Sunday, January 15, 2006

hospice

The development of the hospice is one of the great forward steps in human services in this century. Until this concept was established by Dr. Cicely Saunders at St. Christopher's Hospital (now Hospice) in London, England, in 1967, there was a tendency to ignore dying people simply because there was no therapeutic treatment that could turn away their oncoming deaths. Under the revolutionary idea of the hospice, however, the aim is to help dying people, often cancer victims, to retain as much control over their lives as possible, and to experience death with dignity.
When a patient has been diagnosed as terminally ill and is expected to live only a few weeks or months, a hospice program will provide a continuum of care consisting in the relief of pain, spiritual and psychological counseling, help with bodily care and functions as needed, and social services. Providers of hospice services not only include health professionals and staff specially trained to deal with the dying, but volunteers, clergy, and, of course, the individual's family. The aim is to help both patient and family come to terms and deal positively with the imminent death and to strengthen their capacity to meet death with dignity. In home-based hospice programs, family members give most of the direct care to the dying individual, but they have the help of an interdisciplinary team (physician, nurse, clergy, social worker). In hospice residences care is supplied by professional staff, employees, and volunteers, with the family playing the supportive role. When a patient decides to follow the hospice approach, aggressive techniques (i.e., chemotherapy, radiotherapy, surgery, etc.) to preserve life are discontinued. The alleviation of pain and assurance of physical and psychological comfort-a personal rather more than a medical approach-become central.
A hospice was first established in the United States in 1971 in Branford, Connecticut, following the model established by Dr. Saunders in London. The concept has since spread across the United States, and today there are more than 1,900 hospice programs, which serve over 100,000 patients each year. About 65 percent of the people utilizing hospice programs are over 65, and 80 percent are dying of cancer. A number of states (15 at last count) have passed laws or regulations dealing specifically with hospices. These laws provide for licensure and regulation, and promote the growth of hospice services.
Several states require health insurance policies to include home health care and provide optional coverage for hospice care to individuals and groups. Medicare has been modified to include hospice benefits, although the specific regulations have not been worked out.
Atchley, R. C. Social Forces and Aging, 4th ed. Belmont, Calif.: Wadsworth Publishing Co., 1985.
Millard, S. "Older Citizens Seek Independence," in Aging, Goldstein, E. C., ed. Vol. 2, Art. 64. Boca Raton, Fl.: Social Issues Resource Series, Inc., 1981.

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