Notes on hospice :
I became aware of hospice at an early age. When I was eight years old my mother died. She lived for only a couple of weeks after after experiencing a devastating and totally debilitating stroke. Before she passed, my father brought her home from the hospital for her final days. She was a private person and hated hospitals. He knew that she would have wanted to be at home in the end. I have a hard time recalling all the details clearly, but I distinctly remember the nurse that came to the house.
I recall the hospice nurse projecting an alarming calmness – one of those really warm angelic types. She would always be giving my silently uncomfortable mother medicine that would allow her to rest – and close both eyes. This personal care and thoughtful process was certainly not something my dad had encountered in his death. His end was quick, unexpected, and fortunately without any suffering. The medical examiners report detailed that he had a massive heart attack resulting in sudden cardiac death. I knew that he had past heart issues, but never fully knew the extent of his illness until after his death.
Given this gruesome family history, it is safe to assume that I should stay out of McDonald’s and lay off the Marlboro’s moving forward. This reality has also driven me to pursue my current path in career, and now to find meaning in this developing adventure.
Not wanting to appear as a completely naive medical student, I have jotted down some points of reference to help me get into the hospice mindset as I embark on this new experience. Fortunately there are some good websites that have allowed me to provide the synopsis below….
Hospice care is a philosophy and practice of medicine which accepts death as the final stage of life. It focuses its efforts on the palliation of symptoms that someone with a life limiting illness may face as they approach death. Symptoms can be physical, emotional, spiritual, or social in nature. The ultimate goal is to enable patients to continue an alert, pain-free life, and to manage other symptoms so that their last days may be spent with dignity and quality, surrounded by their loved ones.
It can be said that hospice care aims to affirm life, and does not hasten or postpone death. It treats the person rather than the disease that they live with. It focuses on the quality rather than length of life. It provides family-centered care and involves the patient and the family in making decisions.
Hospice care can be given in a number of settings. It can be provided in a private home, a hospital, nursing home, or private hospice facility. The majority of people who receive hospice care experience it in the home; with family members serving as the main hands-on primary caregiver.
Medical treatments that a patient may receive under the hospice benefit are based largely on individual cases. They may even include treatments that may be regarded as curative – like antibiotics, chemotherapy, and intravenous fluids – as long as the goal of these modalities is to improve quality of life and comfort.
The main caveat of hospice is that it traditionally is reserved for patients that are diagnosed with a life limiting illness, and are not expected to live longer than six months. The typical illnesses that people face associated with hospice care are cancer and AIDS, though stroke, end stage heart, lung, and renal disease are diagnoses becoming increasingly utilized.
Many hospice organizations have their own inpatient facilities, where care can be provided for the patients who cannot get it at home. These are often the patients with refractory and difficult to manage symptoms in the home environment, and/or in situations where there is limited care giving support at home. These facilities are run by specially trained staff that is versed in caring for the terminally ill.
Some patients believe that remaining in their home to die would be too difficult for the family, or feel a need for privacy in front of their family. Having care provided in a facility allows the family to remain “family” and not assume the role of “clinician and provider” at the bedside. Some families have no problem providing the nursing care necessary, while others cannot bear the experience of their loved one’s decline and pain or suffering.
Destination Hospice 