I want to applaud Modern Healthcare for the May 18 cover story on assisted suicide/hospice (“Options for the dying,” p. 22). It's a great topic, and as a family member of multiple hospice patients and executive director of Pathways Hospice in Ohio, I know that education on this subject is vital.
I would like to offer a bit of a tweak to your understanding of palliative care vs. hospice care. The article states, “Palliative care is patient- and family-centered care in which an interdisciplinary team focuses on easing patient suffering; hospice is palliative care delivered near the end of life.”
Hospice care is patient- and family-centered care, coordinated by an interdisciplinary team of professionals, including the patient; family members; two physicians; registered nurses; social workers; chaplains; home-health aides; physical, occupational or speech therapists; and volunteers.
This team focuses on easing pain and symptoms as well as suffering (physical, spiritual or emotional) of the family unit as individuals and as a whole. Hospice care is provided as needed and agreed upon by the patient, family and care team, increasing as needs increase. The team is constantly identifying patient and family goals and helping to educate and support everyone around those goals as well as the family's emotional and spiritual needs.
Currently, the rules for hospice state that aggressive curative treatment must end to accept the hospice benefit, but hospice is revocable at any time. There is no death sentence entering hospice and we don't encourage “giving up.” We attempt to reframe goals to be realistic.
We try to maintain professional boundaries, but we are human and we, too, cry and hurt when these special people hurt and eventually die. Sometimes simply being present is the greatest gift we can give, even to ourselves.
We have statistics that prove, even as there has been large growth in hospices and hospice recipients, that hospice care does save money for Medicaid and Medicare. I've heard figures from $3,000 to $20,000 per patient depending on the avoided aggressive treatment and potential hospitalization and surgeries avoided. In addition, satisfaction among the patients and their families increases measurably along with the immense decrease in pain and suffering that is measurable.
Patients also tend to live approximately 30 days longer choosing hospice over continued curative treatment.
Palliative care is a term taken from the hospice movement and is pretty much like a physician visit, but completed at the location of the chronically ill person. It can be done by a physician, physician assistant or nurse practitioner and involves pain and symptom orders or suggestions for their management. Such care helps many families accept that there is a decline in the health of a loved one. It also allows the individual to continue aggressive treatment of the diseases they are fighting.
Lastly, the article mentions that “some think public discussion about legalization of physician-assisted suicide has led to the expansion of palliative and hospice care. Others don't see any connection.” I don't see any way that this extremely recent discussion about physician-assisted suicide has had any positive impact on the hospice- or palliative-care community. If anything it seems to have scared some people who think that is what hospices do. We don't.
