The word hospice comes from the same linguistic root as our words for hospital and hospitality and suggests similar notions of shelter, respite and caring. During the 1960's, Dr. Cicely Saunders, a British physician began the modern hospice movement by establishing St. Christopher's Hospice, an Inpatient facility, near London. St. Christopher's organized a team approach to professional caregiving and was the first program to use modern pain management techniques to compassionately care for the dying. The first hospice in the United States was established in New Haven, Connecticut in 1974.
Although many people continue to view hospice as a place, it is not a "place" but a philosophy of caring for the terminally ill. Eighty percent of hospice care is provided to patients either in their homes or in nursing facilities. In fact, Federal regulations require that no more than 20% of care being provided by a hospice provider is done so in an inpatient facility.
Hospice is a concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to curative treatments. It's goal is to provide quality time through the last days of a patients life, while offering comfort and dignity.
A few key points related to hospice:
- Hospice care neither prolongs life nor hastens death
- Hospice affirms life and regards dying as a normal process
- Hospice provides an interdisciplinary team approach
- Hospice focuses on quality of life
- Hospice promotes honest communication
- Hospice deals with the physical, emotional and spiritual aspects of care
- Hospice is very family oriented.. It is in fact, the only health care provider that can be cited for not taking care of the family as well as the patient.
- Hospice offers a variety of bereavement and counseling services both prior to, and after the patients death.
- Hospice provides all aspects of palliative care
Do Not Resuscitate (DNR)
Hospice recipients are not required to have a Do Not Resuscitate order. To force a patient to accept a DNR would be a violation of their rights. In a letter from HCFA dated April 20, 2000, clarification is made, stating that Medicare certified hospice providers may not refuse to revive a patient who desires to be resuscitated.
Hospice Levels Of Care
Routine Home Care - Care in the home or care facility is provided by the hospice team through regularly scheduled visits to the home which can be once a week to daily depending on the needs of the patient and family.
Continuous Care - An intensive or crisis level of care can be provided to hospice patients when their symptoms cannot be managed at the routine level of care. Continuous Care is provided on a short term basis (1-5 days) to maintain the patient in their home or care facility. Nursing care is usually provided for 8-24 hours a day and some of the hours may be provided by a home health aide.
Inpatient Care - Inpatient care is provided for pain and symptom management at a participating hospital, long term care facility or specialized hospice inpatient unit. Short term inpatient care is provided for the patient for pain control and symptom management.
Respite Care - Respite Care is short term inpatient care provided to relieve those caring for the patient in their home. Care is normally provided in a contracted nursing home and is for up to five consecutive days.