Hospice

Hospice, service that provides patients in the last several months of a terminal illness with medical care and counseling to ensure the best possible quality of life. Hospice care seeks not to cure disease, but to relieve pain and symptoms, and provide psychological and emotional support to patients and their families during the last months of life and through the dying process. Hospice services also help families with their grief in the year following the death.

The term hospice was first used to describe way stations for travelers and religious pilgrims during the Middle Ages. In the late 1800s, a nun in Dublin, Ireland, donated her house as a special home for dying patients. She called this home a hospice because she regarded dying as one stage of a journey. The modern hospice movement began in 1967 when British physician, nurse, and social worker Cicely Saunders opened St. Christopher’s Hospice in South London. Since then, hospice centers have opened throughout the world.

Patients in the United States generally enter hospice care in the last six months of a terminal illness. Most recipients of hospice care are cancer patients, and less often, patients in the last stages of heart failure, emphysema, cirrhosis of the liver, kidney failure, or advanced dementia, the intellectual degeneration caused by massive strokes or neurological conditions such as Alzheimer’s disease. Patients with acquired immunodeficiency syndrome (AIDS) have also come to rely on hospice care as part of their treatment program. AIDS patients are challenging to hospice care because they often experience fluctuations in health that allow them to periodically cease hospice care and return to their normal activities for a time.

Hospice care is usually provided in the patient’s home by a multidisciplinary team of health-care professionals and trained volunteers, including family members. When home care is not possible, hospice care may be provided in nursing homes, hospitals, and in homelike hospice centers. Hospice patients receive medication for pain and anxiety, and other medications to control various symptoms of their disease. Dietitians provide nutritional counseling to help ensure that patients who suffer from nausea or loss of appetite receive enough nutrients, and physical therapists help patients exercise to maintain strength and range of motion. When patients can no longer care for themselves, home health aides assist with daily activities. Trained volunteers may bring food, help with housework, or simply keep the patient company. Hospice patients may also receive counseling from social workers and clergy members if they so choose.

While professionals and trained volunteers are essential components of hospice care, family members provide much of the daily care that a patient receives at home. This practice helps relieve the distress of a dying patient by providing a familiar environment in which the patient is surrounded by loved ones, and helps both the patient and family prepare for death in a way that many find rewarding. Caring for an ailing loved one can take an enormous emotional and physical toll on the family, however. When they need a short break from providing care, families may get help from trained volunteers, or the patient may be able to spend a brief period in a homelike hospice center. Hospice services also provide counseling and support to family members during the terminal illness and grieving process.

Many studies have found that hospice care for dying patients costs less than mainstream medical care. In the United States, federal health-insurance programs such as Medicare and Medicaid usually cover hospice care, as do many private health-insurance plans. These plans typically cover the cost of hospice care when a physician certifies that should the disease run its normal course, the patient would die within six months. Medicare rules state that to be eligible for hospice coverage, patients must discontinue medical care aimed at curing their disease. Many not-for-profit hospice providers use donations to provide care to indigent patients or to patients whose health insurance does not cover hospice care.