Hospice and Palliative Care Analysis - Essay Example

Hospice Care Introduction Provision of compassionate and specialized care for sick people during the last stages of incurable disease like cancer is known as hospice care. The purpose of this care is to allow the sick individuals to live as comfortably and fully as possible with dignity until the last minute. This term was coined by a London-based doctor Dame Cicely Saunders in the year 1967 when she started the Saint Christophers Hospice in Syndeham, England (American Cancer Society, 2008). The first hospice establishment in America was Connecticut Hospice in New Haven. It was started in the year 1974 (NHPCO, 2008). Hospice care is similar to palliative care that is provided in the hospitals for those who are terminally ill. Both of them aim at relief of suffering, promotion of patient function, delivery of help to meet daily living needs, psychosocial support to the patient and the family and clarification of goals of care and associated treatments. Both of them aim at enhancing the quality of life. The difference lies in where and when the care is delivered (Meier, 2002). Hospice care can be provided any where according to the wish and comfort of the patient, be it at home or in a special facility (American Cancer Society, 2008). 90% of cancer patients choose to get hospice care at home (American Cancer Society, 2008). Hospice is team driven care. The care provided includes expert medical care, pain management, spiritual support and emotional support. The support is extended to the loved ones of the patient too. The focus of hospice is caring and not curing. The care is delivered to any deserving individual irrespective of age, sex, religion, race and type of illness. Types of hospices 1. Home based hospices The primary care-giver in home based hospice care is usually a family member who supervises the all round activities of the patient and coordinates other types of care, like for example, care from a health professional. The relative is trained to handle much of hands-on care by an experienced nurse. One important aspect of home-based hospice care is, there must be somebody with the patient all the time. Creative scheduling and good teamwork amongst relatives and friends can achieve this. The hospice staff will meet the patient regularly and provide the needed care and services (American Cancer Society, 2008). The staff is on-call 24 hours a day, seven days a week. Care plan is individualized and includes pain management and symptom control. 2. Hospital based hospices Some patients may need to be in the hospital and at the same time need the help of hospice care. The relatives of the terminally ill patient will also need psychosocial help. The team of health professionals treating the patient will coordinate with the hospice services to bring solace to the patient and his family (American cancer Society, 2008). 3. Long term care facility-based hospices This is a good option for those who want hospice care but do not have primary care givers at home. Such people may live in long-term care providing establishments with added service from hospice units (American Cancer Society, 2008). 4. Independently owned hospices These hospices are freestanding. They can provide help at home and also provide inpatient care for those who cannot get help at home. Hospice team In most of the cases, the primary care giver is a family member or friend. The activities of the team are coordinated by the primary care physician. Other team members include hospice physician, nurses, home health aides, social workers, clergy, trained volunteers, and other therapists like speech, physical and occupational therapists. The team outlines individualized medical and support services which includes nursing care, personal care like bathing, dressing and taking to toilet; physician visits, social services and counseling (NHPCO, 2008). The team also decides on the tests and procedures to be done on the patient, the medicines and other treatments to be given and the required medical equipment that should be around the patient (NHPCO, 2008). The ultimate aim of the team is high-quality comfort care (NHPCO, 2008). The staff of hospice care is specially trained to assess, anticipate, treat and prevent certain physical symptoms which are the root cause for distress and discomfort. Pain management is the most important aspect of hospice care. The staff of the hospice care coordinates with the treating physician and makes sure that all medicines, treatments and procedures aim to keep the patient comfortable and pain-free. The staff continuously evaluates and monitors the effects of these therapies (NHPCO, 2008). Hospice staff also provides bereavement care for surviving family members. This care is provided by trained volunteers, clergy members or professional counselors (American Cancer Society, 2008). Costs of Hospice care For those who meet the eligibility criteria, Medicare, private health insurance and Medicaid cover hospice care. Along with this support, there may be some co-pays also. Many hospices run their organizations through donations. Hospices offer services based on need rather than the ability to pay (NHPCO, 2008). Ethical issues in Hospice care The main ethical issues in hospice care are as to what constitutes appropriate care, what are the definitions for standard quality hospice care and who are the personnel who will ensure that proper standards of care are enforced (Jennings, 1997). In most of the cases, quality control is done by licensure, peer review, accreditation and external monitors like Joint Commission on Accreditation of Healthcare organizations. Another issue in delivering quality of care is the outcomes which are quantifiable. This issue arises because mortality is 100% is hospice care settings and hence other aspects have to be used to measure quality of life (Jennings, 1997). Euthanasia and Patient-assisted suicide are ever debated topics and even in hospice care, these ethical issues go unanswered. Many physicians feels that addressing fear of disability and loss of cognitive capacity along with pain management and symptom control may help the hospice carers face the pressure of legalizing assisted suicide and even euthanasia (Neuenschwander, 1998). Many researchers have proposed for the formation of ethics committee in every hospice program and infact, many hospices do have ethics committee to take care of ethical issues. Gaps in Health Care Systems Delivery of Palliative Care Though many medical insurance companies cover for hospice services, they have a clause according to which the patients need to give up curative care to undergo hospice care. Also, the coverage is limited to only those with a prognosis of six months or less (Meier, 2002). Hence in many cases, effective but expensive palliative care may not be given. Many hospitals do not have palliative care programs or they do not have necessary workforce needed to staff palliative programs. Palliative care in the hospital Since many terminally ill patients need to be in the hospital during their last stages of life, hospitals have developed the concept of palliative care to keep the patient comfortable until death and also provide psychosocial support to family members of the patient. This form of care adapts the interdisciplinary practice and the philosophy of hospice care and applies it to the severely sick patients irrespective of their prognosis. Palliative care is also independent of whether the patient chooses to continue curative or life-long treatments (Meier, 2002). This is one of the main differences between hospice care and palliative care. In hospice care, since insurance coverage is possible only if the curative care is stopped and the prognosis is poor, many people opt for hospice care only in last stages when the hope is already gone. Role of art and music therapies in Hospice Care Art therapy has many therapeutic benefits as far as healing is concerned, because it allows shedding of grief and provides a platform to express feelings. Art therapy is useful to help terminally ill patients and their families to handle grief. There is no talent required for art therapy. The participants of the therapy are allowed to use the art materials at their own level and ability. Music touches every ones heart and provides a soothening effect which no action or words can do. Music therapy rekindles memories of the past and relaxes the patient and thus reduces pain and sorrow. Music therapy also rakes up issues which are important at the end of ones life. Thus art therapy and music therapy improve quality of life (Hopehospice, n.d.). References American Cancer Society. (2008). What is Hospice Care? Retrieved on 14th April 2009 from http://www.cancer.org/docroot/ETO/content/Eto_2_5x_What_Is_Hospice_Care.asp HopeHospice. (n.d.). Retrieved on 14th April 2009 from http://www.hopehospice.org/therapy/artmusic.html Jennings, B. (1997). Ethics in Hospice Care. London: The Haworth Press, Inc. National Hospice and Palliative Care Organisation (NHPCO). (2008). Caring Connections. Retrieved on 14th April 2009 from http://www.caringinfo.org. Neuenschwander, H. (1998). Ethics in Hospice care: Challenges to Hospice values in a changing health care environment. B. Jennings (ed). Annals of Oncology, 9(1), 120. Meier, D.E. (2002). When pain and suffering do not require a prognosis: Working toward meaningful hospital-hospice partnership. Innovations in End-of-Life Care, 4(1). Retrieved on 14th April 2009 from www.edc.org/lastacts Read More