The patient was a frail, elderly woman who was in the hospital for the fourth time in six months. Her loving daughter had made a promise that she would never let her mother go to a nursing home, yet now she was facing a heart-wrenching dilemma. She knew her mother needed more nursing care than she knew how to provide. She also realized that the repeated hospitalizations and trips to the doctor were taking a toll on her mother and herself. The daughter began to remember what she had gone through with her father a few years earlier and tears welled up in her eyes.
When making decisions about whether someone needs hospice, oftentimes people don’t take into consideration the fact that they need the hospice care just as much as their loved one does. Hospice service helps reduce stress for both the patient and the caregiver, allowing them more space for quality time spent together and other important matters.
Services such as those provided by the Medicare Hospice Benefit are designed to support the family and caregivers emotionally, spiritually and in practical ways as both patient and loved ones prepare for the coming passing and loss. The Medicare Hospice Benefit is for patients who have advanced illness or debility that is likely to result in death in 180 days less.
Trips and visits, often delayed because of frequent hospitalizations or doctor visits, can be accomplished with hospice through careful planning and coordination of services. A nun under my care with very weak heart wanted to travel to Rome, Italy for the canonization of an individual she had known personally. In anticipation of the trip she was hospitalized for several days to receive intravenous medication to strengthen her heart. She was discharged on the day of her flight, went to Rome with a group of friends, enjoyed the ceremony and returned home safely. She died less than a month later, with a contented feeling that her life was complete.
The Benefits of Hospice
Hospice provides a set of coordinated services that address the practical, emotional, spiritual and medical issues that a patient and family face in the final months of life. Unfortunately, too many families opt for these services long after the patient was actually eligible. Studies have shown that patients who enroll earlier live longer and have a better quality of life than similar patients who chose aggressive medical interventions, yet the median time on hospice is still less than three weeks.
There are at least two reasons patients on hospice live longer. First, there is a point at which aggressive medical interventions and too many medications start to cause more harm than good. More is not necessarily better. Second, by turning attention to the patient and family, rather than focusing on ‘fighting’ a disease, it is possible to address the kinds of emotional, spiritual and practical things that make life worth living in the first place. Having a team of individuals providing patient and family-centered services and guidance at a time in which fear, stress and anxiety may be taking a toll, has been shown to bring back control and allow more patients to remain in their homes.
Bereavement often begins before death. It usually is a period with a mix of emotions. There is sadness and grief because of the reality of the coming loss and separation. However, this time also should be a time of growth and a celebration of life for both patient and family.
Hospice often provides the space needed for relationships to be strengthened or mended. Also, practical issues that have been ignored or delayed, such as wills, advance directives, power-ofattorneys and other important matters can be completed. Addressing these issues gives a voice and some control to matters and situations that easily can get out of control later. With a team to help her provide coordinated services in the home, the daughter mentioned at the beginning of this piece will be able to keep her promise to her mother and find greater fulfillment in whatever time is left.
Dr. Timothy Domer, a specialist in palliative care with Hudson Valley Hospital Physicians (HVHP) is affiliated with Hospice of Orange and Sullivan Counties, Inc., located in Newburgh. For more information, contact 561- 6111 or go to HospiceOfOrange.com.