Hospices

Hospice care is comprehensive palliative medical care (treatment aimed at reducing or abating pain and other symptoms, rather than treatment aimed at cure) and supportive social, emotional, and spiritual services to the terminallyill and their families, primarily in the patient's home but also in a hospicein-patient facility. Hospice reaffirms the right of every person and familyto participate fully in this final stage of life's journey.

The word "hospice" is derived from the Latin hospe, meaning both hostand guest. The idea of hospice is rooted in the centuries old idea of offering hospitality to those on a long journey. This concept of providing care, comfort, and aid to travelers can be traced back to Syria in the year 475 A.D.. It was during the Middle Ages, however, that the concept of hospices as way stations for pilgrims and travelers proliferated. By early medieval times, there were more than 750 hospices in England alone. Not only offering hospitality to injured travelers, hungry wayfarers, orphans, and the poor, hospices also sheltered the sick and dying.

The modern hospice movement began in England in the 1940s when Cicely Saunders, a British physician, founded St. Christopher's Hospital, a place where theterminally ill were cared for and could die with dignity. St. Christopher'sHospital continued to be a model for hospices worldwide and was recognized asan innovator in the area of pain management and treatment of the terminallyill.

When Saunders visited Yale University in the late 1960s, her vision of a peaceful place where the dying could find comfort in their final weeks or monthsfound enthusiastic support. She ignited a fire that would lead to the establishment of Hospice, Inc., of New Haven, Connecticut, the first home care hospice in the United States. Soon thereafter the Connecticut Hospice of Branfordwas established, a residential facility designed exclusively for the care ofthe terminally ill. Based on the hospice principles established at St. Christopher's, these two organizations became the prototypes for hospices throughout the United States.

Elisabeth Kübler-Ross, a Swiss-American psychiatrist and renowned authority in the field of death and dying, also provided an impetus to the hospicemovement in the United States. In a book based on more than 500 interviews with dying patients entitled On Death and Dying (1969), Kübler-Rossidentified the five stages through which many terminally ill patients progress. The book became an internationally known best seller. In it, Kübler-Ross made a plea for home care as opposed to treatment in an institutional setting and argued that patients should be able to participate in the decisionsthat affect their destiny.

It is significant that the hospice movement found sustenance in the social and moral climate of the late 1960s and early 1970s a time when great strides were made in the care of those with life threatening illnesses, extending their life expectancies. As medical costs continued to escalate, a great burden was placed on hospitals focusing on acute care. The option of the more humane,compassionate, cost-effective method of care offered by hospices provided anattractive alternative. For a populace enlightened by a growing awareness ofthe needs of the dying by the work of Elisabeth Kübler-Ross, the hospice movement's time had come.

A person is considered terminally ill when he or she has received the maximumtreatment for a disease without achieving remission or eradication of the disease. To be admitted to a hospice program, a patient must be declared by hisor her doctor to have six months to live and not be seeking active medical treatment. Hospice focuses on maximizing the quality of life when the quantityof life cannot be extended with the emphasis on the individual rather than the disease.

In order to die with dignity, the hospice philosophy is that one must be in relative comfort. Thus, medications are used to prevent pain from occurring rather than to control it once it is present. For this reason, medication is given on a 24 hour basis to maintain maximum levels of comfort. Frequently, family members are taught how to administer the medications, decreasing their sense of helplessness and bolstering faltering and fragile self-esteem.Informed consent and active participation in all aspects of care return control to patients and their families whenever possible and appropriate.

In hospice, the patient and family are the unit of care. Total care requiresproviding services for all those affected by terminal illness or death. Families are supported before and during the illness and bereavement period. Theyare given help in coping with their feelings, maintaining a fulfilling relationship with the patient and planning for the future. This support, provided by an interdisciplinary team the physician and primary care nurse, who is thecase manager, social workers, home health aides, clergy, volunteers, and other medical personnel as needed both enhances the quality of the patient's lifeand offers comfort to family members.

Most hospices provide services without charge if patients have limited or nofinancial resources. Insurance coverage for hospice care, however, is available through Medicare, Medicaid, and most private insurance plans.

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