Providing hospice care

Caring institutionally for the dying

Description

Providing care for the terminally ill and dying where the emphasis is pain relief and quality of life rather than treatment. A general objective is to provide a dignified life to the end.

Implementation

The first U.S. hospice was opened in 1974 in New Haven, Connecticut, founded on a model developed in Britain. Every hospice patient has access to a registered nurse, social worker, home health aide and chaplain. The benefit covers all drugs, medical equipment, supplies and services, physical and occupational therapy and even bereavement counselling for family members. One independent study found that Medicare saved $1.26 for every $1 spent on hospice care. Between 1990 and 1999 the number of people using hospices in the final days and weeks of life jumped from around 100,000 to around 700,000. But the average length of stay in a hospice fell from 90 days in 1990 to 48 days in 1999. Half of hospice users received care for 19 days or less. Many received it for a week or less.

Claim

Doctors find it hard to tell their patients they only have a limited time to live. They often subject them more and more treatments until the very end.

Until recently, the fact that aging people inevitably die was simply swept off the agenda in public policy. The fact that we almost always become very sick before we die was seen as some sort of temporary inconvenience. We as a society have not developed a fabric of how to help people deal with degenerative illnesses for a long time and then help them die.

A lot of (hospital) treatment that is provided does not add anything to the patient's quality of life or even to their length of life. A hospital is a very tough place to maintain any quality of life either for patients or their families.

Hospices are extremely cost effective compared to hospitalization. But more savings could be realized if more patients did not delay entering hospices until a few days before death, when expenses were the greatest.