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Benefits of Hospice

  
  
  
  

End of Life caregiving handsA family member has days, perhaps hours, left on this earth.  Their family is preparing to say goodbye. The patient may be conscious and saying their farewells or maybe they've already started to slip into the next phase.  A doctor, nurse, a social worker, suggests that the family consider hospice care. The family starts to question what hospice is and decides it's what's right for their loved one. The patient dies shortly thereafter.

How often do you see this?  The latest statistical reports show that 35% of hospice patients have a length of stay of less than seven days. Add in another 27% to represent the patients that have a length of stay of 8-29 days and you get more than 60% of hospice patients are on-service for less than 30 days.

The services that hospices provide are invaluable. If we look at the overarching benefits, it's understandable why so many people elect hospice.

  • Pain Management
    Patients electing hospice receive medications and often, alternative therapies, to help with the management of pain. It is a hospice goal to enable patients to be as pain free as possible.
  • Quality of Life
    Quality of life can sometimes be confused with quantity by well-meaning family members and friends. Consider, would mom prefer being home, surrounded by those she loves and who love her versus going through another round of chemo or dialysis? Hospices offer quality of life experiences for their patients and their loved ones.
  • Death, with dignity
    Think about a grandmother in the hospital for weeks leading up to her death. She'd lost control of many of her own functions. When she was conscious, she struggled with recognizing loved ones. Perhaps for grandma, being able to be pain free, at home, aware of her surroundings, and with loved ones, may have been more precious than extending her life by a few more weeks.  It would provide her the ability to die with dignity, remembered as she was.
  • Guidance for family & friends
    Hospice patients & families have a network of people who are there to help answer questions, provide suggestions, and most importantly, listen. Hospice caregivers are able to help prepare families for what to expect. Guide them on how they can help their loved one. The hospice team can be a sounding board for many families going through what may be one of the most difficult times of their lives.  
  • Multi-disciplinary review of care
    On a routine basis a team of multi-disciplinary professionals review the patient's care and progression. They discuss what additional services may be needed now, or in the future.  They also discuss what the family’s needs are or what they may be in the future. They discuss the clinical care that's being provided to the patient all with the intent of ensuring the patient and family are receiving the care they need and deserve.
  • Post-death Support and Assistance
    Hospice care doesn’t stop when the patient passes. There are individuals and groups that are available to help surviving loved ones as they take their first steps in the new life without their loved one.

These are just a few of the things I thought of when considering the benefits of electing hospice.

I ask you to share your thoughts on what you might add to this list.  How do you help convey the value of hospice to your patients, their families, and the community?

Comments

With the implementation of Palliative Care within the hospital settings, I beleive that there should be increased utilization of hospice. What I'm seeing however is not. The patients many times are referred to Palliative Care and / or Hospice when they are requiring treatments such as paracentesis, IV pain medication at high doses, etc. These items many times can not be absorbed by a hospice and force the patients to remain hospitalized, unless they find one in which Open Access can be sought out.  
 
We need to do a better job having those difficult discussions with patients prior to utilizing Palliative Care. If the patient wishes to have the treatments, it still provides the Palliative Care team with the opportunity to seek out the hospice that can best support the patient both in the home and at an IPU type setting. If the patient says they don't want to pursue the treatments, then it still provides Palliative Care an opportunity to educate and begin steps to get a patient on hospice for all the reasons Ms Aleksza noted in her article.
Posted @ Thursday, February 02, 2012 1:16 PM by Steve Bednarski
Steve, thanks for the thought provoking post. I agree with you. I too believe that those difficult discussions aren't consistently being had with patients and their families. Time and time again I read stories about families that learned of hospice very late in the diagnosis of their loved one, or worse yet, too late. One story I read talked about a woman who lost her husband. Her husband’s care team suggested that he receive curative treatment for his disease just days before he passed. The husband and wife agreed, because they didn’t know what else to do. They weren’t presented with any other options. The care team, I believe, had one goal in mind: try to save the patient. Admirable, but when it didn’t work and the patient died 3 days later the family mourned the loss of time that they could have spent together at home, saying goodbye. Knowing all of the options available help patients and families make the decisions that are best for them. How can we, in the hospice community, help people with those conversations? Is it training on how to do it? Awareness of what’s available?
Posted @ Thursday, February 02, 2012 1:41 PM by Darlene Aleksza
I think you keyed in on where the issues arise. When a physician or AP provides the pt and family with their options, one of two beliefs drive the conversation. First, that the only reason the patient is present is to find out what else can be done to cure them, or secondly that the physician is thinking of what other options might I offer that will continue to keep them alive. often I find that the discussions are not even presented as Palliative. I beleive that we need to provide opportunities for physicians to meet with their peers and discuss how these difficult discussions are presented. I also beleive that hospice organizations have a responsibility to the providers to offer educational opp's that will better provide them with the tools to support their patients.  
 
I believe we also need to somehow get hospice's to work together instead of constantly "fighting for patients." The latest numbers show that in 2010 only 52% of those patient who passed away were on hospice. I believe a part of that is because of what society thinks of hospice.  
 
To say the least, there is an immense amount of work to do in this industry to improve what hospice represents and how to get it to those who need it.
Posted @ Saturday, February 04, 2012 1:53 PM by Steve Bednarski
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