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Combating Common Hospice Misconceptions
Posted on:
May 15, 2012
In the U.S., approximately 1.5 million people use hospice services each year.1 Even though hospice programs are becoming more prevalent in our society, Americans still have many misconceptions about end-of-life care. This is a health care option that is misunderstood by so many, including some medical professionals.
It helps to start with an explanation of hospice philosophy and services. Hospice is a concept of care that treats the individual instead of the disease process. It is considered the model of compassionate care and is provided to people who have a life limiting illness in which they are not expected to live longer than six months. A top priority of hospice is excellent symptom management so life can be lived as fully as possible.
Hospice offers a multidisciplinary approach to care that encompasses physical, spiritual and emotional support. The hospice team usually consists of a person's primary physician, hospice physician, registered nurse case manager, medical social worker, spiritual counselor, hospice aide, hospice musician, bereavement counselors and volunteers. Dieticians and physical, occupational, and speech therapists are also available if special circumstances arise. Hospice is almost always 100 percent covered by Medicare and most states and private insurance companies offer hospice coverage as well.
DEBUNKING MYTHS
As an intake liaison, I often had the privilege of being the first person to speak in detail about hospice to a patient or inquiring family member. Many people believe they have to leave home to die. In fact, most people receive hospice care in the place they call home. This gives patients and their family members the opportunity to experience end-of-life together. Private residences, nursing homes, residential care facilities, board and care homes, and memory care centers are all places hospice care can be provided. Some communities are fortunate to have a "Hospice House" for people who do not have enough support available or who do not wish to die at home. Hospice inpatient units are utilized when complex symptom management is required.
Enrolling on to hospice means you will die sooner is also a common misconception. According to the New England Journal of Medicine, hospice service may actually help some people live longer because "with earlier referral to a hospice program patients may receive care that results in better management of symptoms, leading to stabilization of their condition and prolonged survival."1
Another misconception is a person must be close to death to be admitted to a hospice program. Anyone who has a prognosis of six months or less and is not seeking aggressive curative treatment may be eligible for hospice. Generally speaking, the earlier someone seeks hospice care the better. Hospice is most beneficial when the multidisciplinary team has time to build relationships with patients and families and assess and fulfill needs throughout the last part of a person's life. The average length of stay on hospice is 19.7 days.1
When hospice care starts it requires a person to stop eating and drinking is another falsehood. Hospice care epitomizes person-centered care, and if a person with a terminal disease wants to eat or drink it is supported. However, the body tends to stop utilizing food and fluid near the end-of-life, therefore eating and drinking usually wanes. When a person is very close to death, high fluid intake may cause discomfort and exacerbation of symptoms, so hospice usually will recommend not "pushing" fluids on someone.
ENGAGE & EDUCATE
Our culture values youth and shuns death and dying. As a result, most people do not think or learn about end-of-life care until it becomes a necessity. It is very important for healthcare providers across the spectrum of care to be able to address, engage, and educate a person about hospice and end-of-life issues. Nurses and other care professionals in the long-term care setting often have a unique, intimate window of opportunity to start educating residents and their families about hospice care to alleviate some of the stress associated with end-of-life decision-making.
Reference
1. The National Hospice and Palliative Care Organization. www.nhpco.org
Lisa Erbsoesser is the founder and president of See Me Communications (www.seemecommunications.com), and is a former hospice nurse.
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