Monthly Archives: July 2012

Will I Die Sooner on Hospice?

In a word, the answer is “no.” Hospice care neither speeds up nor slows down the dying process. It might appear that, after aggressive hospital treatments are stopped, terminal illnesses would progress at a more rapid pace.

Various research projects have shown that patients on hospice care in many cases actually live longer than those with similar conditions receiving treatments such as chemotherapy. Factors other than purely medical ones—such as the comfort of sitting at home in one’s favorite chair—may play a role in those results.

The Boston doctor who wrote an excellent article about hospice care in The New Yorker magazine in 2010 cited an actual study of 4,493 Medicare patients on hospice. The research compared average survival times of patients on hospice versus those not on hospice care.

That research revealed that patients with pancreatic cancer live, on average, three weeks longer on hospice care. Those with lung cancer had six weeks more survival time on hospice care. Persons with congestive heart failure had, on average, three additional months of life on hospice. There was no significant difference for those with breast cancer, prostate cancer or colon cancer.

Click HERE to read the article.

Of course, there is no way to predict how a particular patient’s conditions will progress under hospice care. And every individual is different.

We sometimes read of celebrities going on hospice care and then, just a few days later, dying. This gives the wrong message that hospice care is only for those who are days away from passing. It also implies that being admitted to hospice care means a patient will die in short order.

Along with communicating that hospice care does not speed up the dying process, all hospices, including Hope Hospice, must continue telling the general public and the medical community that hospice care is not just for the very few last days of a person’s life. Most hospices frequently receive comments from family members and other survivors who say, “We wish we had called you sooner.”

Hospice, A Labor of Love

When choosing the area of healthcare in which to work, why would someone choose hospice care? Aren’t there more glamorous and lucrative work situations in the healthcare arena? Of course, there are. But, thankfully, a significant number of healthcare professionals choose to be part of the world of hospice.

For many, the experience of seeing how hospice care has worked with a member of their own family is the primary motivating factor. For others, a fellow nurse or home health aide may have passed along details about the good feeling that comes from helping patients and families. The uniqueness of hospice care, the only form of healthcare in which every patient is expected to die, attracts other medical personnel.

The work of caring for terminal patients can be gratifying, but it can also be heart breaking. The mental stresses and the physical stresses of the job require a special person for the task. The hospice professional has to have thorough medical training, but is also called on to use other skills, such as negotiating with a patient (and, occasionally, with a family member). A hospice nurse or home health aide may be required to help a patient get into and out of a chair or a bed, which is not always an easy chore. Patient and family dynamics cover the spectrum so hospice staff members have to be flexible in order to deal with situations as they arise.

Hospice workers, unlike most of today’s healthcare professionals, make house calls. As opposed to working all day in a sparking clean modern office, hospice workers experience a variety of home situations. Hope Hospice team members visit patients in all parts of our service area: St. Louis city, the suburbs and even some rural areas.

The payoff for hospice workers comes not just on payday, but also when families tell them how much they are appreciated. Hospice patients do things that family members and other caregivers cannot do. They provide valuable information and guidance to family members and caregivers. And they do it at a time when a family is dealing with this stressful, literally once-in-a-lifetime, situation.

As we at Hope Hospice know and are reminded often, it takes a special person to work in hospice. It is a labor of love. We are proud of our team and the great service they provide to our patients every day.

Volunteers—A Vital Part of Hospice Care

A hospice volunteer is a person to be appreciated and admired. She or he contributes that most precious of commodities: time. The time that a hospice volunteer spends with a patient, providing company and companionship, is of great value to all parties concerned: the patient, family members and other caregivers and hospice medical staff and other hospice staff.

Some hospice volunteers come from institutions where they are receiving medical training. But experience is not necessary to become a hospice volunteer. Hospices provide training to volunteers and give them the information they need to be able to provide help when and where it is needed.

What does a hospice volunteer do? She or he may visit patients on a regular basis, get to know them, be a friend. Sadly, it often occurs that a person’s longtime friends (and even some family members) do not visit when they know the patient is terminal. They may fear that they (and, perhaps, the patient) would be uncomfortable. The hospice volunteer can provide a simple human presence during what can be a lonesome journey. By talking to and listening to the patient, a volunteer can make those final days, weeks and months more meaningful.

