The H Word
The word hospice is surrounded by mystery and misconception. Hospice is often misunderstood as a place where patients go to die, where all treatment stops, where a DNR and absolute certainty of prognosis are mandatory.
Most patients and healthcare providers are uncomfortable, to varying degrees, with the reality of a progressive and highly symptomatic terminal illness. They also misunderstand the intent of the Medicare hospice benefit.
The Medicare hospice benefit provides all the healthcare needs for a vulnerable population, and helps prevent overutilization of the ED and hospital near the end of life. In reality, hospice is a philosophy of care for patients with terminal illnesses who are entering the last six months of life. Hospice is not a place, but a set of services brought to patients wherever they call home.
Hospice patients have opted for a symptom-oriented approach to care over aggressive, disease-modifying therapy, which too often comes at the expense of quality of life. Hospice care is provided by an interdisciplinary team with the patient and family at its center. The focus is on expert management of distressing physical, emotional and spiritual symptoms.
Hospice provides all medications and services related to the terminal prognosis, including physician home visits for symptom management. A patient who has elected hospice receives multiple visits each week by various disciplines; goals of care are addressed and symptoms are managed. Even after the patient dies, regardless of his/her length of enrollment, family members have access to hospice bereavement services for at least a year.
"Mysterious? Hardly. I think of the “H” word as human—a natural, gentle, compassionate intervention for a vulnerable population," says Eric S. Shaban, MD, VITAS Regional Medical Director.