COLUMN: Celebrating hospice
November was, among other things, National Hospice Month.
The hospice approach and philosophy evolved in the early 1970s through the efforts of Elizabeth Kubler-Ross and Dame Cecily Saunders who in actions counter to the culture of the times chose to focus great attention to end of life times and the dying.
In 1975, hospice programs served fewer than 6,000 patients a year. Now more than 25 years later, there are more than 3,200 hospices throughout the country serving an estimated 775,000 patients and families per year. Locally, Carol Martinez established IHC Hospice of Cache Valley more than 21 years ago. Most of those served by hospices across the country are Medicare beneficiaries. Less than 1 percent of Medicare beneficiaries live in areas without access to a hospice program.
In a recent national study, Utah scored very low in providing end-of-life care in every area measured. Some of those included pain management, getting hospice services before death was imminent, and allowing people to die where they say they prefer to die in their own homes. We need to begin the conversation about needs and wishes at end of life with our loved ones before the need arises.
When patients and families choose hospice care, they choose a service unlike any other. Hospice care focuses on the patient and family and the control of their symptoms and suffering whether physical, psychological or spiritual. Aggressive medical care eases the emotional and spiritual suffering to provide comfort until death rather than rehabilitative services to prolong life. The multidisciplinary approach includes doctors, nurses, social workers, aides, trained volunteers, chaplains and bereavement counselors. Hospice care focuses on diminishing the financial impact of the terminal illness on the patient and family. Hospice care is available to Medicare, Medicaid, most private insurance plan and HMO beneficiaries at little or no cost to the recipient. IHC Hospice of Cache Valley is a not-for-profit hospice that accepts donations and community contributions and is able to provide free services to those who lack the health care coverage.
Despite this access and comprehensive care, the National Hospice and Palliative Care Organization estimates that for every patient who is currently receiving hospice care, there are two more who could benefit. One might ask, “Why is there such a lack of awareness?” In 2002, the NHPCO found that only 15 percent of Americans know that Medicare is the primary source of coverage for hospice care. Only two out of five polled believe that specialized end-of-life care is paid for by health insurance.
Along with the issue of access to hospice care is the other dilemma of getting the care when the patient is near to death. The Medicare standard is a six-month life expectancy, yet many patients are receiving the service for less than a week and before they die, some imminently dying before the admission process is complete.
Who qualifies? In 1998, a little more than 57 percent of the recipients of hospice care had cancer-related diagnoses. Hospice is no longer a service primarily for those with a cancer diagnosis. If the health condition of the individual is considered life limiting (six months or less) and the general condition seems to be in an irreversible decline, the individual may qualify for hospice services.
IHC Hospice of Cache Valley has been providing end-of-life care for more than 20 years. For more information regarding care for you or your loved one, please call 716-5349.
Patricia Sadoski is a registered nurse and coordinator of IHC Hospice of Cache Valley and adjunct instructor in family and human development. Comments can be sent to her at lopsados@ihc.com.