Hospice in California

What is Hospice?

Hospice is a concept of care for the terminally ill patient that places an emphasis on life and living. Modern day hospice began in 1967 in London when Dame Cecily Saunders founded St. Christopher’s Hospice . The first U.S. hospice opened in Connecticut in 1974.

Hospice care is palliative care.

To palliate means to “ease (symptoms) without curing the underlying disease; to moderate the intensity of.”15 Hospice provides aggressive pain and symptom management by utilizing an interdisciplinary team comprising physicians, physician assistants (PAs), nurses, social workers, spiritual care providers, therapists (psychiatric, art, music, physical, occupational, and speech), and volunteers. The focus of hospice is comfort-oriented care when disease-specific therapy is no longer helpful and end-of-life decisions come to the fore. Living life as fully as possible is emphasized; entering hospice care does not mean all treatments must end. Hospice treatments aim to relieve the physical, emotional, and spiritual distress that often accompany a life-threatening illness. Hospice supports families while they care for their loved ones and provides grief support after the death occurs.

To qualify for hospice care, a patient must have a terminal illness.

While lung, breast, and prostate cancers are the three most common diagnoses,16 a patient may have any diagnosis and be any age[J2] . Hospice patients must usually have a prognosis of 6 months or less.In recent years, there has been a movement within hospice to admit people with conditions that are often not deemed terminal, and account for most non-cancer diagnoses.  These diagnoses may include unspecified debility of age (a chronic “disease” diagnosis with no single major illness), dementia, and heart and lung diseases. An HCP should refer patients to hospice when they have a prognosis measured in months[J3]  versus years and once the goals of care have switched from cure to comfort.

The question to ask is, “Would you be surprised if the patient died within the next year?”

As long as the clinical criteria are met, a patient may usually be referred to hospice, regardless of their ability to pay. Having an AD or caregiver, being homebound, and ceasing treatment are not required to qualify for hospice care. Not all hospice programs require that a patient have a DNR (Do Not Resuscitate) Order, but resuscitation attempts in the hospice setting are rare.

Remember, hospice is not an end to treatment; rather, it is a shift to intensive palliative care that focuses on helping the patient to live  life to the fullest. It is comfort-oriented care with end-of-life closure. Generally speaking, hospice care occurs wherever a person calls home and can be either community or institutionally based[J4] .

Aid-In-Dying

A more recent option now available in some states (Oregon 1994, Washington 2008, and Montana 2010)   is legalized Aid-In-Dying. While controversial in some forums, aid-in-dying provides a process for dignified dying that may be appropriate for individuals who are decisionally capable, terminally ill, suffering and determined to stay in charge of their own end of life.   In the above-mentioned states, this option is available through a strict thoughtful and medical process and physician-prescribed medication in a life-ending dose.

Additional Options

There are other various end-of-life options enabling Individuals to hasten their own death that are supported in law and medicine.  Competent adults – or their appointed healthcare agents – may have the power to direct the commencement or discontinuation of any medical treatment in accordance with individual state law.  Competent adults are permitted to refuse such unwanted treatment regardless of the reason for their refusal or the nature of their illness; they need not be terminally ill. These same patients also have the legal right to stop life-sustaining medications or treatments, including voluntarily stopping  of eating and drinking (VSED). While not for everyone, more people are learning about these voluntary end-of-life choices and discussing them with the families and physicians.