1. Wright, Joan F. BA, CDP

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Very often, when the word hospice is mentioned, people think all is lost. He must only have days left. She'll be drugged now. There's no hope anymore. These, sadly, are the myths connected to hospice. Let's take a look at the true hospice picture.


Question: Isn't hospice care for the very end when nothing more can be done?


Absolutely not! Hospice care emphasizes pain management and symptom relief while focusing on the patient's quality of life. And that life can be months-or more. Although hospice is typically recommended when the patient appears to have less than 6 months to live, some people have "graduated" from hospice because they improved with the specialized, focused care. The whole point is to NOT wait until the final days, but rather choose hospice sooner to take advantage of the many benefits hospice provides both to the patient and family. And, far from the misnomer of giving up, when a patient chooses hospice, he or she is actually controlling his or her own care and quality of life.


Question: Doesn't hospice care drug patients up for the pain to the point that makes them "out of it?"


Another myth. Although hospice focuses on pain, symptom management, and relief, it is done so in a very methodical and judicious way. Hospice is a holistic form of comfort care that focuses on the patient's physical, emotional, and spiritual well-being. The patient is very much a part of the multidisciplinary team (nurse, social worker, chaplain, home healthcare aides) who, with the physician, determines how best to manage pain and enables the patient to have the best quality of life possible. Various therapies such as massage and reiki may be suggested to augment and complement the medicinal approach to managing pain. With comfort as the goal, the team may also suggest special products such as a low air-loss mattress to help. A good hospice team implements creativity and resourcefulness in helping the patient find comfort.


Question: Isn't hospice just for cancer patients?


Actually, cancer accounts for less than half of all hospice patients (National Hospice and Palliative Care Organization, 2014). People with Alzheimer's and other dementias, heart disease, chronic obstructive pulmonary disease, kidney disease, Parkinson's disease, and other life-limiting illnesses all benefit from the focused care of hospice.


Question: Don't we have to wait for the physician to tell us when hospice is needed?


When to choose hospice should be based on how the patient wishes to live his or her final months of life. For example, a patient may no longer wish to go to the hospital or emergency room, as has been the custom with his or her illness. Instead, the patient may want to remain at home, spend quality time with family and friends, visit favorite places and people, or just no longer pursue aggressive treatments. The physician must provide the referral to hospice care services, but the patient and family can bring the subject up for discussion rather than wait for the doctor to bring it up as the next step. It can be a delicate discussion and some physicians may delay it in deference to the patient if they are unaware of what the patient truly wishes.


Question: Can patients on hospice decide to go to the hospital?


Yes, but the hospice agency needs to be notified that they have gone and if they have been admitted. After the hospitalization, they can be readmitted to hospice. Typically, hospice patients wish to avoid the hospital, so if an urgent situation arises, patients usually call the hospice nurse first to discuss what action should be taken.


Question: Will hospice come to patients in an assisted living community?


Hospice comes to wherever one calls home. That may be in the patient's own home, a family member's home, a senior housing complex, an assisted living community, a nursing home, or a hospice residence.


Question: Why would one choose a hospice residence?


For some, a hospice residence is a more comfortable and perhaps safer choice. Patients who have young children at home may elect a hospice residence to spare their children from having the death occur in the family home. Older spouses may find it is too difficult and no longer safe to provide care to their loved one in the shared home. Other patients may not have family or friends nearby to help care for them in their own home. Hospice residences provide a home-like setting with 24/7 care and oversight by the residence staff.


Question: Patients often ask if the nurse will stay with them 24/7 if they choose to remain in their own home.


Hospice nurses are accessible 24/7, but they won't be in a home for that length of time. Typically, the hospice nurse works out a visit schedule that accommodates each patient's specific and individual needs. Other team members such as the chaplain and social worker also schedule visits. If home healthcare aides are needed for personal care, these visits are scheduled accordingly. Visits are scheduled over the full course of the week (weekends included). If necessary, the patient can call the hospice agency to speak to his or her regular hospice nurse during regular operational hours or the on-call hospice nurse during off hours. In other words, there is always a nurse to speak with via phone and, if necessary, to come for a visit any time of the day or night.


Question: What does hospice care cost?


Hospice services are available to patients as a Medicare (or private health insurance) benefit. The only cost to the hospice patient may be room and board services if residing in a hospice residence or skilled nursing facility.


In Historic Shift, More Nurses Graduate With Bachelor's Degrees

The nation's nursing workforce has reached a critical tipping point. In 2011, for the first time ever, the number of nurses who earned baccalaureate degrees in the science of nursing (BSN) was higher than the number who earned 2-year associate degrees in nursing (ADN), according to a recent study of newly available government data about nurse education. The change marks an historic shift in nurse education levels; in every year before 2011, the number of nurses earning ADNs outpaced those earning BSNs. By 2012, more nurses (53%) were earning 4-year baccalaureate than 2-year associate degrees (47%). The percentages were mirror images of each other a decade earlier; in 2002, 55% of nurses earned an ADN and 45% earned a BSN. A strong driver of the change is an explosion of accelerated Registered Nurse (RN)-to-BSN nurse education programs, which enable RNs and nursing students to earn bachelor's degrees in shorter time periods than do traditional 4-year BSN programs.

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National Hospice and Palliative Care Organization. (2014). NHPCO's Facts and Figures Hospice Care in America. Retrieved from[Context Link]