Hospice care for cancer patients

Hospice care is rooted in the medieval concept of shelter for travelers, and many religious orders still offer hospice shelter for those at a critical emotional juncture in their lives. In 1967, Cicely Saunders at St. Christopher's Hospice in London first applied the term "hospice" to specialized care for dying patients.

Today, hospices are places where those experiencing an illness can recuperate in a caring atmosphere, where those requiring lifetime care can be sheltered for brief periods while their families recuperate, and where those with terminal illnesses can live as fully and comfortably as possible.

A hospice isn't just a place for people to go when their illness is terminal. It can also serve as a place of rest for those who, for example, live alone and won't be able to cope with feeding and caring for themselves in the days following a difficult surgery. This kind of care is particularly useful to the elderly, even elderly couples, where both are too old to offer adequate care and supervision to an ailing partner.

This care is applicable to recovering surgical patients, particularly the elderly, but also to the care-givers of victims of long-term illnesses like Alzheimer's and cancer, which require intensive, 24-hour supervision. Hospice care in the latter instance gives stressed family members a much-needed break, allowing them to recoup their strength and experience a bit of respite of their own.

The average stay in a hospice is 12 to 14 days, after which the 20 percent of patients who receive such care for non-terminal illnesses return home. In 80 percent of cases, though, hospice care is provided for the dying. A hospice can be a dedicated facility, but can also refer to a philosophy of care, where death is viewed as life's final journey and terminal patients are given palliative care. This treatment is designed not to cure but to help patients finish their lives with awareness and dignity. This care is commonly provided through pain medication, the alleviation of symptoms and a focus on ameliorating the emotional, social and spiritual impact of the disease on both the patient and his or her family and friends. Hospices are also cognizant of, and respectful toward, differing ethnic, cultural and religious attitudes about death, and care is taken never to offend families or exclude them from the emotional intimacy that attends a loved one's passing.

This care is provided 24 hours a day, seven days a week, by a team-oriented group of specially trained professionals, including inpatient facility members or the home care agency, a social worker, doctors, a pharmacist, clergy, volunteers and even a funeral director. Such care can be provided either in a dedicated facility or by hospice workers and family members in the patient's home.

In the United States, 90 percent of terminal patients choose hospice care in the home. In these instances, respite care in a dedicated facility can provide family members a brief intermission from the emotionally wearing aspects of caring for dying family members. Hospice care also provides bereavement and counseling services to family members, both before and after a patient's death.

Hospice care is a covered benefit under Medicare for those patients who receive a prognosis of 6 months or less. Patients can remain in hospice care beyond six months if a physician provides documentation that a patient is terminally ill. Patients can also leave a hospice facility and be re-admitted on the recommendation of a doctor or oncologist.

Medicare covers all services, medications and equipment related to the illness. These include:

Spiritual, dietary, and other counseling
Continuous care during crisis periods
Home health aides
Physician services
Nursing services
Medical appliances and supplies
Trained volunteers
Bereavement services

Additionally, 43 states offer hospice coverage under Medicaid, as do many health insurance groups like Blue Cross, and many HMOs. There is no mandatory, nationwide program of accreditation of hospice programs and facilities, though most are accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or by the Community Health Accreditation Program (CHAP).

In 2007, there were more than 4,700 hospice programs in the United States. These programs cared for 965,000 Medicare enrollees in 2006 and nearly 1.4 million people in the 2007

The National Hospice and Palliative Care Organization maintains a list of hospices in the U.S. You can also go to JCAHO's home page (http://www.jointcommission.org) and search for a hospice near you. This organization has some of the highest standards for accreditation, so their recommendations provide higher-quality programs. You can also ask your doctor or the hospital currently delivering care.

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