By Timothy Corbin, M.D., Scripps Health
When a person is diagnosed with a terminal illness, quality of life is a top priority, especially during the last weeks to months. Many of those patients choose to spend their remaining days in the comfort of their own home and may require more personal or medical care than their family or loved ones can provide. Hospice enables terminally ill patients to live out their lives in a comfortable, familiar setting while receiving the total care they need.
Hospice provides patients with full-service care. Multidisciplinary teams of care providers evaluate the patient as a whole person with comprehensive needs. These needs focus on the person’s physical, mental, emotional, and spiritual aspects. Teams include physicians, nurses, medical social workers, chaplains, and health care aides, each of which has specialized expertise in caring for patients at end-of-life.
Hospice physicians specialize in symptom management, such as pain, shortness of breath, or anxiety, among others. They not only treat these symptoms but have the expertise to often anticipate and avoid them. This leads to the lessening of pain and suffering, allowing patients to focus on what may be most important to them at end of life, such as relationships with their loved ones; a recent patient wanted to attend a granddaughter’s wedding and be able to once again play a round of golf.
As the designated case manager, the hospice nurse has the most contact with the patient. Hospice nurses manage and coordinate all care; they educate and advocate for their patients, manage medications, evaluate symptoms and coordinate medical treatments with the physicians.
Medical social workers help coordinate social needs and can greatly lessen burdens felt by a family. They can often help identify added resources available to patients and families.
Chaplains address spiritual care needs. They help identify what spirituality means to a given patient and how that may be having an impact on his or her current life. If a patient identifies with a particular religion, the chaplains can help coordinate care that respects and supports the patient’s religious beliefs.
In addition to home aides, who help with issues at home such as bathing and personal care, volunteers are also part of the team. Volunteers, for example, may read to patients or may give the gift of just being present so no patient is ever alone.
Together, team members strive to provide the best quality of life for their patients day to day and honor the patients’ wishes for how they want to spend their time.
While most hospice services are designed to care for patients in their own homes, team members may provide care in assisted living or skilled nursing facilities if appropriate. Some hospice services also have their own facilities or are associated with hospital systems, such as Scripps. Scripps’ hospice care ensures that Scripps patients have continuity of care. The hospice team continues to help coordinate care with primary physicians as well as specialists as may be required.
Hospice benefits not only patients, but their family members and friends as well. Team members provide support for those facing the loss of a loved one. In addition to providing bereavement services after a patient passes, hospice can be there to help family and friends with the grieving process.
Most insurance companies, including Medicare, will cover hospice for qualified patients. Although many patients are older, hospice is available to patients of any age—including children—who have a terminal diagnosis with limited life expectancy. Generally, a physician must agree that a patient’s life expectancy is less than six months in order for hospice care to be covered; however, because it is nearly impossible to predict exactly how long a patient will live, some patients may receive hospice care beyond six months.
Like hospice care, palliative care also focuses on providing comfort and support to very ill patients, focuses on the whole person and evaluates the physical, mental, emotional, and spiritual needs. Unlike hospice care, however, palliative care is offered to patients who are still being treated for their illnesses and are not necessarily near the end of life; in fact, many make a full recovery. Palliative care is provided in parallel with curative treatments and can be a tremendous resource. A patent with cancer, for example, may receive palliative care to help with the side effects of chemotherapy treatment or can evaluate and treat pain.
Timothy Corbin, MD, is the medical director for the Scripps Hospice Program. “To Your Health” is brought to you by the physicians and staff at Scripps. For more information or a physician referral, call 1-800-SCRIPPS or visit www.scripps.org.