Hospice Care/Hospice

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Question
Does hospice care work to speed up death "euthanasia like" or is it only to allow the patient to be comfortable during the end of life process? Also, do they help treat the dying person so they can possibly still recovery or are they only used when the person for sure is not going to recover and death is certain?

Just curious after being at a funeral recently where the hospice care here in Florida had been used. I hadn't realized hospice had home services.

Answer
Hi, Howard!  What great questions!

Hospice neither delays nor hurries death.  Hospice is only about the quality of life--we manage pain and anxiety and other symptoms (like nausea, constipation, inability to move about, and general comfort).

Most people have a sort of "rally" when hospice care begins.  We attribute that to a benefit of being more comfortable and relaxed.  I had one client who actually improved enough that he wasn't eligible for hospice care!  He was later--but it was almost a year before he had gotten to that stage.  For the record, hospice eligibility in the US means that the patient (or patient's power of attorney, if the patient is unable to express himself or herself) has determined that "cure" is not of interest, but comfort is.  Efforts at "cure" stop, but efforts at comfort continue. (One hopes that even during the "attempts to cure" stage of a terminal illness, comfort and "palliation"--which means relief of symptoms--take place anyway, but sadly I have known providers who did not "get" that!).

Near the end, sometimes people are unable to relax.....  This is more when people have not had hospice care and have been anxious and in pain.  Hospice care provides pain management and anxiolytics (meds that "cut" anxiety) and, finally relaxing, they are able to pass on, to die.  Sometimes families do not recognize that and think that hospice has killed their family member, but nothing could be further from the truth.  We are only about quality of life.  God, disease process, whatever one wants to credit with controlling the end, that's what determines that the fight is over, and the reward (or whatever makes sense for you!) is at hand....

If there is a desire for cure, then hospice is very inappropriate.  I have had patients who did not accept until near the end that they were, in fact, near the end.  One lovely lady had 8 hours left when the family called for help (that was heart breaking!).  As with many aspects of life, "near the end" is a matter of opinion for all but the physician.  There are specific guidelines to be followed for most conditions, specifically what symptoms and disease progressions are indicative of a prognosis (prediction of life remaining) of six months or less, if curative treatment is not pursued.  But patients and families are not always ready when the physician and the progress of the disease makes the patient eligible for hospice care.  Hospice should never be forced on anyone!  (Personally, though, I hope it is there for me and mine, when the time comes.)

Lastly, hospice in the US is usually provided in the "home setting."  That is often (and in my opinion, ideally) provided in the patient's home, the home of family or of friends.  (I did have one hospice patient who received his hospice care in a neighbor's home!  Can you imagine the incredible soul of those neighbors?)  But it is wherever the patient resides.  Sometimes the patient lives in a nursing home.  Sometimes hospice is provided in an actual hospital, although that is a little unusual--most hospitals are about cure, and the nurses and other staff usually do not understand hospice.  They worry about such things as whether managing symptoms might "cause" death.  (This is especially the case with pain management.  We do not worry about whether pain medications interfere with the breathing centers in the brain.  Certainly we do not overdose pain medications, but if we have to choose between less breathing and more pain, we opt for less breathing--a side effect of some pain medications.  By asking for hospice care, patients--or their families--accept that the goal is no pain and no anxiety.  Period!)

I am not sure I have answered your questions, but I hope I have!  I rarely have the chance to teach about hospice care and so I am especially grateful that you have written to me.  I am sorry for your loss--but happy to know that hospice was able to ease someone's dying.

Take care--
Christine

Hospice Care

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Christine Johnson

Expertise

I can give suggestions, encouragement and direction on what hospice is and is not, when it is appropriate, and how to go about getting it. I am familiar with Medicaid and Medicare hospice benefits. I can answer general questions about disease process, what dying looks like, how hospice handles pain and other symptoms, what to expect from a hospice when end of life nears. I can provide support, direction and encouragement related to spiritual matters and psychological matters related to death and dying.

Experience

I am a certified hospice and palliative care nurse, and have been the director of nurses for three hospice centers, under two different companies. I have also worked as a contract hospice nurse for a large American hospice company. On a personal level, my father died without benefit of hospice (it was not popular then). I have taken care of dying patients in hospitals and recognize that for most of us, it is preferable to die at home (or in our residence, wherever that may be), comfortably and without anxiety. Also I had no support when my father died; hospice clients are the whole family (however that is defined by the "patient"), and support is provided at least a year after the patient passes. These are the sorts of things (and probably others) that I can help with.

Organizations
HPNA (Hospice and Palliative Nurses Association)

Publications
none yet

Education/Credentials
Registered Nurse (TX), Licensed Marriage and Family Therapist (TX) ADN Nursing, Excelsior College, Albany, New York (2004) 4.0 GPA BA, Psychology (minor Social Work), Oklahoma University, Norman, OK (1986) 3.67 GPA MHR (MA) Human Relations, Oklahoma University, Norman, OK (1988) 3.5 GPA

Awards and Honors
Phi Beta Kappa (and others)

Past/Present Clients
Unable to name as this would violate their privacy (and HIPAA....)

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