Hospice care and end-of-life services

¶ … health care system has focused on the prevention and cure of disease and illness. When people got sick, every bit of energy and finances went into trying to figure out how to stop it. This was true even when the patient had a disorder or a disease that was deemed incurable. For many years when someone got a disease in which there was no cure, it did not change the method of treatment. The medical community, the family and the patient continued to try every possible avenue to stop the progress. Often times the patient would submit to painful and disorienting treatments, because they didn't want to disappoint their family members or their doctors. At the same time the medical community was expanding the length of life so that many people were living longer than ever before. These two things began to clash. At what point do people stop trying to cure diseases, that are incurable? At what point is it okay for the patient to say enough and die with dignity? In recent years the shift in the United States has moved from constant cure efforts to knowing when it was time to stop. The patients who were going to die, were allowed to do so, with their dignity in tact. Whether the patient was a child, a teenager or an adult, the nation has moved in the direction of providing comfort to the dying and allowing nature to take its course. Often times, the patients and their families face impending death with fear and lack of education. They are not sure what to expect, they are not sure who to ask and the family doesn't know whether to move in closer or give the patient isolation. The Hospice Foundation is an organization that is solely about dying. The organization is based in the belief that death is inevitable and the kindest thing to do for the dying is to allow it and usher them to it with love, comfort and acceptance. This paper proposes that it is time to provide Hospice services to other nations. The need for Hospice services in Morocco and in Egypt is easily defined. The need for services is also easily understood if one examines the place in medical ability that the world has reached and the care and comforts that Hospice takes in the treatment not only of the patients, but in their families during the process of dying.

There are several supporting elements for the proposal of Hospice services in Morocco and Egypt. One of those elements is the shortage of doctors in the nations. Egypt has reported that for every 1,000 residents there are only 2.1 doctors to care for them. It is vital with such a shortage to begin the acceptance that terminally ill patients would be better served through Hospice services and let the doctors handle the patients who need medical care for the purpose of diagnosis and treatment

The government has drawn up a comprehensive plan to overhaul the delivery of healthcare in Egypt, with the focus shifting from curative to preventative care. The most radical element of this programme is the establishment of the family practitioner as the starting point for healthcare. The idea is that the family doctor will carry out regular check-ups, tracking families through illnesses, births and vaccinations

This means that instead of having more funding for medical services there will be less as the populations continue to grow, providing another element of proof that Hospice could do a great service for the nations.

HOSPICE

Before one can begin to analyze the many reasons that Hospice services are needed and warranted in the nations of Egypt and Morocco, it is important to understand what Hospice is and how it operates in America, where it was founded.

Hospice is often thought of as a place, or a number of places because of the facilities it often provides. If it is not thought of as a place then it is often thought of as people going into the homes of those who are terminally ill. Hospice is a concept in health care. It does provide facilities and it does send workers into homes, but the actual definition of Hospice is that it is a concept in health care delivery.

Hospice is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments

Hospice care does not make life longer, and it does not hasten death. It allows the natural process to occur and the concept is that it is okay, and it is something that can be entered with a minimal of suffering and a maximum amount of comfort.

Hospice works with a paid staff as well as a roster of volunteers who have been specially trained in the process and steps of the dying process.

Hospice has a single goal. It is to provide quality of life in the end days of a patient's life, and allowing that to happen through the offering of comfort and dignity.

Hospice operates by providing a specially trained team for each patient it has on its roster. The team works together to provide several things. One of the things that is unique to Hospice as opposed to other aspects of health care is the fact that it works not only with the patient but with the entire family. The team works together to do several things

Basically Hospice is focused on addressing every single symptom of the terminal disease or disorder. The major focus is of course on providing the alleviation of discomfort for the patient. While many health care facilities provide similar services Hospice continues further. Hospice works with the emotional and spiritual needs of the patient as well as the family as well

The social impact of the terminally ill also places a stress not only on the patient but also on the family of the patient. Hospice has trained specialists to help the family deal with the feelings of isolation that can occur when energy is used to care for a terminally ill patient.

