Hospice is a philosophy that focuses on providing comfort to the chronically ill and attends to their emotional and spiritual needs. Palliative care focuses on the relief of pain, symptoms and stress of serious illnesses. Palliative Care is used in all stages of an illness while hospice care will focus on the end of life. The Hospice’s goal is to improve the quality of life for the patient and the family. Both will eliminate or greatly decrease a patient’s pain or discomfort, one will attend to the needs of the patient and the other will attend to the needs of the patient and the family.
Who becomes a hospice patient? When a person has an illness and two doctors (Primary doctor and the second opinion) claim that nothing else can be done, or if a doctor states the patient has 6 months or less to live, the patient becomes eligible for hospice. There are additional situations that make hospice an appropriate choice for an ill person: If a patient is not strong enough for the surgery that would bring a healing, hospice treatment may be appropriate. When a patient consciously refuse a treatment and prefer quality of life in lieu of life with limitations brought on by aggressive treatments, hospice may be the best solution. Hospice Care is a decision made by the patient or the family. If a patient is unable to make their own decision, a pre designated person can choose hospice care for the patient with the doctor’s permission. Hospice Care is a personal decision but if chosen it comes with a package of support and a team to provide that support. Medicare will pay for everything.
Hospice allows one to live without aggressive treatments. There will be no waking a patient or other interruptions to take the blood pressure or vitals. Medication will be administered to eliminate or decrease pain. Every action will be done to make the patient as comfortable as possible. The good thing about hospice: if a patient chooses to change their mind and try a new treatment, unapproved or not, they can. A patient can be discharged from hospice. People are discharged from hospice every day; some get well others decide to try another medication or treatment. Hospice is not a death sentence, it is a decision to accept and continue life in peace. The hospice decision, a personal decision, is a decision that can be changed at any time.
The Hospice philosophy is to provide their care in the patient’s home among their family and loved ones. However, the care can be provided in a nursing home, an assisted living facility or the hospital but the main focus of the hospice philosophy is to make the person as comfortable as possible without a clinical environment When or if the patient is admitted to a hospital, the patient’s room will resemble a bedroom and the common area for family will look like a family room or the dining area in your home. If the family, the patient or both want to try a new treatment or a trial treatment or participate in clinical trials or try something not approved by the FDA, then they don’t want hospice.
Some people do not believe in hospice care or hospice companies; they see it as something negative, as if they are giving up on a person. I’ve seen the subject of hospice and the debate that followed divide families. Unfortunately, there are those who remember or read about the Tuskegee Study. They believe that hospice is a conspiracy that denies treatment to the sick and allows them to die; fade out. Those who remember the Tuskegee Study are adamant about leaving hospice care alone.
Hospice manages all of the patients’ medical need. Cancer may make a person eligible for hospice but the hospice physician will treat the cancer and all other medical issues the patient may have. The patient may have cancer of the esophagus and asthma and diabetes and arthritis and Irritable Bowel Syndrome with constipation. The hospice physician manages all of this and ensures that what he prescribes for one issue will not adversely affect the others. The patient becomes the focus of a team that has at least 3 members: The Certified Nurse Assistant, the Social Worker, the Registered Nurse, the physician and the chaplain. There may be a musician/music therapist on the team. All will visit the patient at least once. This team will provide complete care to the patient and the family.
The hospice CNA, who will provide personal care to the patient and make them physically comfortable with baths and massages, will help you. The social worker, who will get you everything needed to make the patient comfortable such as a hospital bed, a toilet chair and anything else, is there for you. You will receive the most visits from the hospice nurse who will come as needed to provide medication. Towards the end they will visit daily. The experienced hospice nurse has seen a lot and is wealthy in wisdom; they will be very helpful to the patient and the family. The chaplain is available to the patient and family. Sometimes the patient needs the chaplain to listen as the patient struggles thru thru the various stages. More often than not, by the time the chaplain visits the patient is in acceptance but the family is having a hard time.
In my journey as a seminarian, chaplain intern, chaplain and minister, I have witnessed pastors without any formal education or training provides “pastoral care.” I’ve seen them verbally beat up on patients or relatives for displaying anger or giving up on God. Anger or blasphemous language from the sick or grief-stricken should be handled with compassion and understanding. Instead, the pastor used language that chastised and shamed the patient and family. Worst, I’ve seen pastors just not respond to a patient or their family during a difficult illness. The patient is dying, everyone know their loved one is dying and the pastor is nowhere to be found because, “We’re all going to die one day.” No spiritual care is provided to the sick person or their family. They are ignored until the announcement of the funeral arrangements.
When a patient or their family choose hospice care they will all receive care from the moment the patient is admitted to a year beyond the patient’s death. Hospice takes a holistic approach and tends to the patient’s physical, emotional and spiritual needs and extends that care to the family.
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