As part of the celebration of National Home Care Month during November, the National Association for Home Care (NAHC) developed themes for both home health and hospice services, and the 2012 theme for hospice is Completing the Circle of Life with Love and Dignity.
“This year’s NAHC theme for hospice really exemplifies what hospice represents”, said Susie Compton, a registered nurse and administrator of Lincoln Medical Home Health and Hospice in Fayetteville. “Hospice is a philosophy. It’s about shifting the focus from treatment of a patient’s illness with the goal of cure, to recognizing that the dying process is a part of the normal process of living and focusing on enhancing the quality of remaining life.
“Once that approach is taken, then death is viewed not as something to be feared, hastened, or postponed, but as a natural part of the growth and development of every living thing.”
For patients who have a terminal illness, once they became ill, their lives and the lives of their families may be completely focused on fighting their disease. Multiple trips to physicians and clinics, surgery, hospitalizations and countless treatments are frequently endured as patients fight to overcome such diagnoses as cancer, end stage lung disease, renal failure, heart failure, or liver failure. The hope, of course, is cure or improvement.
But, what happens when cancer continues to spread despite aggressive therapy? When a heart continues to fail or breathing becomes more labored? Where can patients and their families turn when medical or surgical treatment to cure or combat a disease is no longer effective? When continuing treatment cannot change an outcome, or even worse, causes the quality of life to become so poor, that treatment is no longer beneficial or desired?
For many patients with terminal illness, hospice can be a welcome answer. What exactly is hospice? Compton explains, “Hospice care is provided as a benefit of many insurance plans, including Medicare and Medicaid. It is a team-oriented approach to medical care, pain management, and emotional and spiritual support tailored to a dying patient’s needs and wishes. A team comprised of physicians, nurses, a social worker, bereavement coordinator, spiritual counselor, and volunteer coordinator looks at not only the patient’s needs, but the needs of the caregivers as well.”
Hospice is frequently associated with cancer, but there are many chronic illnesses and conditions in which a patient is considered to be terminal with a limited life expectancy. Patients with end stage dementia, terminal neurological conditions, and evidence of decline in their health status due to long term debilitating chronic diseases may also be eligible to take advantage of hospice. For patients who qualify, Medicare and many other insurance plans will pay for comprehensive end-of-life care delivered in the patient’s home, whether that home is a residence, assisted living facility, or nursing home.
“Sometimes patients and families worry that by electing hospice they are ‘giving up’, but hospice offers incredible support in situations where continuing aggressive therapy will not change the outcome and may decrease the quality of life,” said Nancy Thomas, RN, who has been a home care and hospice nurse for several years. “There also is no requirement that the hospice beneficiary be homebound. In fact, hospice patients are encouraged to do as much as possible for as long as possible. Quality of life is paramount in the hospice treatment plan.”
Another thing to remember is that a patient is not locked into the benefit once he or she elects it. If there is a substantial improvement, or the patient later decides to pursue aggressive therapy, it’s possible to revoke the benefit. Patients can also re-elect hospice at a later date if they so choose.
“Death and talking about death can be very frightening for people”, said Debbie Kilpatrick, a social worker and volunteer and bereavement coordinator for Lincoln Medical Home Health and Hospice. “Discussing end of life plans and advance directives is avoided by many, as if refusing to acknowledge our own mortality will somehow postpone the very inevitable end to life that we all must face.
“While electing to receive hospice requires a patient and family to acknowledge that death is going to occur, the focus of hospice care is not on death,” she said. “It is on having the best life possible. We help patients and families feel supported and prepared to handle a life limiting illness. That support can ease fears, reduce distressing symptoms, and improve the quality of life. What a fantastic way to complete the circle of life.”
How can the public find out more about hospice? The Centers for Medicare and Medicaid Services (CMS) provides information about the Medicare Hospice Benefit. To download Medicare’s booklet on the hospice benefit, visit www.medicare.gov/Publications/Pubs/pdf/02154.pdf. In addition, the nursing staff at Lincoln Medical Home Health and Hospice is available to consult with terminally ill patients or their families who are not yet in a hospice. The consultation can occur in a hospital, nursing home, other facility, or at home, and may include counseling on care options and advance care planning. Interested individuals may contact the agency at (931) 433-8088 or visit the Lincoln County Health System webpage at http://www.lchealthsystem.com/lchs.nsf/View/homehealthhospice.