From the Grace Archives | Originally Published March 10, 2011 | By Dr Ramchandran
Hospice is both an organization and a philosophy of care. It was first conceptualized in the United Kingdom in 1967 by Dame Cicely Saunders who was a nurse, physician and social worker. She advocated for a multidisciplinary approach to the care of people with advanced illness with a focus not only on the physical, but on the social, emotional, psychological and spiritual. She started the first free standing hospice called St. Christopher’s hospice. In the 1970’s, hospice was brought to the United States and the first hospice was Connecticut Hospice in New Haven. In 1982, The Medicare Hospice Benefit was passed. This entitled all patients with Medicare the right to hospice regardless of ability to pay.
Hospice is appropriate for any patient with an advanced illness who no longer benefits from curative or life prolonging therapy. The focus is quality of life with a comprehensive multidisciplinary approach including a team with a physician, nurse, social worker, and chaplain. Hospice care can be provided in a free standing hospice, at home, or in a facility.
Below are some common misconceptions about hospice, with appropriate clarification.
Fiction: Hospice “expires” after six months.
Fact: Hospice is a benefit for patients with advanced illness with a prognosis of six months or less based on a physician’s clinical judgement. However the hospice benefit does not expire at “6 months”. Patients can be recertified for the hospice if they continue to meet eligibility based on physican assessment.
Fiction: Hospice is mainly for psychological support.
Fact: The focus of hospice is management of symptoms, physical, and psychological, as well as social and spiritual support for the patient and their family. The hospice team includes a physician, a nurse, a social worker and often a chaplain, volunteers, and nursing aides.
Fiction: Hospice provides 24 hour care.
Fact: Hospice is a medical team that makes brief (approximately 1 hour) but frequent (2-3 x a week) to make an assessment of physical and psycho-social needs and make appropriate recommendations.
Fiction: Patients on hospice can no longer see their primary oncologist.
Fact: Patients on hospice can continue to see their regular physician. Their treating physician can continue to be involved in treatment recommendations.
Fiction: Hospice requires patients to be DNR/DNI (no CPR/ no intubation).
Fact: There are no requirements regarding code status for hospice enrollment.
Fiction: Hospice is the same as palliative care.
Fact: Palliative care is an official medical specialty that focuses on the multidisciplinary care of patients with complicated illness. Palliative care can be applicable to any patient, at any stage of illness. The scope of care can include management of complex medical symptoms such as refractory pain or nausea, as well as support and guidance for patients and their families during transitions in care.
Fiction: Hospice is available to everyone, without regard to type of insurance.
Fact: For patients over 65, with Medicare, hospice is part of the Medicare benefit. However for patients under 65, the hospice benefit differs based on individual insurance.
Fiction: Hospice can only be provided at home.
Fact: Hospice can be provided at home, in a facility, or a stand alone hospice.
Fiction: Hospice is a one way street; once enrolled, you cannot de-enroll.
Fact: Patients can de-enroll in hospice at any time. For example, if a new clinical trial opens up, or if clinical status improves, or if it just doesn’t seem to be a right fit.
Fiction: Hospice provides care only for the patient with illness.
Fact: Hospice provides care for the patient and family. They continue to provide care for a patient’s family, after the patient dies, through bereavement support.