Tak­ing a closer look at hospice, pal­lia­tive care

Modern Healthcare - - COMMENT -

I want to ap­plaud Mod­ern Health­care for the May 18 cover story on as­sisted sui­cide/hospice (“Op­tions for the dy­ing,” p. 22). It’s a great topic, and as a fam­ily mem­ber of mul­ti­ple hospice pa­tients and ex­ec­u­tive direc­tor of Pathways Hospice in Ohio, I know that ed­u­ca­tion on this sub­ject is vi­tal.

I would like to of­fer a bit of a tweak to your un­der­stand­ing of pal­lia­tive care vs. hospice care. The ar­ti­cle states, “Pal­lia­tive care is pa­tient- and fam­i­ly­cen­tered care in which an in­ter­dis­ci­pli­nary team fo­cuses on eas­ing pa­tient suf­fer­ing; hospice is pal­lia­tive care de­liv­ered near the end of life.”

Hospice care is pa­tient- and fam­i­ly­cen­tered care, co­or­di­nated by an in­ter­dis­ci­pli­nary team of pro­fes­sion­als, in­clud­ing the pa­tient; fam­ily mem­bers; two physi­cians; reg­is­tered nurses; so­cial work­ers; chap­lains; home-health aides; phys­i­cal, oc­cu­pa­tional or speech ther­a­pists; and vol­un­teers.

This team fo­cuses on eas­ing pain and symptoms as well as suf­fer­ing (phys­i­cal, spir­i­tual or emo­tional) of the fam­ily unit as in­di­vid­u­als and as a whole. Hospice care is pro­vided as needed and agreed upon by the pa­tient, fam­ily and care team, in­creas­ing as needs in­crease. The team is con­stantly iden­ti­fy­ing pa­tient and fam­ily goals and help­ing to ed­u­cate and sup­port ev­ery­one around those goals as well as the fam­ily’s emo­tional and spir­i­tual needs.

Cur­rently, the rules for hospice state that ag­gres­sive cu­ra­tive treat­ment must end to ac­cept the hospice ben­e­fit, but hospice is re­vo­ca­ble at any time. There is no death sen­tence en­ter­ing hospice and we don’t en­cour­age “giv­ing up.” We at­tempt to re­frame goals to be re­al­is­tic.

We try to main­tain pro­fes­sional bound­aries, but we are hu­man and we, too, cry and hurt when th­ese spe­cial peo­ple hurt and even­tu­ally die. Some­times sim­ply be­ing present is the great­est gift we can give, even to our­selves.

We have statis­tics that prove, even as there has been large growth in hospices and hospice re­cip­i­ents, that hospice care does save money for Med­i­caid and Medi­care. I’ve heard fig­ures from $3,000 to $20,000 per pa­tient depend­ing on the avoided ag­gres­sive treat­ment and po­ten­tial hos­pi­tal­iza­tion and surg­eries avoided. In ad­di­tion, sat­is­fac­tion among the pa­tients and their fam­i­lies in­creases mea­sur­ably along with the im­mense de­crease in pain and suf­fer­ing that is mea­sur­able.

Pa­tients also tend to live ap­prox­i­mately 30 days longer choos­ing hospice over con­tin­ued cu­ra­tive treat­ment.

Pal­lia­tive care is a term taken from the hospice move­ment and is pretty much like a physi­cian visit, but com­pleted at the lo­ca­tion of the chron­i­cally ill per­son. It can be done by a physi­cian, physi­cian as­sis­tant or nurse prac­ti­tioner and in­volves pain and symp­tom or­ders or sug­ges­tions for their man­age­ment. Such care helps many fam­i­lies ac­cept that there is a decline in the health of a loved one. It also al­lows the in­di­vid­ual to con­tinue ag­gres­sive treat­ment of the dis­eases they are fight­ing.

Lastly, the ar­ti­cle men­tions that “some think public dis­cus­sion about le­gal­iza­tion of physi­cian-as­sisted sui­cide has led to the ex­pan­sion of pal­lia­tive and hospice care. Oth­ers don’t see any con­nec­tion.” I don’t see any way that this ex­tremely re­cent dis­cus­sion about physi­cian-as­sisted sui­cide has had any pos­i­tive im­pact on the hospice- or pal­lia­tive-care com­mu­nity. If any­thing it seems to have scared some peo­ple who think that is what hospices do. We don’t.

Dar­rell Miller Ex­ec­u­tive direc­tor Pathways Hospice

Berea, Ohio



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