From OncoLog, June 2012, Vol. 57, No. 6

House Call: Hospice Care
Patients and families have choices for care and comfort

When patients are told they likely have less than 6 months to live, hospice arrangements are usually suggested.

In hospice care—either at a facility or in patients’ homes—medical attention shifts from treating the disease to making the patients as comfortable as possible. Quality of life becomes the ultimate concern, and pain management and social, spiritual, and psychological support for the patients and their families are addressed. Studies have shown that the earlier a terminally ill patient engages in palliative care or hospice services, the better the patient’s quality of life will be.

What is hospice care?

A typical team providing hospice care will include, at the minimum, a physician, a nurse, and a counselor, although it may include other health care professionals, social workers, and chaplains. Together, the team will work to ensure that patients receive medical attention as well as medicine required to manage pain. Hospice workers strive to help patients reduce stress as much as possible by providing a home-like environment or providing care in the patients’ homes.

Hospice workers address patients’ psychological, social, and spiritual needs by providing counseling and companionship and sometimes by helping them reminisce about the life they have lived. Combined, the two-pronged approach of pain management and psychosocial care ensures that patients enjoy as dignified and comfortable an end-of-life experience as possible.

Hospice care options

Hospice programs are becoming increasingly available as awareness grows of the benefits of attention to a patient’s comfort in his or her last months of life. With nearly 5,000 hospice facilities in the United States alone, patients and their families have many options for hospice care and can select a provider that best aligns with their individual needs.

Photo: Nurse and hospice patient

If patients still require medical attention, it may be provided within the hospital or in a nursing home that offers advanced medical care, with special attention paid to maintaining their level of comfort. In some cases, a facility specifically designed for hospice care may be available.

Typical facility hospice programs include:

  • 24-hour medical care through one’s physician or a specialty hospice doctor and a staff of nurses, therapists, and aides;
  • easy access to various treatments or medical equipment;
  • counseling services for mental well-being;
  • spiritual comfort from onsite or visiting clergy;
  • help for personal needs through social services; and
  • visitation hours that allow family members to come at any time.

If the life-threatening disease does not require constant medical care, patients may choose to return to their homes and receive treatment from mobile specialists trained to provide hospice care. While in-home care usually will not provide around-the-clock assistance, help is always available when it is needed.

Typical in-home hospice programs include:

  • in-home medical care as well as 24-hour access to nursing support;
  • hospital or doctor visits as needed;
  • help with getting required medical supplies or equipment;
  • help with day-to-day necessities such as cooking, cleaning, or personal care;
  • information for the patient’s family about how to give medical care between care team visits;
  • time spent with the patient to provide family members much-needed physical and social relief from fulltime caregiving; and
  • counseling for both the patient and family during the illness and after the patient has died.

Each option has its merits. Choosing a hospice program should involve identifying one that aligns with a patient’s specific needs and beliefs as well as investigating the agency’s credentials. A patient’s insurance coverage may affect his or her choice, but most insurance plans and Medicaid now cover hospice care, and Medicare offers the Medicare Hospice Benefit.

Knowing their options can help patients and their families find the hospice program that best suits their needs.

– L. Jorewicz

For more information, talk to your physician, visit www.mdanderson.org, call askMDAnderson at 877-632-6789, call MD Anderson’s Department of Social Work at 713-792-6195, contact the National Hospice and Palliative Care Organization at 703-837-1500 or www.nhpco.org, or contact the Hospice Foundation of America at 800-854-3402 or www.hospicefoundation.org.


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