Hospice care during end-of-life treatment

Hospice

Death and dying are concerns that every human being must deal with at some point in their lives (Jennings et al., 2003). Hospice care is a practice that assists patients and their families with coping with death and dying. The purpose of this discussion is to examine death and dying and the roles of hospice care workers in providing care not only to the patient, but also the families of those that are dying. Let us begin our discussion by defining hospice care and providing some background information.

According to an article found in the Hastings Center Report, the term hospice can be defined as both a philosophy of care and a type of health care delivery. The article explains that hospice care is inclusive of professional nursing care, personal assistance with activities of daily living, various forms of rehabilitation therapy, dietary counseling, psychological and spiritual counseling for both patient and family, volunteer services, respite care, provision of medical drugs and devices necessary for palliative care, and family bereavement services following the patient's death (What is Hospice Care?, 2003)."

The article also explains that in most cases those responsible for hospice care include social workers, nurses, pastors and nurses aids. All of these individuals are managed by a physician who may be the primary care physician or a doctor that works with the hospice program (What is Hospice Care?, 2003).

The idea of hospice care began in England and first appeared in the United States in the 1970's. Within the United States, Connecticut was the first state to have a hospice care program which began in 1973. The program came at a time when deaths from cancer were growing rapidly. By the 1980's hospice care was added to the Medicare plan. Initially the hospice care movement was external to the Medicare system. It was a movement that believed in dignity in death and that dying people needed a place to dye other than a hospital. Initially, hospice care was designed primarily for those dying of cancer and only took place within homes; later hospice care developed into programs that can be managed in-home or at an actual hospice care facility.

With the growth of hospice care and an increased awareness of what hospice care does for those who are dying, there are hospice care programs throughout the world that provide people with the care that is needed at the end of life. Although hospice care was originally created to address the needs of those dying of cancer, hospice care facilities are now designed to take care of patients that are dying from any type of disease or as a result of a serious accident (Jennings et al., 2003).

Roles of Hospice care Workers

The growth and increased capacity of hospices to provide patients and their families with the assistance they need is evidence of the human benefits that hospice care can provide (What is Hospice Care?, 2003). The article points out that although hospice care has become a standard for end of life patients and is still a system that is distinct from that of the general medical care system. In addition hospice care is not viewed as an option for only those who are wealthy since it is included in Medicare coverage and many other private insurance policies.

In the past, professionals in the field of healthcare and insurance have been fairly ignorant about the role of hospice care as a necessary aspect of care for the terminally ill (Jennings et al., 2003). For this reason organizations and foundations such as the Robert Wood Johnson Foundation have committed a tremendous amount of resources in an effort to educate the aforementioned professional as it relates to the role of hospice care (What is Hospice Care?, 2003). For this reason, healthcare providers throughout the world now have a greater understanding concerning hospice care and the need to support hospice care programs.

With all of these factors being understood, there are several factors that must be taken into consideration when caring for an individual that is dying and their family. For the most part these needs can be classified by physical, emotional, and social well-being (What is Hospice Care?, 2003).

As it relates to each of these issues the healthcare system plays a role in meeting the needs of patients and their families. The physical needs are inclusive of pain control, the proper nutrition and food, a comfortable place to dye, personal care such as bathing and feeding, changes in the physical condition of the individual over time and how to manage the physical condition of the individual that is dying (What is Hospice Care?, 2003).

Emotional needs are inclusive of such factors as respect for the individual that is ill, respect for their dying wishes, therapy to assist the dying person in understanding what is occurring; assistance with planning in advance for death, and making sure that spiritual concerns are taken care of (What is Hospice Care?, 2003).

The emotional needs of a patient and family are just as important as taking care of the physical needs of the patient. According to Simmers (2003) it is important for hospice care providers to understand the ways in which the physical ailment of the individual may affect them psychologically and how these psychological problems may result in additional physical problems (Simmers, 2003). For instance, an elderly person who has difficulty hearing and seeing may have increased anxiety and the increased anxiety may lead to high blood pressure or difficulty eliminating waste. Understanding these issues assist the caretaker in easing the anxiety of the patient so that other physical ailments do not arise (Simmers, 2003).

Taking care of the social needs of the patient is also important. The social needs of the dying patient are inclusive of making certain that the patient can function socially to whatever extent possible. Companionship is also an important factor as it relates to the social needs of the patient; loneliness can make the dying process even more painful (What is Hospice Care?, 2003). It is also important that the dying patient resolve in relationship issues that may exist with family members or friends.

As it relates to the aforementioned needs, there is a broad continuum of care that is complex. Indeed, individuals who are facing death need access to and utilize various areas of the healthcare system (What is Hospice Care?, 2003). These areas of the healthcare systems include long-term care, acute care, and psychological care. For this reason an interdisciplinary team is usually needed to assist the patient and the family.

According to a book entitled "Hospice and Palliative care: Concepts and Practices" interdisciplinary care is the preferred method that hospices use to treat families. Within the context of interdisciplinary care "each discipline has expertise to contribute to the care of the patient and the family. The goal of interdisciplinary team is to work with patients to identify their specific needs and health goals within a holistic framework (Forman, p.13)." With this being understood all members of the interdisciplinary team care for the patient in accordance with their particular area of expertise. Depending on the medical environment the structure and purpose of an interdisciplinary team may vary. However, Forman (2003) explains that the hospice care system is designed to have the input of an interdisciplinary team from the beginning until the end and even after the patient's death.

