What is hospice care?

The word "hospice" means "a place of shelter." Today, the "place of shelter" is not so much a physical location as it is a service that helps a patient who is terminally ill to die with dignity and peace. Hospice care is also the type of care provided to support a terminally ill patient at home or wherever he or she lives. Care usually involves relieving troublesome symptoms and providing psychological and social support for the patient and family. The goal of hospice care is to not only provide the terminally ill patient and the family with a comfortable death experience, but to also enable the person to live to the fullest, even with a terminal prognosis.

To qualify for hospice care, a patient usually has a life expectancy of less than 6 months.

Research has shown that hospice care at home helps the entire family. Family members are encouraged to take an active role in providing supportive care to the patient. In doing so, the family has fewer feelings of helplessness and the patient is not relying solely on strangers for all of his or her care.

Settings for hospice care

Although many patients receive hospice care at home, hospice care can also take place in other settings, including:

• Hospital-based hospice. Most hospitals have a hospice program to give terminally ill patients access to support services and other healthcare professionals. Some hospitals even have a special hospice unit. Often these units provide intensive medical and psychological support to patients who need aggressive symptom management.

• Long-term care hospice. Many nursing homes and long-term care homes have hospice units with specially trained staff for those patients who don't have a primary caregiver at home, or who need medical services not suitable for a home setting. If this is not available, patients can be cared for in the nursing home with hospice services being delivered directly and individually to them.

• Freestanding hospices. Independently owned hospices may sometimes include an inpatient care facility. This is in addition to their home care hospice services. The inpatient facilities offer patients hospice services when a primary caregiver is not available at home, or the patient needs medical services not suitable for a home setting.

• Assisted living facility. Many patients live in personal care homes or assisted living facilities as their home. When they become terminally ill, hospice care services can be provided in their home setting with little or no disruption.

What services does hospice care provide?

Hospice services are similar to home healthcare services, but also include:

• Spiritual services

• 24-hour care or on-call care

• Bereavement support

• Volunteer services

• The choice of having a death attended by hospice staff

Four levels of care are offered to accommodate the patient and family needs. Routine hospice care (RHC) is provided in the patient's residence (this includes patients who live in assisted living facilities and long-term care or skilled nursing facilities). General inpatient care (GIP) is offered when pain or other symptoms are best treated in a facility offering patient care 24 hours a day. Once the pain and other symptoms are under control, patients are often able to return home and continue routine hospice care. Continuous home care (CHC) is another option for when pain and other symptoms are out of control. CHC is focused nursing care for a minimum of 8 hours a day. While most of CHC care is provided by a nurse, supplemental care also includes assistance from the hospice aide and family/caregiver. The fourth level of care is inpatient respite care (IRC). This level of care offers the family or primary caregiver temporary relief from care. IRC provides 5 days of caregiver relief. Patients are temporarily moved to a facility offering care 24 hours per day At the end of the 5-day period, patients return to their home and routine hospice care is resumed.