Patients also say they want to awake and conscious when their pain is managed. The issue is that there are not many U.S. physicians and nurses who are certified to extend palliative care. There are only 33 physicians and only 41 nurses for every 10,000 patients (Peres).
The hospice movement has been changing the face of care for people at the end-of-life stage (Radulovic 2004). Hospices have been providing options and choices to these patients for the last three decades. The hospice movement began in the UK but spread to America in response to the need for more compassionate care for the dying and terminally ill. A hospice is not a place but a concept of palliative and support services for the terminally ill to be cared for primarily at home. A home can be the patient's residence or that of a loved one, a long-term care facility. It provides the specific care these patients demand. Almost 90% of adults surveyed expressed the preference to be cared for by their own family if they were terminally ill or were in the last six months of life. The American public's priorities at this time include home-based care, patient control and choices on services available to them, emotional and spiritual support for them and their families, pain control according to their wishes, and freedom from financial cares. Congress put the Medicare Hospice Benefit in place in 1982. It has enabled millions of Americans to receive end-of-life care. More than 96% of U.S. hospices are Medicare certified and more than 80.9% of Medicare beneficiaries made claims on it as their payment source in 2002. Most private insurance plans, managed care providers and Medicaid in most states cover hospice services. But as the population ages and life expectancy increases, more sophisticated and costlier medical interventions have been required for health care needs. Today's hospices address a wide range of terminal and end-of-life disease states and palliative care services. In 2002, 50.5% of admissions were cancer patients. Hospices now also serve those with end-stage heart, kidney and liver diseases, as well as dementia, lung disease, HIV / AIDS and other severe conditions. Treatments associated with curative care, such as chemotherapy and radiation, are being used to palliate end-of-life care (Radulovic).
The U.S. General Accounting Office found and reported in 2002 that more and more patients are choosing hospice towards their end-of-life stag (Radulovic 2004). This was attributed to factors, such as physician practices, patient preferences, compliance with Medicare eligibility requirements, and lack of awareness of the Medicare Hospice Benefit. In December 2003, Congress approved the Medicare Modernization Act in order to improve access and make hospices more available to patients their families earlier during their illness. Provisions include educational consultation for patients, availing of specialized nursing services, continued nursing care by nurse practitioners no longer employed by hospice, and evaluation of rural hospices. Hospice and palliative care providers have been required to acquire full knowledge and expertise on end-of-live and make it available to more people. They should also reach out to more Americans and much earlier in the course of their illnesses. The hospice philosophy of care enables patients to move from more aggressive therapies to holistic palliative care services. As a matter of fact, hospitals and long-term care facilities like ICUs mimic and use the skills of palliative care to providing appropriate care to patients (Radulovic).
The elderly and terminally ill should be admitted to ICUs only when they can strictly benefit from the special care made available there and for a restrictive period only. In the final days and weeks of their lives, they should be moved to a more comfortable, cheaper, less restrictive and personal environments like a home or a hospice. Medical professionals should be called in to administer special services and medications the patient may need.
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Peres, Judith. U.S. End-of-Life Gets Passing Grade.…