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Hospice Basics

A really great video overview of Hospice care

Hospice Philosophy & History

The hospice philosophy recognizes that every person deserves to live out his or her life with respect and dignity, alert and free of pain, in an environment that promotes quality of life. This concept of care came to the United States in the early 1970’s, at a time when the vast majority of terminally ill people died in the hospital, often alone and in pain. From its beginnings, hospice has focused on the whole person–body, mind and spirit–with an understanding that serious illness profoundly impacts not only the patient, but also family and loved ones as well.

Terminology

HOSPICE CARE provides compassionate, holistic care that addresses all aspects of a patient’s needs: physical, spiritual, and emotional. It also provides support to family members during and after the dying process. A multitude of healthcare professionals from doctors and nurses to social workers, bereavement counselors and chaplains form a support team to help the patient and the family through this very difficult period. In Indiana, hospice care is available for those individuals expected to live six months or less.

END OF LIFE issues include patient rights, pain and symptom management,health care options, grief and loss, financial concerns of the impact of car on the family; closures of relationships, providing for loved ones after the physical death, and maintaining dignity and respect for the dying patients. Only 5 percent of the dying process is physical.

PALLIATIVE CARE, an approach originally defined and actively practiced by hospice, is the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological,social and spiritual problems is paramount. The goal of palliative care is the achievement of the best possible quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of illness in conjunction with treatment.

Hospice Programs & Service

A team of hospice professionals and volunteers work cooperatively with the patient,family and the primary physician to provide this special kind of care. Hospice addresses the physical, emotional, social and spiritual needs of the patient while attending to the equally important needs of the family and caregivers.

The Hospice Team

  • The patient’s physician who becomes an integral part of the hospice team and continues to direct the plan of care.
  • The hospice’s medical director who oversees the medical services provided to each patient in the hospice program and ensures the high quality of care.
  • Registered nurses who specialize in pain management and symptom control, particularly for end-stage diseases.
  • Licensed social workers who assist the patient and family with emotional concerns, including bereavement, as well as access to supportive community resources.
  • Pastoral counselors who service people of all faiths, or of no religious faith, providing comfort and support whenever required. They also will facilitate contacts with community clergy as needed.
  • Bereavement counselors who support the family and loved ones of all ages with support groups, one-on-one counseling and other special services during the bereavement process.
  • Home health aides who provide care and help with the activities of daily living.
  • Volunteers who have been trained to provide companionship and support the patient and family with the everyday challenges of life.

All licensed hospices in the state of Indiana provide these team services.

In addition, many programs and support groups are available to members of the community who are coping with loss and grief whether or not their loved one was served by hospice.

Advance Directives

An advance directive is a legal document that allows you to communicate your health care preferences if you should lose the ability to make decisions for yourself. This advance directive has been developed in compliance with Indiana law to help you document your wishes about health care. It has three parts:

  • The Indiana Appointment of Health Care Representative allows you to name someone you trust to speak for you any time you are unable to make your own medical decisions, not only at the end of life.
      
  • Indiana Living Will Declaration (Declaration A) allows you to refuse life-prolonging treatments if you develop a terminal illness and can no longer make your own medical decisions. It goes into effect only when your doctor certifies in writing that you are in a terminal condition and that your death would occur within a short period of time without the use of life-sustaining medical care.
      
  • Indiana Life-Prolonging Procedures Declaration (Declaration B) allows you to request the use of all life-prolonging treatments should you develop a terminal condition and can no longer make your own medical decisions.
      
  • Out of Hospital Do Not Resuscitate Declaration and Order is for situations outside of a hospital or health facility. The "Out of Hospital Do Not Resuscitate Declaration and Order" is used to state your wishes. The law allows a qualified person to say they do not want CPR given if the heart or lungs stop working in a location that is not a hospital or a health facility. This declaration may override other advance directives. You may cancel the declaration may be canceled at any time by a signed and dated writing, by destroying or canceling the document, or by communicating to health care providers at the scene the desire to cancel the order. In a hospital or health facility setting, if you have a terminal condition and you do not want CPR, your physician will write a "do not resuscitate" order in your medical chart.

The Indiana Hospice & Palliative Care Organization recommends that you complete the Indiana Appointment of Health Care Representative and either Declaration A or Declaration B, to best ensure that you receive the medical care you want when you can no longer speak for yourself.

These documents are designed to ensure that your wishes are known and followed.Discuss your advance directive with your doctor, family, friends, clergy, attorney and anyone who may be involved in your care. Completing this workbook first can make the process easier. It provides some questions to help you think about your future and make decisions about what is most important to you.

For more information about Advance Directives from the Indiana State Department of Health, click here.