Life Care in the United

¶ … Life Care in the United States: Perspectives on Inpatient/ICU Palliative Care, Nursing Home, and Hospice Programs

End of life (EOL) care has, over the years, become an important service in the healthcare sector, critically involving one of the country's increasing demographic, the elderly. The issue of end of life care contains numerous facets, although chief of these facets is the determination of the efficiency and benefits that different EOL programs provide. These programs that dominate EOL care in the current healthcare sector in the country include the inpatient/ICU or hospital-based palliative care program, nursing homes, and hospice EOL programs.

Discussing these three EOL programs, this research posits that among the three, it is the ICU palliative care program that provides the least efficient and beneficial results in providing EOL for the elderly. Conversely, both hospice and nursing home programs are determined as better "substitutes" to the ICU palliative care program, primarily because both programs provide the care efficiency and satisfaction that the elderly need as they go through the end of life phase in their lives.

The discussion provided herein argues the position assumed against ICU palliative care programs, including an analysis of the advantages and disadvantages of said program. In addition, both hospice and nursing programs are analyzed in terms, not only on their efficiency, but also on the economy of the service and program to the patient and patient's family and quality of care provided by healthcare professionals in these types of EOL programs.

The argument for the ICU palliative programs is put forth by Imhof (2005), who recommended utilizing the ICU palliative programs provided in hospitals (hospital-based programs). EOL care services, as argued by the author, provide numerous benefits to the facility of the patient's care, that is, hospital-based programs "require limited organizational effort, pose minimal risk, and cause little disruption to the ongoing operations of the organization" (161). Apart from these advantages of the hospital's palliative programs, patients enjoy other services that come with the program, such as the provision of informational literature for the patient and his/her family, consultation services, palliative care rooms, and additional linkages with the community through collaboration with local hospice, home health agencies, and long-term care facilities and integration into the community (of the patient) (162).

These are the services provided by (ideally) hospital-based EOL programs. Ultimately, these services aspire to provide the patient with the "best-practice" EOL program, comparatively better when compared against the hospice and nursing home care programs. An important leverage that hospital-based programs boast of is the existence of both clinical (i.e., technological) and palliative care, which enables the patient to seek professional and high-technology medical services when needed, while at the same time, receiving palliative care. Looking at the ICU EOL program holistically, it seems that this program is, indeed, the best option for the elderly and their families to seek quality, efficient, and beneficial end of life care.

However, studies were conducted that demonstrated the inefficiency and lack of qualitatively beneficial EOL service and care in hospital-based palliative programs for the elderly. Robichaux's (2006) analysis of hospital-based EOL care highlighted the fact that, in contrast to Imhof's assertion that these programs are beneficial and efficient to the patient, hospital-based EOL care is actually misleading and detrimental to the patient. Hospital-based EOL services, according to the author, give the 'illusion' that the care provided to the elderly is highly reliable, mainly because hospitals provide professional healthcare service through its medical professionals and high-tech facilities. The author argues against this perception, stating that (487):

the ICU environment depicted...remain dominated by the technological imperative. Health professionals often accept and endorse this dominance. However...generally a vast difference exists between what healthcare providers understand and what laypersons are able to comprehend. This immeasurability of knowledge was evident in the participants' narratives and was exacerbated by the conveying of "false hope" or "false optimism" to patients and patients' family members.

Seconding Robichaux's argument is Backstrand's (2006) findings that hospital-based EOL programs are not the "ideal" form of healthcare that elderly patients should receive, according to a survey of nurses. For the nurses, "no patient should face death alone," which ultimately happens when patients are confined in a hospital facility receiving palliative care. Comparing ICU EOL care against the hospice and nursing home care programs, 'dying with dignity' is remote in this kind of program, since "[t]he ICU is no place to die. It would be nice to have a comfortable, quiet, spacious room for those who are dying. Let everyone in and let the rest of the ICU function as it should" (41).

Indeed, the image of a comfortable and quiet resting place for elderly patients are embodied in both hospice and nursing homes, which, compared against ICU-based EOL care, specifically target the elderly and provision of EOL care as its main goals. Both hospices and nursing homes do not provide EOL care as a secondary nor optional program infused within their own healthcare services, unlike in the ICU environment, wherein palliative care is but one of the programs only of the hospital, an additional healthcare service on top of the medical services it offers to people of all socio-demographic profile.

Hospices are considered as being able to meet the necessary EOL care needed by the patient. In addition to EOL care, patients are also able to receive "exceptional pain management while alleviating emotional burdens, providing spiritual support, and enhancing quality of life" (Elliot, 2006:85). Evidently, hospices provide a more individual-centered and multi-dimensional perspective to the concept of end of life care. It takes into consideration not only the medical care that the patient must receive, but also the emotional and psychological needs that the individual would want to have as s/he reaches the end of life stage.