Hospice

What is Hospice?

Hospice is a form of end-of-life care that emphasizes palliative care services. End-of-life care refers to supportive services for individuals with advanced and potentially fatal illnesses. These services may include curative, life-prolonging, and palliative treatments. Palliative care includes comfort services designed to provide relief from symptoms without necessarily addressing or resolving underlying health problems. The intent is to provide relief from symptoms associated with serious, chronic, or terminal illness to improve quality of life, not to either extend or hasten the dying process. Hospice programs differ from other end-of-life care and palliative programs by specific patient enrollment requirements; they are limited to terminally ill patients with limited life expectancy. In addition, to be recognized as a hospice program, formal licensure or accreditation according to state regulations is required.

Hospice provides palliative or comfort care only to patients who have been diagnosed with terminal illness. Eligibility for inclusion in a hospice program varies by state and institution, but generally requires that the patient not only have a terminal diagnosis, for example, cancer or AIDS, but also a prognosis or life expectancy of less than six or 12 months to live. Determining a specific prognosis is very difficult and has proved to be a problem in hospice enrollment. Physicians are often reluctant to suggest that a patient has such a limited life span. Rather than requiring a definitive prognosis, enrollment in hospice may be based on a reasonable belief that a patient is likely to die within the next six months or year.

In addition to these eligibility requirements, patients may be required to have a “do not resuscitate” (DNR) order. This is a statement that allows health care professionals to forgo cardiopulmonary resuscitation (CPR) in the event that the patient's heart stops or other advance directives that limit life-sustaining treatment, for example, the use of ventilators, feeding tubes, or antibiotics. To be enrolled in a hospice program, patients must consent to the treatment approach and specific requirements. For those who are unable to consent themselves, for example, unconscious, comatose, or mentally incapacitated patients, a surrogate decision maker, usually a close family member, may consent on the patient's behalf.

Hospice is considered a concept or philosophy of care rather than a place. The concept dates back to medieval times and symbolizes care designed to comfort travelers and the sick. While hospice care may be provided in a particular place such as a unit in a hospital or a free-standing facility, it is more often provided in a patient's home or care setting (e.g., nursing home or assisted living facility), wherever it is most appropriate for the patient. The concept is one of comprehensive, interdisciplinary care for patients approaching the end of their lives. The emphasis is on palliative or comfort care rather than curative treatment, and usually includes emotional, spiritual, and practical support as well as physical treatment. Some curative treatments, such as hip replacement surgery or radiation therapy for cancer, may be offered to increase the patient's comfort. The goal is to offer personalized services [Page 446]to support patients comfortably through the dying process.

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