Hospice: How do you know when it’s time?
So when is the right time to have the conversation about switching an individual’s plan-of-care from curative treatment (intended to cure the illness or disease at hand) to hospice, which focuses on keeping the patient happy and comfortable during their final days, weeks and in some cases, months, and helping prepare both the patient and family – both mentally and emotionally – for the inevitable loss they will soon endure?
Many times, individuals struggling with chronic and terminal illness and their families and loved ones have strong misconceptions about their or their loved one’s prognosis, leading to decisions to pursue any and all curative measures, even when the disease long ago progressed beyond the point wherein curing the individual was still a possibility.
As anyone who has undergone chemotherapy or radiation can attest, these procedures are painful, and come with many significant adverse side effects. When a disease such as cancer progresses so far that no amount of chemotherapy, radiation or any other treatment is going to send the cancer into remission, that is to say, when the patient’s prognosis becomes imminently terminal, transitioning from curative treatment to hospice, which uses a variety of palliative care measures as well as grief counseling and other services, is not only appropriate but is also the right thing to do for the dying individual.
Palliative care is not curative in nature. Rather than attempt to cure one’s illness, hospices instead focus on ensuring the patient is as comfortable as is possible given the circumstances, and helping make sure they receive maximum enjoyment of what time they have left on earth.
This allows the terminally ill to spend quality time with family, friends and loved ones right at home (or an assisted living facility). The alternative is to going back-to-back, to-and-from the hospital to receive intense treatments that harm quality of life, rob the patient of time that could be spent pursuing favorite activities or bonding with family when these treatments are administered to terminal patients who are either unaware that their prognosis is terminal or are in denial and hoping for a miracle.
In many cases it’s best for everyone involved for someone (usually a doctor, nurse or family member) to be honest and direct with the patient and his or her family, leaving no doubt that the individual is going to die from their illness or condition, likely within six months of the disease runs its usual course, and that no amount of curative treatment is going to change that.
This way, instead of families holding on to false hope until the very end, then being surprised and distraught when the inevitable occurs, the patient can be made optimally comfortable, while both the patient and family receive both psychological and spiritual counseling beginning weeks or months, helping prepare all involved parties emotionally and spiritually for when the inevitable death occurs.
Palliative Care is defined by the World Health Organization as follows:
“Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”
Palliative Care is certainly a major component of hospice, however the terms are not necessarily simultaneous. For one thing, palliative care can be applied at any point during the course of treatment from a surgery, injury, disease or illness. Whereas Hospice Care is reserved exclusively for individuals who are terminally ill (meaning the are going to die, and that no form of curative medicine is going to change that), and includes palliative care among a plethora of other services.
Wikipedia defines Hospice as follows:
“Hospice care is a type of care and philosophy of care that focuses on the palliation of a chronically ill, terminally ill or seriously ill patient’s pain and symptoms, and attending to their emotional and spiritual needs.”
Also from Wikipedia’s Hospice definition:
“In hospice care the main guardians are the family care giver and a hospice nurse who makes periodic stops. Hospice can be administered in a nursing home, hospice building, or sometimes a hospital; however, it is most commonly practiced in the home. In order to be considered for hospice care, one has to be terminally ill or expected to die in six months.”
- Baton Rouge / Gonzales
- Ponchatoula/Hammond (serving all of Tangipahoa Parish)
- Metairie (serving New Orleans, Kenner and all of East Jefferson, Chalmette & St. Bernard)
- Gretna/Terrytown (serving all of the West Bank, including Marrero and Belle Chase)
- Covington (serving all of the Northshore, including Mandeville and Slidell)
- Plaquemines Parish (office located in Port Sulphur but serving the entire parish including Empire, Buras, Delacroix and surrounding areas).
- Bogalusa (serving all of Washington Parish)