Attending to a dying loved one in the peace and quiet of the home with caring children and grandchildren surrounding the bed can be a blessing and a spiritual experience for all involved.
There is a great divide separating the kind of care Americans say they want at the end of life and what our culture currently provides. Surveys show that we want to die at home, free of pain, surrounded by the people we love. But the vast majority of us die in the hospital, alone, and experiencing unnecessary discomfort.
It is unfortunate that many people who have died in a hospital or who have received heroic treatments to prolong life in a hospital or nursing home may have had the alternative of dying at home in familiar surroundings, with family or other loved ones at their side.
When someone is dying but there really is no hope for recovery, the family often calls 911 and starts a process which can result in great stress and great emotional discomfort. The loved one who is dying ends up in a hospital or nursing home in a strange environment, frightened and confused and tied to tubes and monitoring devices. This is not the ideal way in which to spend one’s last hours on earth.
The end of life cannot be predicted for any of us. We do not know when it will happen, who will be with us, how it will occur, or what we will feel. However, we do know that most people prefer to die at home surrounded by their loved ones because it allows them to be safe, comfortable and secure. As such, they are dying on their own terms. Hospice can allow this to happen. Memories of a loved one passing in peace can provide great comfort for family members in years to come.
When there is no longer hope for prolonging life, especially when this decision is made months in advance, hospice is a better alternative to other medical intervention. Advances in technology (home ventilators, tube feeding) and greater availability of services to support families at home (home care and hospice services) have made it easier for elders. children and families to choose to die at home.
Remember that not all people who are dying are elders. Many are children.
Hospice is a form of medically supportive care for patients who are terminally ill. It allows for compassion and dignity in the process of dying. A commonly used definition for terminally ill patients is,
“patients who have a progressive, incurable illness that will end in death despite good treatment, and who are sick enough that you would not be surprised if they died within six months.” A list of hospice providers in the state of Wisconsin can be found at http://www.wisconsinhospice.org/. The site has lots of other useful information.
Hospice care is a valuable service and is generally underused except for terminal cancer patients. Most families wait too long to have their doctor prescribe hospice from Medicare. Many doctors or family don’t often consider this care alternative for Alzheimer’s, degenerative old age or other debilitating illnesses where a person is going downhill fast. They should.
Hospice involves a team approach using the following providers.
- Family caregivers;
- The patient’ s personal physician;
- Hospice physician (or medical director);
- Nurses;
- Home health aides;
- Social workers;
- Clergy or other counselors;
- Home care agency staff
- Speech, physical, and occupational therapists, if needed.
The purpose of hospice is the following:
- To manage the patient’s pain and symptoms;
- To assist the patient with the emotional, psychosocial and spiritual aspects of dying;
- To provide needed medications, medical supplies, and equipment;
- To coach the family on how to care for the patient;
- To deliver special services like speech and physical therapy when needed;
- To makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time; and
- To provide bereavement care and counseling to surviving family and friends.
A person can receive hospice from Medicare if he or she is:
- Eligible for Medicare Part A (Hospital Insurance), and
- The doctor and the hospice medical director certify that the person is terminally ill and probably has less than six months to live, and
- The person or a family member signs a statement choosing hospice care instead of routine Medicare covered benefits for the terminal illness, and
- Care is received from a Medicare-approved hospice program.
A person may continue to receive regular Medicare benefits from his or her customary doctors for conditions not related to the hospice condition.
South Central Wisconsin is fortunate to have one of the finest hospice organizations in the country in HospiceCare,Inc. HospiceCare is nationally recognized for the comprehensive hospice services provided in patients’ homes (including assisted living facilities and nursing homes), the HospiceCare inpatient unit for symptom management and respite stays. It also has a residential facility.
Dying at home should be an option for all who choose it. If and when health care reform and universal health insurance become a reality in this country, it is important that palliative care and end-of-life services be a part of the coverage for all Americans!
Stephen P. Rudolph has a Masters Degree in Health Care Administration and is the owner of Comfort Keeper of South Central Wisconsin, a leading non-medical, in-home service offering care on an hourly, daily, weekly or live in basis. Comfort Keepers provides personal cares and other non-medical services for aging adults, new mothers and others needing assistance to allow them to continue living safely and in the privacy of their own, Comfort Keepers is a member of the Better Business Bureau of Wisconsin (A+ rating), the National Private Duty Association (NPDA)and is accredited by Shield Accreditation. Rudolph is Board Certified in Health Care Management, a Fellow in the American College of Health Care Executives(FACHE), is a Certified Senior Advisor (CSA) and a member of the Society of Certified Senior Advisors. He lives in Verona.