All About Nursing · Hospice & Palliative Care

Definitions Hospice

You matter because you are you. You matter to the last moment of life, and we will do all we can, not only to help you die peacefully, but also to live until you die. (Saunders in Stoddard, 1978)

  • Centers for Medicare & Medicaid Services (CMS) defines hospice as:

“A holistic approach to treatment that recognizes that the impending death of an individual warrants a change from curative to palliative care. Palliative care means ‘patient-and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice.'”

  • The National Hospice and Palliative Care Organization (NHPCO) defines hospice as:

Hospice is considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury. Hospice care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes. Support is provided to the patient’s loved ones as well. At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so. Hospice focuses on caring, not curing, and in most cases care is provided in the patient’s home. Hospice care also is provided in freestanding hospice centers, hospitals, and nursing homes and other long-term care facilities. Hospice services are available to patients of any age, religion, race, or illness. Hospice care is covered under Medicare, Medicaid, most private insurance plans, health maintenance organizations (HMOs), and other managed care organizations. 

  • Hospice and Palliative Nurses Association (HPNA) defines hospice as:

Hospice nursing as the provision of palliative nursing care for the terminally ill and their families with the emphasis on their physical, psychosocial, emotional, and spiritual needs. This care is accomplished in collaboration with an interdisciplinary team through a service that is available 24 hours a day, 7 days a week. The service comprises pain and symptom management, bereavement, and volunteer components. Hospice nursing, then, is holistic practice conducted within an affiliative matrix. The hospice nurse, in developing and maintaining collaborative relationships with other members of the interdisciplinary team, must be flexible in dealing with the inevitable role blending that takes place. In functioning as a case manager, coordinating the implementation of the interdisciplinary team developed plan of care, the hospice nurse also an advocacy role for patients and their families with other members of the team. 

Reacting to the “cure at any cost” syndrome, hospice challenged that idea with another way of talking, so what is hospice?

  • Hospice is a philosophy of care for terminally ill patients and their families
  • Hospice Interdisciplinary Team: personnel that address the facets of “total pain”
  • To address the spiritual aspect of pain: There are pastoral care staff who can facilitate interaction with the patient’s religious community or provide personal support.
  • For the psychological aspect of pain: There are social workers and bereavement care personnel. In addition, there are certified music therapists whose music helps with emotional distress. Music therapists use music to reduce anxiety, which can help reduce shortness of breath and pain.
  • Volunteers are also an integral part of the hospice team. Something as simple as a volunteer holding a patient’s hand can help reduce anxiety and in turn, help reduce physical symptoms.
  • To address physical symptom management, there are specially trained nurses and doctors to manage pain, nausea, vomiting, respiratory distress, and other physical symptoms.
  • The Centers for Medicare and Medicaid Studies (CMS) give the definition of a terminal illness as “focusing on a six month prognosis rather than focusing on a specific diagnosis”.
  • CMS listed the top 10 diagnostic codes for 2005: lung cancer, congestive heart failure (CHF), debility, chronic airway obstructive disease (CAO), Alzheimer’s, failure to thrive, cerebral vascular accident (CVA), senile dementia, prostate cancer, and breast cancer.
  • According to National Hospice and Palliative Care Organization in 2007, the top five hospice diagnoses were: cancer 41.3%, heart disease 11.8%, debility (unspecified) 11.2%, dementia (including Alzheimer’s) 10.1%, lung disease 7.9%.
  • Medications, as well as non-pharmacological treatments, are part of the hospice plan of care.
  • Opioid therapy is potentially analgesic in all types of acute and chronic pain, especially related to cancer, HIV/AIDS, or advanced medical illness of any type.
    • Common side effects of opioids are constipation, somnolence, and mental clouding
    • Although opioids can have sedating effects, opioids are prescribed and administered with the primary intent of pain analgesia- not to make a person sleep or to steal time from them that could be spent interacting with loved ones or allowing a person time for closure.
  • non-pharmacological treatments such as Reiki, comfort baths, massages, music, and distraction techniques integrated into a hospice patient plan of care can help to reduce anxiety and lessen pain.

Patient who have been given a terminal diagnosis and a prognosis of approximately six months to live can elect for hospice care. However, Medicare allows continuation of the hospice benefit for 90 days. If the patient is still living and remains appropriate for hospice, the patient must be recertified as terminally ill.

References:

Rogers, T. (2009). Hospice myths: what is hospice really about?. Pennsylvania Nurse, 64(4), 4-8.

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