Hospice provides care for the terminally ill and support for their families and caregivers. Although the concept of hospice has been around for centuries, the first U.S. hospice program began providing services in Connecticut in 1974. Since then, the concept has grown to include more than 3,000 hospice programs that annually serve nearly 1 million Americans.
Many of the terminally ill may experience a sense of fear of the unknown about the dying process. Patients may have concerns about where they will die, whether they will need to be hospitalized, whether they will experience pain or other uncomfortable symptoms, and how their loved ones will cope with their dying.
Fortunately, for those with a life-limiting illness or injury, hospice provides a concept of care that preserves the dignity of the patient while providing comfort care and family support. It is based on the idea that dying is a normal process.
Hospice is not a place where care is provided, but rather a way in which care is provided for the terminally ill. In most instances, hospice care is provided in the comfort of the patient's own home rather than in a hospital or nursing home.
The goal of hospice care is not curative but rather to provide comfort and enhance quality of life. This is accomplished through a multidisciplinary approach that incorporates the patient, family members and caregivers, the patient's physician, trained hospice nurses, counselors and chaplain staff, social workers and health aides. Trained volunteers also may provide respite for family members and caregivers.
The services provided to hospice patients and their families are equally diverse. Patient caregivers receive training and support in the care of their loved ones from hospice staff. Broad support that addresses the physical, emotional and spiritual needs of the patient and family is available. Patients often are enabled to maintain their independence for as long as possible. Medication and other therapies are made available to enhance quality of life and ensure comfort and freedom from anxiety.
As a patient's disease progresses, hospice staff are on call around the clock to address issues that may arise. Caregivers receive support and resources to assist in alleviating patient pain and anxiety. It is important to note that hospice care neither prolongs nor hastens death but instead focuses on the comfort of the dying patient.
Hospice care has been shown to be cost-effective and is less expensive than hospital-based or nursing-home care for patients in the final stages of illness. In 1982, Congress created a Medicare hospice benefit. For eligible Medicare beneficiaries, this benefit is available when a physician certifies a terminal illness with a life expectancy of less than six months. In most states, Medicaid and private insurance will provide for hospice services.
Hospice services do not end with the death of the patient. Bereavement services are available to family and caregivers for up to 13 months after the patient's death.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Southern Ute Health Center in Ignacio.