I am standing on the seashore. A ship spreads her white sails to the morning breeze and starts for the ocean. I stand watching her until she fades on the horizon and someone at my side says, "she is gone." Gone where? The loss of sight is in me, not in her. Just at the moment when someone says "she is gone," there are others who are watching her coming. Other voices take up the glad shout, "Here she comes," and that is dying.
- Henry Scott Holland
Hospice, or 'a shelter or lodging for travelers, children, or the destitute', according to Webster's dictionary, is a service offered by Buena Vista Regional Medical Center's Hospice Team to allow dignity for those with terminal illnesses and their loved ones.
Hospice offers a comprehensive program of care to patients and families facing a life threatening illness. It is a philosophy of caring that assists a person nearing the end of life.
The focus of hospice care is on the patient and the family rather than the disease. The goal is to improve the quality of life that remains. Professional medical care is given in conjunction with symptom relief. "Hospice is care when cure is no longer or choice and the goal is to promote quality of life and to help people live life to the fullest," said Janel Kaufman, RN/BSN Hospice Case Manager.
Hospice seeks to provide an array of services based on a holistic philosophy of living and dying. Since its goal is to prolong meaningful living, no active, curative therapies are conducted. Hospice seeks to make the patient comfortable. Hospice proposes to neither accelerate nor postpone death for terminally-ill patients. Kaufman stated, "Hospice looks at pain holistically, emotional, social, spiritual, psychological and physical need. It seeks to control the pain with medications, alternative pain relief strategies such as massage, ice and heat."
Care is provided to all terminally ill residents, not just those with a cancer diagnosis. Hospice is a service that is provided to patients who have a limited life expectancy. However, if a hospice patient shows signs of recovery, he or she may be returned to regular medical treatment. Hospice care is delivered mainly in the home; however, care can also be provided in the nursing home, and for short-term inpatient medical care in the hospital.
The process of hospice starts when a referral is made for an individual. Any person with a terminal illness electing non-curative comfort care may be referred. The decision for hospice services to be provided is made in conjunction with the physician. "The physician needs to certify that the patient has a life limiting illness and that the patient is not actively treating the illness, such as aggressive chemotherapy", explained Kaufman.
The hospice team makes visits to the patient and family. Included in the hospice team are the medical director, pharmacist, social worker, hospice case manager, hospice nurse manager, dietician, chaplain, volunteers and family members, along with the primary physician. The team works together to review the case and decide for appropriateness. Each person in the team plays a crucial role.
When hospice services are being provided, the patient needs to have a primary caregiver involved in order to provide care when the patient is no longer able to provide care by themselves.
Kaufman explained, "Patients take care of themselves until they cannot, at this point other arrangements are made. Only one dedicated caregiver is needed; however, the more the better, of course," said Kaufman.
Hospice care does not end after the patient passes away. Hospice care provides a follow-up bereavement support group. The team follow families for up to a year after the death of a loved one. Individualized bereavement counseling is available for family and friends. Bereavement support group meets the second Monday of every month. Mailings are also sent at one month, three months, six months, and one year following. Follow up with phone calls and visits are also available as the family desires. The hospice team also offers a Living with Loss class one to two times per year. This class is an intensive educational class that is offered to the newly bereaved.
Hospice care is provided regardless of payer source. Medicare is the primary source of reimbursement to hospice. If the patient is not covered by Medicare or any other health insurance, hospice donation funds can be used a for those who do not have funding available.
Services provided by the Buena Vista Regional Medical Center Hospice staff include a 24-hour, seven-days-a-week, on-call system. Coordination of care, pain control, symptom management, emotional and spiritual support, counseling, durable medical equipment, volunteer services and support, medical supplies, appliances, pharmaceuticals related to terminal illness, follow-up bereavement support, and physical therapy, occupational therapy, and speech therapy as appropriate. Medical social work services and an available chaplain are other services provided.
For more information about hospice, call (712) 749-2741 and ask for Janel Kaufman or Lynn Radke.