History
The concept of hospice as an interdisciplinary approach to providing comprehensive end of life care began in Great Britain during the 1960’s. It made its way into the United States during the 1970’s and, in contrast to European hospices that delivered care in designated hospice facilities, was modeled to provide care in the patients home environment.
As the hospice movement grew, lobbyists began to seek funding for care. This led to the Medicare Hospice Benefit in 1982. The Medicare benefit has served as the basis of the hospice model of care in the US and as a model for Medicaid (Medi-cal) and private insurance provision and reimbursement.
Hospice VS Palliative Care
Hospice care is similar to palliative care in that the goals are to alleviate symptoms and improve quality of life. In contrast to palliative care, however, hospice is appropriate when there is a life expectancy of six months or less. When curative treatments are no longer working and/or a patient no longer desires to continue them, hospice becomes the care of choice.
The mission of hospice is to affirm life and view death as a natural process. Hospice is not designed to hasten death or “help” someone die, but rather to help patients live the remainder of their lives as fully as possible. Most people, if asked, will say they dream of a peaceful, comfortable death surrounded by their loved ones. An interdisciplinary team of trained professionals work together to deliver hospice services that can make that dream a reality.
Hospice Services
Services provided by hospice have been defined by the Medicare Hospice Benefit and are the same whether hospice care is covered by Medicare, Medicaid (or Medi-cal in California), private insurance, or charity. They include:
- Nursing services
- Physician participation
- Medical social services
- Counseling
-Pastoral or spiritual
-Bereavement counseling (for family up to one year after patients death)
-Dietary
- Home health aide services
- Medications
- Medical equipment
- Other medical supplies
- Laboratory and other diagnostic studies related to terminal illness
- Therapists as appropriate
-Physical therapy
-Occupational therapy
-Speech therapy
Additional services may be available through individual hospice agencies through volunteer and charity programs.
Appropriateness
Hospice is appropriate when a patient has a terminal illness with a life-expectancy of six months or less. It is important to note that a life expectancy is never “by the book”. Some patients with a life expectancy of six months will live much longer and some will die much sooner than expected. It is generally accepted that the sooner a patient can access hospice services, the more they will benefit from the care received.
A patient is ready for hospice when they have decided to pursue treatments meant only to promote comfort, not cure the illness. Those treatments may include medications to relieve pain, nausea, shortness of breath, loss of appetite, muscle cramps, itching, hiccups, and many more. They may also include more aggressive palliative treatments such as blood transfusions, chemotherapy, and radiation when the goal is to alleviate pain and discomfort, not cure the disease.
