Tuesday, September 28, 2004
Hospice (or End of Life Care)
I just came home from my "Hospice day." It is a required day for every student at my school during Family Medicine. Today, I went to one of the 2 larger hospice companies and went around town with a social worker and physician.
It was pretty cool. I enjoyed how upbeat the SW and physician were. It was somewhat depressing when we went into some of the houses, but overall it was a good experience.
For instance, the first stop we made was at a little lady's house just outside of town - about a 20 minute drive from the main office. She had been a home health patient for some time - she had a hospital bed and some other durable medical equipment (walkers, bath chairs, etc) in the house the company had already procured for her. However, her condition had deteriorated such that in the past week she became unable to rise from bed and go to the bathroom, feed herself, or go to her recliner.
She has worsening cardiac disease, and her exercise tolerance has gradually been worsening - now to the point to where she cannot even sit up without becoming short of breath and having to lay back down. She is completely bedridden.
The truly unfortunate thing (as if the above isn't enough) is, that in listening to her family, this woman basically raised her entire neighborhood. She was one who would help anyone that needed it - regardless of whether she had it to give. She lives in a little 2 bedroom house with her sister, her daughter, grand-daughter, and great-grand-daughter. 4 generations in one house. She is so frail - it really was a tragedy to see. And when she awoke, she was sweet as can be... It's just heartbreaking.
So, because of her worsening cardiac condition, she was qualified for hospice care.
If you don't know what Hospice means, let me briefly explain: There are (basically) two trains of thought when dealing with any illness - curative and palliative. They are not exclusive of each other - even when you go to your physician's office for a sore throat he tells you to use saltwater gargles along with the antibiotics he prescribes for you. Both palliative (comfort measures - the gargles) and curative (the antibiotics) together. However, when an illness or condition is terminal (cancer, end stage COPD, Liver disease, etcetera), while the initial stages of treatment may be curative AND palliative (i.e. the physician may try chemo/radiotherapy to cure the cancer or a liver transplant to cure your cirrhosis), if those treatments fail, then sooner or later palliative-only care will take over. This is Hospice.
It is something of a paradigm shift in the way the medical community has thought for many years. For the longest time, any death was deemed a failure. It was not always this way. Death is a part of life, as is birth. One is born, so one must die.. Ashes to ashes, dust to dust. You see the point. What hospice care does is make sure that a patient is comfortable when their time comes. They have hospice aides, nurses, chaplains/pastors/priests, social workers and physicians that work together to help the last days of a patient's life be as comfortable as possible.
How does one qualify for hospice? The general rule is a patient must be certified by two physicians to have less than 6 months to live. This is not a strict rule, but I've heard it said, "If it wouldn't SURPRISE you if this patient were dead in 6 months, you need a hospice referral." Maybe it is really 3 days, maybe it will be a year - but 6 months wouldn't surprise you.
The hospice program evaluates the patient, the patient (or surrogate) must fill out and sign a Do Not Resuscitate order, and the patient and family are educated on what hospice care is, not to call 911 for "emergencies," and how to deal with the upcoming changes. The hospice program sends an aide and a nurse daily, and a chaplain at least monthly. Social worker and physician visits are also at least monthly, or the physician may be reached by telephone for additional orders.
All-in-all, the patient is very well cared for. Hospice care can be done in the home (as is the case of the woman above) or in a nursing home. The only difference is who takes care of the patient when the aides, nurses, physicians, chaplains, and social workers are away.
I think it is a good system. I enjoyed my visit with the hospice program today. I learned a lot about the system and when to refer a patient to hospice. Hopefully my experience shared above can help you as well. ¶ 11:26 AM
It was pretty cool. I enjoyed how upbeat the SW and physician were. It was somewhat depressing when we went into some of the houses, but overall it was a good experience.
For instance, the first stop we made was at a little lady's house just outside of town - about a 20 minute drive from the main office. She had been a home health patient for some time - she had a hospital bed and some other durable medical equipment (walkers, bath chairs, etc) in the house the company had already procured for her. However, her condition had deteriorated such that in the past week she became unable to rise from bed and go to the bathroom, feed herself, or go to her recliner.
She has worsening cardiac disease, and her exercise tolerance has gradually been worsening - now to the point to where she cannot even sit up without becoming short of breath and having to lay back down. She is completely bedridden.
The truly unfortunate thing (as if the above isn't enough) is, that in listening to her family, this woman basically raised her entire neighborhood. She was one who would help anyone that needed it - regardless of whether she had it to give. She lives in a little 2 bedroom house with her sister, her daughter, grand-daughter, and great-grand-daughter. 4 generations in one house. She is so frail - it really was a tragedy to see. And when she awoke, she was sweet as can be... It's just heartbreaking.
So, because of her worsening cardiac condition, she was qualified for hospice care.
If you don't know what Hospice means, let me briefly explain: There are (basically) two trains of thought when dealing with any illness - curative and palliative. They are not exclusive of each other - even when you go to your physician's office for a sore throat he tells you to use saltwater gargles along with the antibiotics he prescribes for you. Both palliative (comfort measures - the gargles) and curative (the antibiotics) together. However, when an illness or condition is terminal (cancer, end stage COPD, Liver disease, etcetera), while the initial stages of treatment may be curative AND palliative (i.e. the physician may try chemo/radiotherapy to cure the cancer or a liver transplant to cure your cirrhosis), if those treatments fail, then sooner or later palliative-only care will take over. This is Hospice.
It is something of a paradigm shift in the way the medical community has thought for many years. For the longest time, any death was deemed a failure. It was not always this way. Death is a part of life, as is birth. One is born, so one must die.. Ashes to ashes, dust to dust. You see the point. What hospice care does is make sure that a patient is comfortable when their time comes. They have hospice aides, nurses, chaplains/pastors/priests, social workers and physicians that work together to help the last days of a patient's life be as comfortable as possible.
How does one qualify for hospice? The general rule is a patient must be certified by two physicians to have less than 6 months to live. This is not a strict rule, but I've heard it said, "If it wouldn't SURPRISE you if this patient were dead in 6 months, you need a hospice referral." Maybe it is really 3 days, maybe it will be a year - but 6 months wouldn't surprise you.
The hospice program evaluates the patient, the patient (or surrogate) must fill out and sign a Do Not Resuscitate order, and the patient and family are educated on what hospice care is, not to call 911 for "emergencies," and how to deal with the upcoming changes. The hospice program sends an aide and a nurse daily, and a chaplain at least monthly. Social worker and physician visits are also at least monthly, or the physician may be reached by telephone for additional orders.
All-in-all, the patient is very well cared for. Hospice care can be done in the home (as is the case of the woman above) or in a nursing home. The only difference is who takes care of the patient when the aides, nurses, physicians, chaplains, and social workers are away.
I think it is a good system. I enjoyed my visit with the hospice program today. I learned a lot about the system and when to refer a patient to hospice. Hopefully my experience shared above can help you as well. ¶ 11:26 AM
