WHEN IS IT "TIME FOR HOSPICE"?
by Mary "Rusty" Hudson, R.N.

    When the patient says, "Enough treatment. Let me die," physicians and family ought to listen. Families may feel guilty "letting him go," and Hospice staff can often help them come to terms with their feelings about the patient's choice.

    Second, Medicare regulations provide for Hospice care for six months or longer when the medical record shows it is justifiable. Although time of death is not predictable with certainty, it is clear that death need not be imminent for a patient to be admitted to the Hospice program. Sadly, we too often admit patients in the last day or week of life, and recognize that they and their families were prevented from receiving the physical and emotional support they badly needed during a long and agonizing illness.

    Third, patients, families, and physicians need to know what Hospice offers:

1. We offer care for six months to one year or longer.

2. Our goal is to keep the patient free of pain and other symptoms. We neither lengthen nor shorten life. We try to make the life that remains better.

3. The patient's own physician remains his or her physician. Hospice staff work under that physician's orders and keep the physician informed of the patient's needs and condition. When trips to the doctor's office become too arduous, the nurse can report on the patient's condition and carry out the doctor's orders.

4. We are a team of nurses, certified nursing assistants, social workers, chaplains, and any other professionals and volunteers needed to support the patient and family to cope with the physical, emotional, spiritual and bureaucratic aspects of terminal illness. We spend time answering questions, giving care, and interpreting the disease process to the patient and family. We are available 24 hours a day, 365 days a year. Where can you match that kind of care?

5. Our patients usually prefer to remain at home. The family or someone it provides such as a companion in the home or a nursing home must be available to give the patient round-the-clock care. Hospice cannot provide the day-to-day routine custodial care needed throughout the illness. We give care during visits of approximately an hour, and when medically indicated, we provide continuous nursing care in the home or placement in hospital for a limited number of days for pain and symptom management and imminent death.

6. Our patients, contrary to common belief, need not have cancer. Some of our patients have heart or kidney disease, extreme old age and failure to thrive, AIDS, Parkinson's disease, Alzheimer's disease, strokes, and a variety of other conditions that will predictably lead to death within six months to a year. They range from infancy to old age.

7. Hospice pays for durable medical equipment, supplies and medications to control symptoms.

8. Hospice is supported by reimbursements from Medicare, Medicaid, HMOs, private insurance companies, and donations. We never turn a patient away for financial reasons, send a bill, or attach property. We do welcome donations and are grateful to the hard-working groups and individuals who raise funds to help make up our deficits. Many wonderful people, some of them friends and relatives of former patients, volunteer their time to our patients and in the office.

9. We strive to prepare the family for the death, to facilitate anticipatory grieving, and to help the survivors begin making plans. We provide follow-up support for the bereaved family and significant others for 13 months after the patient's death to help the survivors get on with emotionally healthy lives.