Hospice also offers counseling and bereavement services to the family members of the dying. The entire premise of the organization is that the concept of dying must be accepted and it cannot be denied. It can be greeted with dignity if the support and comfort devices are in place

Hospice is a concept but it use facilities to provide that concept. Nurses and caretakers can be dispatched to the home of the terminally ill patient or the patient can reside in a Hospice facility for the end stages of his or her life. Often times a patient starts out with having the services come into the home. Eventually they move to the facility for the final stages. The facilities provide the same level of comfort and care to the patient and the family as they were providing in the home.

HISTORY

The word "hospice" stems from the Latin word "hospitium" meaning guesthouse. It was originally used to describe a place of shelter for weary and sick travelers returning from religious pilgrimages. During the 1960's, Dr. Cicely Saunders, a British physician began the modern hospice movement by establishing St. Christopher's Hospice near London. St. Christopher's organized a team approach to professional caregiving, and was the first program to use modern pain management techniques to compassionately care for the dying

How it Works

When a patient is deemed incurable and told to be in the last six months of life they become eligible to have the services of Hospice. Hospice sends a representative out to the house to meet with the patient, and if the patient desires, the family members of the patient. The referral to Hospice can either come from a doctor or the family who would contact Hospice services on their own.

Patients referred to hospice when life expectancy is approximately six months benefit most from hospice care. While patients must have a doctor's referral to enter hospice, the patient, family and friends can initiate the process by contacting a local hospice program

There are several initial steps to be taken for the Hospice services to be initiated for optimum benefit including:

Before providing care, hospice staff meets with the patient's personal physician(s) and a hospice physician to discuss patient history, current physical symptoms and life expectancy.

After an initial meeting with physicians, hospice staff meets with both the patient and their family. They discuss the hospice philosophy, available services and expectations.

Prior to service, staff and patients also discuss pain and comfort levels, support systems, financial and insurance resources, medications and equipment needs.

"plan of care" is developed for the patient. This plan is regularly reviewed and revised according to patient condition.

Bereavement services and counseling are typically available to loved ones for a year after the patient's death

This benefit covers all services, medications and equipment related to the illness. These include:

Physician services

Nursing services

Home health aides

Medical appliances and supplies

Spiritual, dietary, and other counseling

Continuous care during crisis periods

Trained volunteers

Bereavement services

Approximately 43 states and the District of Columbia offer hospice coverage under Medicaid

The need for Hospice can be clearly evidenced by the increasing number of patients who are entering the system. http://www.cdc.gov/nchs/images/nhhcsd/2000chart.gif

The below chart clears up some of the questions that are often asked of the program:

Myth: Hospice is where you go when there is "nothing else to be done."

Reality: Hospice is the "something more" that can be done for the patient and the family when the illness cannot be cured. It is a concept based on comfort-oriented care. Referral into hospice is a movement into another mode of therapy, which may be more appropriate for terminal care.

Myth: Families should be isolated from a dying patient.

Reality: Hospice staff believe that when family members (including children) experience the dying process in a caring environment, it helps counteract the fear of their own mortality and the mortality of their loved one.

Myth: Hospice care is more expensive.

Reality: Studies have shown hospice care to be no more costly. Frequently it is less expensive than conventional care during the last six months of life. Less high-cost technology is used, and family, friends, and volunteers provide 90% of the day-to-day patient care at home.

Myth: You can't keep you own doctor if you enter hospice.

Reality: Hospice physicians work closely with your doctor of choice to determine a plan of care

Hospice counts on volunteers. The American system has almost 100,000 volunteers working nationwide. Hospice believes that dying is more than a physical event, it is also a personal event and one that is a journey to be supported through comfort and understanding with an emphasis on acceptance.

Volunteers in hospice find it personally gratifying, intellectually stimulating, and emotionally meaningful to assist those in need at a critical point in their lives