one that includes all members of the family that will be responsible for the patient’s care if doing home hospice, as well as the patient. Once recommendations have been made, everyone should meet with the hospice teams and visit the facilities being considered to ensure that the patient's needs will be met and that all parties are comfortable with the team or facility, and to address any quality of care, insurance coverage, along with the training and expertise of the staff . This is a decision that should be undertaken soon after a terminal diagnosis is received so that the patient can participate in their own care as much as possible.
During and After Hospice
Respite care is a facet of hospice that allows for the family of patients being cared for at home to take some time off. It can be draining to watch a person that is loved slowly dying and causes an emotional toll, even if family members are not the ones directly caring for the patient. It’s important that family be allowed this time off to regroup emotionally, some hospice services offer respite care of up to five days at a time. During that time the patient will be transferred to either a hospital or care facility for care.
The period after the patient dies is known as the bereavement period. The hospice team will work with the family to help with the grieving process by getting them in touch with a grief specialist such as counselors, clergy members, trained volunteers or support group and are usually provided for up to a year after the death of the patient. Hospice care is the most important part of the terminal patient's journey with illness. Hospice teams help the patient to understand that while death is the final stage of life, it can be had with dignity and in comfort whilst being surrounded by those that value you.
