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Has Hospice Changed?
10th May

2018

Has Hospice Changed?

In her 1972 testimony before Congress, Dr. Elisabeth Kubler-Ross stated,

“We live in a very particular death-denying society. We isolate both the dying and the old, and it serves a purpose. They are reminders of our own mortality. We should not institutionalize people. We can give families more help with home care and visiting nurses, giving the families and the patients the spiritual, emotional, and financial help in order to facilitate the final care at home.”

End-of-Life Care

In the past 46 years since then, hospice care in the United States has helped create a culture and a system of end-of-life care that enables patients to pass in comfort in the familiar setting of their residence. By providing pain management, psycho-social and spiritual support, patient care education, medications, medical supplies, equipment, and grief counseling, hospice companies have made it possible for millions of individuals with a limited life expectancy to pass peacefully at home rather than in a hospital.

Many individuals are surprised to learn that hospice is designed for the last 6 months of a person’s life. Hospice diagnoses include(National Hospice and Palliative Care Organization):

  • cancer (28%)
  • cardiac (19%)
  • dementia (17%)
  • respiratory (11%)
  • stroke (9%)
  • other terminal illnesses (16%).

Although many more patients are receiving hospice care, only 46% of Medicare decedents receive hospice care. This means that the majority of individuals who are eligible for hospice do not receive hospice care. And even though most seniors express that they do not want to die in a hospital, many still do because of decisions that are made in times of a medical crisis.

Discussions about end-of-life care

Dr. Atul Gawande, author of the New York Times bestseller, “Being Mortal: Medicine and What Matters in the End” explains why our culture still has difficulty accepting hospice care. “The goal is not a good death. The goal is a good life all the way ’til the very end” states Gawande. Gawande challenges physicians and patients to have the difficult discussions about end-of-life care while one is still healthy and to think about what really are one’s priorities in life. Medicine today can extend life expectancy but the quality of life may be impacted. Many physicians personally struggle to inform patients that they have a terminal illness as they may feel that not being able to cure their patient is a failure. Studies show however that patients would prefer that their physician be upfront about their prognosis. When patients have a realistic understanding of their diagnosis, life expectancy and disease process, they can better plan for the time that they have left. Instead of spending valuable time at medical appointments or having aggressive treatments, they may choose instead to have hospice care in their home and spend more time with family and friends.

Our culture in the past few decades has learned more about the benefits of hospice. We still have a lot of work to do in regard to teaching patients more about end-of-life care and having the often uncomfortable discussions about death and dying. Fortunately hospice teams are available to provide important information to patients and families during their most difficult times.

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