Hospices Offer Comfort at Life's End

It's a subject no one wants to think about, but for each of us, our lives must come to an end.

As medical progress prolongs our lives, the end can linger, draining patients and loved ones alike. So, more and more people are turning to hospice care.

Hospice isn't just for elderly patients, says Carol Paprocki, public relations coordinator at Samaritan Hospice, the oldest and largest in southern New Jersey. Children receive hospice care, as do patients with Parkinson's disease, neurologically progressive degenerative diseases like Lou Gehrig's disease, and HIV.

This holistic approach to the end of life treats pain and symptoms to make the patient as comfortable and functional as possible. Counseling helps patients and families come to terms with the process.

Idea has spread

Three decades after hospices spread here from Britain, 1.3 million Americans receive hospice care each year, according to the National Hospice and Palliative Care Organization (NHPCO) in Alexandria, Va. Still, the NHPCO says, for each patient who got hospice care, another one should have but didn't.

Medicare, Medicaid, and most health plans cover hospice programs. A patient can enter hospice care when a doctor says he or she has six months or less to live. The patient, family, and doctor decide when hospice service should begin.

Although a person enters hospice with less than six months to live, hospice services don't automatically end at six months. Some people in hospice care live much longer. Medicare, for instance, continues to provide hospice coverage after six months, as long as the patient's doctor recertifies that the patient is terminally ill.

Team approach

Typically, a hospice patient is treated by a team of people. The team includes not only the patient's family members, but also a doctor, a nurse, counselors, a social worker, home health aides, and trained volunteers. The goal is to control pain and symptoms so that the patient is comfortable yet alert enough to make decisions, according to the American Cancer Society (ACS). The team also helps the family through the grieving process.

Some hospices have a site where people receive care in their final days. But most hospice programs bring doctors, nurses, and other staff to patients' homes. Surveys show most Americans prefer it that way.

A hospice can give family caregivers a break, through respite care. A trained caregiver will step in to allow family members some time off. Under Medicare, a patient under respite care is cared for at a hospice center or hospital.

Despite these benefits, many people still have the misperception that you come to hospice when there's nothing else to do, says Kenneth J. Doka, Ph.D., senior consultant to the Hospice Foundation of America, an educational foundation in Washington, D.C.

Instead of a person waiting until the very last moment to enter hospice, hospice officials urge families to discuss end-of-life issues well in advance, while an ill person can still state his or her wishes.

"Despite our great technology, people are going to die," says Stephen Goldfine, M.D., Samaritan Hospice's chief medical officer. The hospice can give patients quality time with families and permit "a good closure process," he says.

To learn more

To learn about hospice care in your area, the NHPCO suggests these resources:

  • Doctors, nurses, and other health care professionals

  • Social workers, clergy, and other counselors

  • Friends or neighbors who have experienced hospice care

  • Your local yellow pages

  • Local or state offices on aging or senior centers

Experts say you should call or visit the hospice to watch, talk, and agree on treatment and services for the patient and the family.

You can also visit the NHPCO's " Find a Provider " section on the Web.


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