 | Tom Welk
DMin is Director of Pastoral Care & Professional Education at Harry Hynes Memorial Hospice. He also teaches at the University of Kansas School of Medicine-Wichita. He has certification with the American Association of Pastoral Counselors in Clinical Pastoral Education. His memberships include Park Ridge Center for Study of Health, Faith, and Ethics, and St. Louis University Center for Health Care Ethics, Charter Board Member Kansas Health Ethics, Inc., and Ethics Committee Member for National Hospice Organization. He has received the President's Award of Excellence for Public and Community Awareness, for the "Dying Well" project from The National Hospice Organization. Tom's group presentations include: Association of Kansas Hospices, Midwest Congress on Aging, and Kansas Health Ethics Conference. Tom Welk can be contacted by fax at (316) 265-6066, by e-mail at: twelk@hynesmemorial.org, or at his office at (316)219-1791. |
Hospice
2004-10-01 10:31:00
What if the patient gets well?
ANSWER: The reader who submitted the question used in the above title had a multi-faceted question that also included: "Does it happen often that a hospice patient gets better? How can the family stay involved in the care of a loved one receiving hospice services? Are people with any type of terminal illness eligible to receive hospice services?"My column in a previous issue of the Q&A Times dealt with the last question listed above. To briefly repeat my answer: Admission into a hospice program does not depend on any particular type of illness (diagnosis); appropriateness for hospice depends on determination by a physician of a life expectancy of six months or less (prognosis), no matter what the illness might be. This prognosis does not have to be an exact prediction, since obviously there are many factors and variables that might make this prognosis longer or shorter than six months.This leads to another question raised by this reader, "Does it happen often that a hospice patient gets better?" Yes, some patients who have been admitted into hospice do get better and live longer than six months. Getting better, however, does not necessarily mean that they are cured of the life-threatening disease. In my personal experience of working in a hospice program for over 21 years there have been very few patients who were discharged from our program because they were cured. In the rare instances where this happened, discharge took place because of a mis-diagnosis. Initially it had been thought the person suffered from a life-threatening illness, but this later was indicated not to be the case.There are a few patients who do get better regarding their medical condition. In the case of these patients the illness slows down in its progression, to the point where the patient's condition stabilizes. When this happens the patient is discharged from hospice, with the clear indication that when the disease again becomes life-threatening, the patient can return to the care of hospice. As a matter of fact, Medicare/Medicaid and other insurance providers require a regular review of the patient's condition, and when it is obvious that the patient's medical condition has stabilized, then the hospice program is required to discharge. Depending on the appropriateness, after discharge from hospice the care of the patient might be turned over to a home health agency.Finally, "How can the family stay involved in the care of a loved one receiving hospice services?" Actually, the family is expected to be involved in the care, particularly in meeting basic daily needs. Hospice staff (nurse, social worker, health care aide, chaplain, volunteer) work closely both with the patient and the family to take care of needs such as pain control and symptom management, emotional issues, spiritual support, personal hygiene (bath, shampoo, nail care, etc.) and light household tasks related to the patient's care. The patient's family is always closely included in every dimension of their loved one's care. Hospice staff members provide extensive education to family members so that they can be comfortably involved to the fullest extent possible in the care of their loved one.Caring for a terminally ill loved one in the home setting can be physically and emotionally challenging. This demanding care can wear out the family. The client for a hospice program is both the patient and the family. Hospice staff is available to offer extensive support to family members. Volunteers, above all, are there to assist the family in a variety of ways: staying with the patient so family members can leave the home to take care of business, recreational, religious or other needs; running errands for the family; doing light household tasks; and many other support services.Dealing with a terminal illness can be challenging for both the patient and the family. Hospice is available to provide the support necessary to ensure that life, even in these demanding circumstances, can be lived as fully as possible.
