Is Hospice the Right Choice?
By Miranda Pacchiana, MSW
I became a hospice volunteer years ago, after attending a family friend’s funeral. During the service, I listened to his adult children describe their father’s last days under hospice care, and I was struck by how peaceful his transition seemed to be for him and his loved ones. With the help of a quality hospice team, this gentleman was able to take control of his final days, allowing him to make his last moments with family meaningful and beneficial for all of them.
The man I have described, who I will call Sam, had a degenerative disease. He gradually lost his sight in the last few years, and had become completely physically dependent on others, eventually receiving hospice care in his home. After some time, Sam made a decision to have his feeding tubes discontinued. Over the next few days, as Sam’s family described, he became more lucid than he had been in months. He asked his son, a professional writer, to compose his eulogy and read it out loud to him. Sam had the opportunity to hear himself depicted, in eloquent detail, as a father who was loving and devoted, compassionate and quirky. I remember one part in which Sam’s son described the ritual that he and his sister had carried out each evening as children, of sitting on the stone steps of their walk and waiting for their dad to arrive home from his job in New York City. He captured in words the excitement with which they all greeted each other, an evocative scene of family closeness and evidence of the value that Sam’s presence had in the lives of his loved ones.
Sam made sure to have private time with his daughter as well during his final days. Together they chose a Walt Whitman poem for his service and selected the passages that she would read in his honor. Father and daughter joked and expressed their love and affection one last time. Soon after, Sam passed away.
It seemed to me that Sam experienced the kindest and most desirable kind of death, for the hospice program made sure that Sam was supported and comforted, both physically and emotionally, and that his own and his family’s unique needs were attended to. Sam was allowed to choose the time and manner of his own death, and his wishes were respected and carried out after he was gone. After I had glimpsed this inspiring example of a man’s final steps toward death, I signed up to train as a volunteer myself.
To die with dignity, with as little pain as possible, surrounded by loved ones – these are important features of the hospice philosophy. Death is seen as a natural and normal process. Hospice seeks to enhance the quality of life in the patient’s time remaining. They attend to the unique wishes of the individuals involved so that they may achieve a degree of satisfaction in the preparation for death, and afterwards. Like a small community, hospice provides a variety of services for the patient and family in order to attain these worthwhile goals.
You may be considering hospice for yourself or a loved one. The following information will help you to learn more about the specifics that hospice has to offer, as well as the criteria to consider in making the choice for your family.
- Hospice is a palliative program, meaning that it provides comfort and relief from pain, rather than a cure for illness. The quality of the patient’s life is emphasized over the quantity, and every effort is made to ease the patient’s discomfort.
- In order to qualify for hospice, patients must have a life-expectancy of six months or less. They can be referred by a personal physician, a family member, or by request of the patient.
- Hospice services are provided by a team which consists of: a physician, a nurse, social workers, counselors, home health aides, clergy, therapists and volunteers. The patient and family have the freedom to choose the services they desire, and they can adapt the care plan as needed. Most hospices provide continuing support for family members for at least a year following the death of the patient.
- Hospice also provides medications as well as necessary equipment and supplies.
- Nursing care is not provided around the clock. However, the hospice team is available 24 hours a day for emergencies.
- Hospice aims to attend to all kinds of pain, including emotional and spiritual. In addition to the latest pain medications and devices for symptom relief, they may offer massage, music therapy, art therapy, Reiki, nutritional counseling, emotional and spiritual counseling, and more.
- Hospice care does not necessarily take place in the home. It may be provided in nursing homes, hospitals and assisted living facilities. Some programs have their own inpatient hospice programs.
- Hospice care is covered by Medicare in every state, by Medicaid in 47 states, and my most private insurance providers. This coverage extends to services to the patient’s family.
- There are many types of hospice programs; some for profit, and some non-profit. To find the best hospice program for your needs, inquire with your physician and others in your community. You may want to interview various programs to learn about their specific services and approach. There are many factors to consider when choosing a hospice program. For a detailed list, click on: http://www.hnmd.org/publications/How_to_Select_a_Hospice_Program.pdf and read through the Question Checklist, the last subject listed in the “options” column on the left of the page.
- Patients occasionally “graduate” from hospice. Some patients, provided with a comprehensive team approach to their case, begin to improve. If their health advances significantly enough, they may be taken off hospice. Of course, they can resume services at a later time if they are again deemed appropriate candidates.
The final steps toward the end of life can be a challenge to navigate on many levels. With the support, care and guidance of a quality hospice program, the final transition can be made easier for all involved. We, the staff of Growing Options, are available to assist you and your family in deciding whether it’s the right time for hospice, and if so, which program will best suit your unique needs and how to get started