It is also important to remember, physical needs such as pain control may necessitate, advanced treatment regimens and technologies and may include custom-made drug courses of therapy to palliative radiation or surgery. Also factors associate with feeding and hydration may be managed through unique diets or helpful counseling when patients can no longer eat (What is Hospice Care?, 2003).

The article also points out that careful nursing is often necessary for bathing, feeding, skin care, and other personal care issues that allow the patient to be more comfortable. In addition, health education is sometimes appropriate so that the patient and the family understand both the physical and emotional changes that will take place and what can be done to make these changes easier for the patient and the family (What is Hospice Care?, 2003). Hospice care is often inclusive of mental health services as depression is a common problem amongst those who are at the end of life and their families. The article also explains that Some of the care needed must be provided by highly skilled health care workers, but much of it can and should be undertaken by families, friends, and members of the dying person's faith community. Family caregivers may take care of the patient's home, provide meals, help with personal care, offer companionship, and help the patient maintain social functioning. Friends and community organizations may help family members with these care giving activities. Religious organizations may provide spiritual support to the patient (What is Hospice Care?, 2003)."

Overall there is no real distinction between the care that should be performed by healthcare professionals and the care that others can perform (What is Hospice Care?, 2003). Who provides the care is dependent upon the patient and the type of care their illness requires. Also, some families are more active in taking care of end of life patients than other families.

Indeed, hospice care providers have a significant number of responsibilities as it relates to taking care of the patient. The type of illness that the patient has can increase or decrease the number of responsibilities of the hospice care providers. In any case, hospice care providers provide services tat ensure the comfort of the patient and they also attempt to make the emotional and psychological issues associated with dyeing, more palatable for the patient.

In addition to the issues that arise for the patient, caring for a loved one that is terminally ill is also extremely difficult for family members. As was mentioned previously in the discussion the purpose of a hospice is to serve both the patient and the family of the patient.

The family must be educated concerning the condition of the patient and how to care for them. In addition, if the patient has a long-term debilitating illness such as Alzheimer's disease, the family may have to be educated concerning the needs of the patient and the progression of the disease (Jennings et al., 2003). Additionally the family of a patient often requires access to mental health professionals because of the stress and depression that may occur as a result of caring for a loved one or dealing with the inevitability of death (Jennings et al., 2003). The hospice care is also there to assist the family when the patient dies. Many hospice programs provide bereavement counseling and may even assist with funeral arrangements. All of these services are extremely valuable to the family when they are losing someone that is loved (Jennings et al., 2003).

Most hospice care programs hold family conferences. The first family conference usually takes place when hospice care first begins (Forman, 2003). During the initial conference difficult emotional issues are discussed and the patient identifies various caregivers within the family who will be responsible for making decisions (Forman, 2003). The family conference is also important for the hospice care givers because it allows them to see the family dynamics and whatever communications problems that may be present within the family (Forman, 2003). Having this information allows the caregivers to bridge some of the communications gaps that may already exist within the family (Forman, 2003).

The author points out that at least one member of the interdisciplinary team must be present during the family conference.

Although hospice care workers such as nurses, doctors and psychologist are the most prominent members of the interdisciplinary team, social workers also play an important role in hospice care as it relates to patients and their families. According to an article found in the journal Health and Social Work, social workers are often needed in a hospice care situation to assist families in dealing with ethical dilemmas related to patient care (Csikai, 2003). Ethical dilemmas may include the type and dosage of pain medication that the patient will receive. In addition ethical dilemmas may be inclusive of the patient desire not to be on any life sustaining machines or vice versa (Csikai, 2003). The article further states

Other frequently discussed issues were families' denial of the terminal illness and that families might not be following the patients' wishes, which could cause or increase the risk of patient-family conflict (another identified common issue). Social workers can provide significant input into the resolution of these issues and discuss with other team members strategies they can use during home visits with patients and families. The resolution of these difficulties in hospice might make a critical difference in whether the patient has a "good death;" often defined as a death that occurs at home in concert with the patient's wishes and preservation of self-determination (Reese, 2000; Csikai, 2003)."

Because the aforementioned issues exist within the context of hospice care, it is important that the social worker is qualified to take on this type of responsibility. The social worker can greatly impact the ability of patient to die in the manner they wish.

Hiring hospice care providers

As a result of the type of care that is provided by a hospice program, hiring employees to work at a hospice program can be a difficult and complex undertaking. The difficulty associated with hiring the proper people exist because hospice care can be stressful and emotionally taxing on caregivers. Just because of nurse is equipped at working in a hospital or some other type of medical facility, they may not have the capacity to work in a hospice care program.

Nurses and nurses' aids are extremely important in the process of caring for end of life patients. These individuals are usually responsible for administering medicines. Taking care of patients' hygiene needs and making sure that the patient is comfortable. Other individuals such as doctors, and therapists also play a significant role, but nurses and their assistants are usually with the patient the most; in some cases the patient spends more time with these individuals than with their family. For this reason it is extremely important for these individuals to be properly trained and have the empathy to work in a hospice program.