Hospice+Care

= = Hospice Care


 * Hospice** is a type of care and a philosophy of care that focuses on the comfort care of a terminally ill patient's symptoms and improve your quality of life while the patient is dying. These symptoms can be physical, emotional, spiritual or social in nature. Hospice has been around for centuries, dating back to the medieval times. The current movement of hospice began in London in 1967 and then came to the United States. The first hospice care facility was open in 1974 in New Haven, Connecticut.



A Hospice care team consist of a physician, nurse,social worker, chaplain, nurse's assistant, and a program director. The main focus of the hospice care team is to provide comfort care by addressing the physical, emotional, spiritual or social need of the individual patient in collaboration with the family member and/or love ones. To receive hospice care benefits the patient primary attending physician and the hospice physician must both agree that the patient is terminally ill and had a prognosis of <6months.Hospice programs offer services 24 hours a day, 7 days a week, in the patient's own home or in a hospice center. Some hospices also offer services in nursing homes, long-term care facilities, or hospitals. Hospice provides care for patient who suffer from a verity of different diagnoses, which includes: Hospice services generally include but not limited to:
 * Cancer
 * Heart disease
 * Lung disease
 * Dementia
 * Liver disease
 * HIV/AIDS
 * Renal falilure
 * Amyotrophic lateral sclerosis/ ALS
 * Adult failure to thrive/ debility unspecified
 * Basic medical care with a focus on pain and symptom control.
 * Medical supplies and equipment as needed.
 * Counseling and social support to help you and your family with psychological, emotional, and spiritual issues.
 * Guidance with the difficult, but normal, issues of life completion and closure.
 * A break (respite care) for caregivers, family, and others who regularly care for you.
 * Volunteer support such as meal preparation or errand running.
 * Counseling and support for your loved ones after you die

Hospice patients are evaluated by using the palliative performance scale (PPS). Which is a functional assessment tool developed by Victoria Hospice that is based on the Karnofsky Performance Scale (KPS) [|[3]] and is incorporated into the collaborative care plans in the Palliative Care Integration Project that began in Kingston. This tool provides a framework for measuring progressive decline in palliative patients. In the PPS[|[4]], physical performance is measured in 10% decremental levels from fully ambulatory and healthy (100%) to death (0%). These levels are further differentiated by five observable parameters:
 * 1) the degree of ambulation
 * 2) ability to do activities/extent of disease
 * 3) ability to do self care
 * 4) food/fluid intake

Payment for hospice services is covered through Medicare and most Medicaid programs. Most, but not all, private insurance programs offer a hospice benefit. Most patients has advance directive(living will, power of attorney for health care, do not resuscitate order/DNR) in place coming into hospice. However, that is not always the situation. A health care surrogate may be chosen to make health care decisions for the patient if the patient is unable to make a decisions for themselves. media type="youtube" key="Pp-AMyiYbNU?rel=0" height="360" width="640" A Day in the life of a Hospice Nurse Hospice nurses perform many traditional nursing duties such as observing, assessing, and recording symptoms, and they still work closely with physicians, administer medications, and provide emotional support, preform medical procedures. Hospice nurses have a particularly tough job because, from the outset, they know that the patient for whom they are caring is terminally ill. The medications that hospice nurses administer and the symptoms they record aren’t intended to aid a patient in his or her recovery, but rather to make his or her remaining days as comfortable as possible. Most of the nurse’s duties involves minimizing pain, respiratory distress, nausea/vomiting, and terminal agitation/restlessness. A hospice nurse deals with a dying person requires which requires an exceptional temperament, one that embodies great caring, patience, and resolve. Hospice care is what is known as comprehensive palliative medical care. Therefore, nurses provided treatment to reduce pain and other troubling symptoms as opposed to treatment to cure. The hospice doctrine states that terminally ill patients have the right to spend their last days in the comfort of their own homes surrounded by their families, and hospice care provides professional medical care as well as supportive social, emotional, and spiritual services to accomplish this. The hospice nurse’s duties fall somewhere in between all of these ideals, with emphasis on medical care.

www.abanet.org/aging www.caringinfo.org www.codaalliance.org www.nlm.nih.gov/medlineplus/**advancedirectives**.html http://www.hospiceanswers.org palliative.info/resource_material/**PPS**v2.pdf