More Could Benefit
From Hospice Care

Each year approximately 700,000 terminally ill patients and their families rely on the invaluable end-of-life care provided by the 3,100 hospice programs located in the United States. In 2001, President George Bush proclaimed November as National Hospice Month "to honor the professionals and volunteers that dedicate their lives to caring for terminally ill patients through hospice care."

Based on current trends, the National Hospice and Palliative Care Organization projects that "more than three quarters of a million U.S. patients will receive hospice care this year - a seemingly large number but only a fraction of those who could benefit." Unfortunately, many will receive the care only in the last few days or weeks of their lives. The impact of the missed opportunity is profound. For instance, research by the National Hospice Foundation finds that while 80 percent of Americans wish to die at home, less than 25 percent actually do.

We plan for weddings, the birth of a child, college and retirement. But rarely, if ever, do we talk about how we want to live in the final phase of our lives. We're more willing to talk to our teen-agers about drug abuse or safe sex than to discuss end-of-life care options and preferences with our parents or loved ones.

It's not that we don't make end-of-life decisions. We write a will, buy life insurance and give consent to posthumous organ donation. But we don't prepare or plan for the actual process of dying. No society has ever dwelled more on ''quality of life'' concerns. Yet ''quality end-of-life'' may be our only remaining truly taboo subject.

Myra Downs, RN, MSN, Vice President Clinical Operations for Haven House Hospice in Atlanta states that, "All too often we receive patients in the final stages of dying. We are unable to truly give the gift of hospice. Care becomes centered around managing pain and out-of-control symptoms. Our care team of nurses, social workers, volunteers and chaplains are unable to provide for the family and patient the full benefits of hospice care."

Part of the problem is the public's perception of hospice. It is not only the public that views hospice as "giving up". Many in the medical community see hospice as going against their Hippocratic Oath. In fact, patients in hospice may be discharged to continue aggressive therapy if their condition improves or if the disease is in remission.

Many also believe that the medication administered will prevent a patient from being able to speak or retain consciousness. Actually, physical and occupational therapists may be used to assist the patient in becoming as mobile and self-sufficient as possible, allowing them to achieve a pain-free but alert state. Hospice care does not speed up or slow down the dying process.

Hospice is about living with choice and control. It is not giving up. Educated in treatment options and free to choose them, patients and their loved ones maintain control over their lives.

This month as the country honors the professionals and volunteers who dedicate their lives to aiding the terminally ill through hospice care, we should also use this observance as a time to increase awareness of the importance and availability of hospice service, a true gift.