Hospice

Hospice care in the United States has experienced tremendous growth since 1974, and it served as the forerunner to the health care community's current focus on palliative care. Although there isn't a universally accepted definition of palliative care, it is often described as "a way to meet the physical, mental, and spiritual needs of chronically ill and dying patients. . . (with) attention to relieving symptoms and meeting patient goals" (Lynn, Schuster, and Kabcenell, p. 134). In contrast to hospice care, where the patient must have a limited prognosis and a terminal illness, patients receiving palliative care must have a disease that is life limiting. This criterion broadens the number of patients who can benefit from palliative care. At the foundation of both hospice and palliative care is the effort to improve an ill person's quality of life through expert symptom management.

The challenges that hospices face are not unique to this area of health care. Americans' growing concern with the cost of health care means that hospice programs need to continually provide the highest quality end-of-life care at the lowest cost, whether the care is provided in the home, in another community-based setting, or within a hospice inpatient unit. In the future hospices will also be confronted with shortages of registered nurses as nurses and other health care providers from the baby-boom generation retire.

Finally, hospices must also continue to aggressively educate the public about the services that they provide. In 1999, the National Hospice Foundation conducted a public opinion survey of people age forty-five or older and found that:

• • Only 24 percent of Americans put into writing how they want to be cared for at the end of life. A substantial proportion (19 percent) have not thought about end-of-life care at all, while 1 percent have thought about it, but not told anyone their wishes.
• • Of those people who experienced the terminal illness of a loved one in the past year, only 22 percent used hospice services.
• • Eighty percent of the respondents said that they did not know the meaning of the term hospice.
• • People do know what they want from end-of-life care: 83 percent believe that making sure a patient's wishes are enforced is extremely important. Being able to choose among the types of available services was also extremely important, according to 82 percent of the respondents.
• • People are willing to have an outside organization come into their homes and assist with care for a family member in the last stage of life. Fully 66 percent would welcome help from an outside organization, while 24 percent would prefer to take care of the family member themselves, with the help of family and friends. (NHPCO, p. 2).

Hospice care makes a difference in the lives of persons who are experiencing the end of their lives. With the graying of America, it is expected that the demand for hospice care will continue to increase. Hospice professionals and volunteers support persons with terminal illnesses (and their families) to optimize quality of life during this difficult transition. It is essential that referrals for hospice care are made in a timely manner in order to maximize the benefits of hospice care both prior to, and after, the death of a family member.