The answer to this question may surprise many people. Hospice is no longer only for terminal cancer patients who have less than 3 months to live. Hospice and Palliative Services take care of many chronically ill individuals who need nursing support but do not meet criteria for other resources. Dame Cicely Saunders pioneered the concept of palliative care and hospice in the UK in the 1960’s. She introduced effective pain management and insisted that dying people needed to be treated with dignity, compassion, and respect. She died in 2005 but has left a legacy that continues to follow her mission to this day.
The National Hospice and Palliative Care Association says the top 5 qualifying diagnosis for hospice in 2021 are still led by cancer with 29.6% of their patients. Second is heart disease at 17.4%. This can include coronary artery disease, congestive heart failure, or damage secondary to multiple heart attacks. For the past several years the amount of patients with heart disease in hospice has been steadily increasing. Third is dementia with 15.6% of patients being affected. Early admission to hospice can help bring support and education for the family when behavioral changes start to occur. Fourth is respiratory disease at 11% with chronic illnesses like COPD or Pulmonary Fibrosis. Lastly, strokes with 9%, many patients are left with paralysis, speech and mobility issues.There are other specific situations that may prompt hospice like frequent hospitalizations, a desire to end curative treatment of some kind , someone with declining cognitive abilities or diseases like ALS or Parkinson’s.
Hospice has 4 levels of care and patients may experience one or all 4 depending on their needs. Palliative Care is the stage before hospice and in this area usually involves a monthly nurse practitioner visit for closer monitoring. Routine hospice care gives support through weekly nurse visits, a team approach to treatment and avoiding complications, a social worker, chaplain and sometimes a home health aide for bathing assistance. Inpatient hospice units are for patients who need stabilization either from pain or a complication like a UTI, the stay is usually limited to 3 days. The final stage is crisis care where an RN is present around the clock until they either stabilize or pass away. This also is usually around 72 hours.
In my experience as a nurse most people wait too long to obtain hospice services. It no longer means the end is near and they have shifted their focus to maintaining a wonderful quality of life until our time here is done. Don’t be afraid to discuss this as an option with your family physician. We are fortunate to have 4 agencies to choose from; Hospice of St Francis, Health First Hospice, Vitas, and Wuesthoff Hospice.