A hospice volunteer can also provide a break for a family member or other caregiver who may need to get away from the house for a moment of relief. The volunteer can also help the caregiver by running small errands, such as picking up a bag of groceries or stopping by the dry cleaner.

Because hospice care is provided to persons who are expected to pass away in the very near future, likely prospects may be drawn away to more upbeat healthcare volunteer opportunities. Those who choose to become hospice volunteers are often people who have seen a dying family member experience the compassion of hospice care.

If you would like to know more about becoming a hospice volunteer, please call us at Hope Hospice at 314-984-9800. C.J. Bilbrey is our Volunteer Coordinator. He will be happy to talk to you and answer your questions about becoming a hospice volunteer.

To all our Hope Hospice volunteers, on behalf of patients, families, caregivers and hospice staff, we offer a since “thank you” for your efforts. You are truly appreciated!

Beyond Six Months

The main qualification for admitting a new patient to hospice care is a diagnosis stating that the patient has six months or less to live. But that diagnosis is an educated guess. In many instances, such a diagnosis is amazingly accurate—but not always.

Sometimes this speculation significantly underestimates a patient’s remaining months of life. Many hospice patients live beyond six months. A variety of factors can affect a patient’s longevity.

Occasionally, removing a patient from aggressive drug treatment can have positive results when major side effects are taken away. The tests and observations that identified the reason for the six-months-or-less estimate are not necessarily rendered invalid. But a change in circumstances can lead to other physical changes and attitude changes.

With certain illnesses and diseases, life expectancy can be predicted more accurately, based on medical records of other patients. But with other conditions, data may be more difficult to analyze, making the time until a patient’s passing harder to pinpoint.

Additionally, patients often strive to hang on for milestone events: Christmas, Easter, an anniversary or other family event. This determination to stay alive can actually help extend life. We at Hope Hospice have seen it occur many times. Often, once the milestone has been celebrated, a patient’s decline can be rapid.

Just because a patient is admitted to hospice care, friends and family should not presume that her or his demise is imminent. Yes, in some cases when family or caregivers wait until the very last days of life, death comes quickly. But when a doctor tells a patient that he or she should go on hospice care, this means that end-of-life is approaching. It does not mean that it is just around the next bend.

Sometimes patients do stay on hospice care beyond six months. They must be periodically re-certified according to state guidelines. At Hope Hospice, in the majority of situations, the conditions of our longer-term patients generally dictate that continued hospice care is the most appropriate form of healthcare for them.

As pointed out above, determining how long a patient will live is an inexact science. Doctors and other medical professionals give us their best evaluations and we do our best to make each patient’s end-of-life experience as comfortable and pain-free as possible.

Hospice Care For The Patient’s Family

Of course, the care given by Hope Hospice begins with the patient. It is the patient whose vital signs are monitored. It is the patient whose freedom from pain is our #1 goal. It is the patient who is visited each week by a nurse or home health aid. It is the patient whose condition is discussed by the Hope Hospice team at our weekly meetings.

But the family and other caregivers also receive great assistance from hospice care. The hospice team is a resource that family members can depend on from the moment their loved one qualifies for hospice care and is admitted as a hospice patient.

At Hope Hospice, our team includes a social worker and two chaplains. They know that each situation is different. They work to accommodate family dynamics, which may change during the course of a patient’s time with hospice. They can offer informed guidance at times when family members may not know which way to turn. They share not just information, but also compassion.

During the last few days of a patient’s life, when bedside vigils continue around the clock, the Hope Hospice medical team works to ensure that the patient is free of pain. The team also works to provide certain types of basic care to the patient that family members may not be able to provide.

For family members who have not experienced the death of a close relative (spouse, parent or sibling), the obligation to make important decisions can be overwhelming. This is when hospice team members (medical staff, social worker, chaplain) can present useful input to assist in making those decisions. In some cases, the Hope Hospice team simply provides another opinion. In others, our team leads family members through a process they have not previously traveled.

After death occurs, our team stands by to offer grief counseling and to answer questions that may continue to arise. Though our time with patients and their families may be brief, from as little as a few days to as long as several months, we do tend to establish strong bonds. Our mission is one of compassion and love—for our patients and for our patients’ families and caregivers.