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Dr Jerry Old
Jerry Old MD is chief consulting medical officer with Hospice Care of Kansas and an associate professor at the University of Kansas School of Medicine-Wichita. He is a nationally recognized author and speaker on end-of-life issues. You may contact Dr. Old by phone at 1-800-HOSPICE.
Hospice
2009-03-01 14:08:00
The role of hospice in modern medicine
Answer: Most people hear the word “Hospice” and they think of Death. However, hospice is about LIFE! It is about living the best quality of life that you can live for as long as you can live it. A recent medical study has proven that people on hospice actually live longer than similar patients on aggressive therapies—an average of 29 days longer. Patients can have quantity and quality! Hospice began in England and migrated to the United States in 1974. In 1982, Medicare began paying for hospice services (paid 100% with no out-of-pocket deductible or co-pays from the patient). There are now more than 4,500 different programs in this country. Hospice is not a place—it is a philosophy. A recent Gallup poll showed that 90% of Americans want to stay at home, and to die at home, if possible. That becomes the goal of hospice. Hospice is simply good medical care, even though “cure” is not the goal. There comes a time in everyone’s life when cure is not an achievable goal. At that point, our hopes need to change—perhaps to achieve peace or reconciliation with family or friends or to live long enough to reach a special event. Perhaps the goal becomes pain control, a dignified death, or staying in control of your life. Hospice services are for persons with terminal illnesses, with a life expectancy of six months or less if the disease runs its normal course. However, life expectancy is hard to determine, even by physicians trained in Hospice. As long as the patient still meets Medicare guidelines, the Hospice benefits continue indefinitely. Some people may live 2 days; some may live 2 years on hospice – the average is 29 days. The most common comment I hear from families is “I wish I had known about hospice sooner!” End-of-life care is very individualized and requires a “team” approach - a physician, nurse, home health aide, social worker, chaplain, and various volunteers coordinate hospice services. As needs vary, an individual patient may use all these disciplines, or one more than the others. Medicare (and most private insurance companies) covers all medications related to the terminal diagnosis, nursing visits at least every 2 weeks, physician supervision, home health aide visits, medical equipment (oxygen, hospital beds, etc.), social worker and chaplain visits, and volunteer services. Respite care (relief for the caregiver), general in-patient treatment if needed, and crisis intervention are also available. Families are followed for at least 13 months after the loved one dies for bereavement support. All Hospices are paid the same Medicare amount—whether “for profit” or “not for profit.” How does one choose the hospice that is right for them? After providing the things above that are required, what else do they provide? Here are some questions patients and families need to ask when making the tough decision in choosing a hospice organization: How frequent are nursing visits? Medicare requires once every 2 weeks, but each company has their own standard. What is the nursing caseload? Does each nurse care for 10 patients or 30 patients? It makes a big difference in how much time can be spent with each patient. When emergencies occur on weekends or at night, is there an alive, awake, hospice nurse to answer the phone 24/7? When a patient or families calls, do they get a recording or the dreaded “press one—press two” machine. Is there a local medical director? Does the company spend money on such things as a wound care program? Do they support education for employees and the community? Unfortunately, dying is part of the life cycle. It is a time of reflection and tremendous mental, emotional, and spiritual growth. 70% of our population still dies without the support that hospice can offer. Families who have experienced the support and care that Hospice can offer generally make statements such as, “I don’t think I could have done this without Hospice!”
 
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