What Is Hospice and When Should It Be Considered?

When a loved one is suffering from a terminal illness and all treatment options have been tried and exhausted, the next best option is hospice care. More is not better; in fact, it has been demonstrated that more when it comes to healthcare in terminally ill patients results in more suffering rather than an improved quality of life. Some studies have defined “more” as an approach that results in as many as twelve different medical specialists involved in the care of a loved one during this terminal period. “More” has been defined as treatment that results in an imbalance of expenses, in which 85% of Medicare expenditures are spent reactively on 10-15% of Medicare beneficiaries in this terminal period. As a physician and a son of two physicians, I too was faced with this difficult decision with my father. Despite all my medical training and rational medical reasoning, I was conflicted in making this choice. Do I, for selfish reasons, try to extend my father’s life, or, being a father’s son and knowing how he chose to live life, allow him to die on his own terms? It is a very humbling and awakening event caring for a dying parent, regardless of one’s career and background. In this article, I maintain that one needs to put personal guilt, fear, and selfishness aside, and when faced with making a decision on behalf of terminally ill loved ones, one must make the decision with their best interest, not one’s own, in mind.

What Is Hospice Care?

Hospice care is a specialized care provided by healthcare professionals that is designed to provide medical services, emotional and psychological support, and spiritual and social resources to offer the maximum comfort possible. It aims to improve quality of life for those who are terminally ill or who are in the last stages of serious illnesses such as cancer or heart failure. Hospice care also helps family members of the patients by providing them with counseling, practical support, and respite care to deal with the emotional challenges of caring for a loved one, explains Dr. Alexander Salerno.

Hospice care can be summarized as a place where professional caregivers and experienced physicians and nurses provide personalized choices so that patients can receive help with basic, hour-by-hour physical needs, along with up-to-date pain and symptom management approaches that provide peace of mind to the patients and help them live better lives despite their illness.

Hospice care does not provide medical treatment to cure the underlying disease; rather, its goal is to provide care to support the highest quality of life possible to those who have little time left. Hospice care is a type of palliative care, states Dr. Salerno.

Dr Salerno says that hospice care is for anyone who is terminally ill, chronically ill, or seriously ill and who is expected to have only six months or less to live. The length of hospice care may extend past six months when needed; it is provided as long as the patient’s doctor and caregiver team consider it to be appropriate for the patient. Hospice care is not only for those suffering from cancer, but is also for those suffering from other diseases such as heart disorders, kidney failure, dementia, or chronic obstructive pulmonary disease.

Hospice care can be provided at home, or is also available at hospitals, nursing homes, assisted living facilities, and dedicated hospice facilities.

When to Consider Hospice Care

Hospice care is to be considered when:

  • An individual has a disease or illness that is expected to shorten his or her life.
  • The treatment option to cure the illness or prolong life has been fruitless and instead of benefiting from it, the patient sees it as a burden.
  • The patient who is suffering wishes to spend her remaining life peacefully and comfortably in a setting of her choice, such as at home.
  • The patient wants family members and friends around him and wants them to participate in the care management.
  • The relatives of the patient want their loved one to have a comfortable and quality life at home instead of going through painful medication and treatment at the hospital.

Hospice care can be considered when the person suffering from the terminal illness or his family wishes to change the focus from disease-modifying care to care that provides comfort and improves the quality of life. This sensitive issue can be discussed with hospice care providers, and then the appropriate hospice care-providing facility can be chosen.

 


Since 2001, Dr. Alexander G. Salerno has led Salerno Medical Associates in East Orange, New Jersey. Dr. Alexander Salerno focuses largely on urban communities and on delivering patient education about both medical and behavioral health issues.