Understanding Hospice Care

A brief overview of what it is and how it works

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By:

Benjamin Horn

I can vividly recall when I first heard the word “hospice.” I was barely nine years old when I learned my grandfather was entering hospice for pancreatic cancer. I found myself confused and lost as to what was happening: "What is hospice?"  "What is happening to my grandfather?" Over the 6 months that my grandfather was in hospice, I came to appreciate the gravity of his condition and respect the level of care he received. 

Making a decision on whether or not to choose hospice care can be daunting, whether making that decision for yourself or on behalf of a loved one, but know that everyone's situation at end-of-life is unique. 

What Does Hospice Care Mean? 
Hospice Care is an alternative to spending the final moments of life in a hospital; it allows individuals to spend the end of their lives surrounded by loved ones, family, friends, and pets, often in the comfort of their own home. Hospice is traditionally reserved for those whose life expectancy is six months or less and involves palliative-based care, or pain and symptom management/relief, rather than the ongoing curative measures you might find in a hospital. Some hospitals and nursing home facilities offer hospice on-site, while other hospice programs only offer their services in the patient’s own home. 

How Does Hospice Care Work?
Hospice care is a multidisciplinary, team-based approach to end-of-life care. Services typically comprise of nursing, social care workers, at-home health aides, a chaplain or other religious leader, volunteers, and a hospice medical director. Hospice provides four levels of care for both the patient and their family members: routine home care, inpatient care, continuous care, and respite care. 

Most hospice care is provided in the form of routine home care at the patient’s home. Providing care at one’s home gives the patient a sense of familiarity and comfort and helps mitigate the stress that might come with being away from family members at a hospital. Members of the hospice care team visit the patient at their home to assess current and ongoing symptoms and adjust medications in order to alleviate pain. Family members do not need to worry about securing a hospital-style bed, a commode, supplemental oxygen, or any of the medicine, as these are all covered under hospice care. 

Some patients have more complex cases and require more frequent care. If a patient has pain that cannot be managed with medication alone, they may need to visit a hospital. Being in hospice does not disqualify someone from being able to go to the hospital. In these care settings, hospice teams on staff will visit daily and manage their needs continuously as they arise. Individuals will have the hospital team as well as the hospice team to assist them.

In contrast to inpatient hospice care, continuous care is when symptoms can be managed but the patient needs more direct levels of care. Continuous care can provide up to twenty-four hours of medical care in the comfort of the patient’s home. This level of care allows the staff to manage complicated symptoms during a pain crisis that can be managed over time and do not require hospitalization. 

Finally, hospice care services provide comfort to the family members or friends that are assisting in providing care through respite care. Respite care allows for skilled hospice care staff or volunteers to come and relieve family caregivers from their duties. Family members can leave the home or stay, but it provides them a moment to catch their breath and recharge. 

Who Can Benefit from Hospice Care?
Hospice care providers offer specialized knowledge and medical skills in support of the patient and their family members at the end of life. When a person has a terminal illness of six months or less, hospice can help patients and family members make the most out of their remaining time together. Hospice care is most often used by older patients, but it is available to anyone, including children, as long as their terminal illness is in its last stages. Many individuals with chronic and/or genetic ailments like advanced stages of cancer, Alzheimer's Disease, Lou Gehrig Disease (ALS), AIDS, and severe chronic disease utilize hospice care at the end of their lives, finding benefit in its extreme level of care. No individual is left behind despite what conditions they may be facing.

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Benjamin Horn is a medical student that will be entering medical residency in 2021. He has had the opportunity to work in hospice and palliative care facilities in the US, as well as in Germany, furthering his passion in the medical field. Additionally, Benjamin has used his Masters in Bioethics to further this passion by examining conversations in end-of-life care as well as the emotions that arise during these difficult times.

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