Hospice is a specialized approach to coordinating the care of terminally ill patients. It works to improve patients' quality of life while supporting their various needs through the end of life. This specialized approach to delivering care is organized around an interdisciplinary team of professionals and other helpful volunteers. The hospice team commonly employs physicians, nurses, social workers, chaplains, therapists, and counselors. Instead of the traditional medical model of curative care used in the rest of the U.S. health care system, hospice employs the palliative care model. The palliative care model emphasizes controlling pain, lessening anxiety, and relieving symptoms rather than supplying curative care, in light of a patient's likely terminal condition. The goal of prolonging life is set aside, which allows care to focus on interventions that support and improve quality of life as defined and decided on by the patient and his or her family (Fiebach et al., 2007). Medical interventions during the final stages of a patient's life are often traumatic and invasive and typically also involve moving the patient from home to hospital or from nursing facility to hospital over and over and over. In many cases the result of this is unnecessary pain, discomfort, and stress on the dying patient, with no significant overall benefit to the patient's condition. The patient's overall well-being is at risk of being lost in the medical shuffle at a time when control of pain, reduction of stress, and ensuring peaceful surroundings should be the focus of care efforts (Matthews, 2010).
A specialized approach to coordinating the care of terminally ill patients.
palliative care model
Health care that emphasizes controlling pain, lessening anxiety, and relieving symptoms rather than curative care.
Outside the United States, hospice care began as a nonprofit, volunteer effort. Although several models of care for the dying exist, St. Christopher's Hospice in England is commonly recognized as the primary model that influenced hospice development in the United States. Another strong influence on the growth and development of hospice in this country was Elisabeth Kubler-Ross's book On Death and Dying (1969). This book, especially during the late 1960s and early 1970s, was particularly powerful in bringing attention to the experience of dying and the stages of dying, as it detailed those experiences for both terminally ill patients and their caregivers.
Since the introduction of the palliative model of care and the founding of the first hospice in the United States in 1974, hospice teams have provided care to many patients in their homes, in skilled nursing facilities, in hospitals, or in other residential hospice facilities. Despite the many care settings offered, the majority of hospice services continue to be supplied in the patient's home. This allows the continuation of familiar home surroundings of peace and comfort, while the necessary services are brought to the patient and are provided with dignity and respect. Family members and friends are usually encouraged to participate in supportive care if they are willing to do so (Wolper, 1999).
The different perspective used by hospice workers has challenged the traditional curative medical model by insisting that the personhood of a dying patient be recognized and not be lost in a maze of science and technology. Under this new model, palliative care and psychosocial support have grown in popularity, as many terminally ill patients and families are choosing supportive comfort care and opting to forego advanced medical interventions at the end of life. The palliative care model has challenged the traditional paternalistic role of the physician as well. Physicians on hospice teams must accept rather limited roles because they are serving as only one member of an interdisciplinary team bringing specialized care to the dying patient – care that at times delivers more spiritual and emotional guidance and support than actual medical care (Raffel & Barsukiewicz, 2002). The decision to “give up” on curative care can be very difficult for these physicians, and some have great difficulty in agreeing to stop treatments even when the odds of survival become extremely poor.
Hospice care providers are experiencing a steady rate of growth, of approximately 19 percent annually for agencies that are Medicare certified, with freestanding hospices being the fastest growing segment among the hospice care providers (Wolper, 1999). Data from the CDC's 2007 National Home and Hospice Care Survey reveal that the most common diagnoses of hospice care patients in that year were “malignant neoplasm (46.4%) ... heart disease (32.2%),including congestive heart failure (15.4%); essential hypertension (23.5%); dementia (21.3%); ... chronic obstructive pulmonary disease and allied conditions (14.8%); diabetes mellitus (12.2%); and cerebrovascular disease (10.9%)” (Caffrey, Sengupta, Moss, Harris- Kojetin, & Valverde, 2011, p. 7).
With the rapid growth of demand for hospice services, most third-party payers, including Medicare Part A, now provide hospice benefits. To qualify for hospice benefits under Medicare, a patient must meet the following criteria: “the patient must be terminally ill with a life expectancy of six months or less, must be unable to benefit from or have refused further aggressive (curative) therapy for his or her terminal illness, must be able to receive most care at home, and must have a caregiver who will assume the responsibility for custodial care of the patient and be the decision maker in the event the patient becomes incompetent to make decisions” (Fiebach et al., 2007, p. 196). Bereavement services in the form of grief counseling, educational support, and pastoral care support for the families of deceased hospice patients are provided for up to thirteen months following the death. Additional counseling services can also be obtained using a caregiver s own insurance plan if he or she has difficulty coping with the death of a loved one. Because of the high level of hospice coverage by Medicare and many other insurance providers, hospice care should be considered by anyone who is nearing the end of life.