Hospice

  • Medical Author:
    Siamak N. Nabili, MD, MPH

    Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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What is the history of hospice?

Toward the end of the 19th century, hospices became designated places for the care of terminal patients in Ireland and England. The modern concept of hospice was later developed in England in 1967 by Dr. Cicely Saunders.

St. Christopher's hospice was the first hospice under the direction of Dr. Saunders. The philosophy of end-of-life care and the practice of hospice have since spread to many other countries around the world.

In the United States, hospice was originally run by volunteers who cared for dying patients. In the 1980s, Medicare authorized formal hospice care and Medicare hospice benefits became part of Medicare Part A. State-run insurances or Medicaid also offer hospice benefits, as do most private insurances.

Currently in the United States alone there are several thousands of hospice agencies. This branch of the medical field continues to grow as more people live longer with their chronic conditions. As a result, hospice can become a reasonable option for more patients during the disease progression.

In the early 1990s, hospice became an official medical subspecialty and physicians involved in the care of hospice patients could become board certified in hospice and palliative medicine.

What are the main goals of hospice care?

The end-of-life period is a sensitive part of everyone's life cycle. Psychosocial, financial, interpersonal, medical, and spiritual conflicts are all intertwined.

The main goal of hospice care is to reduce potentially unavoidable physical, emotional, psychosocial, and spiritual suffering encountered by patients during the dying process.

As a result, medical care during this period is very delicate and needs to be individually tailored. End-of-life care requires detailed attention to each person's wishes, beliefs, values, social situation, and personal characteristics.

The complex care of hospice patients may include the following:

  • Managing evolving medical issues (infections, medication management, pressure ulcers, hydration, nutrition, physical stages of dying)
  • Treating physical symptoms (pain, shortness of breath, anxiety, nausea, vomiting, constipation, confusion, etc.)
  • Counseling about the anxiety, uncertainty, grief, and fear associated with end of life and dying
  • Rendering support to the patient, their families, and caregivers with the overwhelming physical and psychological stresses of a terminal illness
  • Guiding patients and families through the difficult interpersonal and psychosocial issues and helping them with finding closure
  • Paying attention to personal, religious, spiritual, and cultural values
  • Assisting patients and families making their wishes known and also reaching financial closures (living will, trust, advance directive, funeral arrangements)
  • Providing bereavement counseling to the mourning loved ones after the death of the patient
Medically Reviewed by a Doctor on 10/6/2015
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