Hospitals Embrace the Hospice Model

The goal: Make the prospect of death as natural and comfortable as possible

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By Dennis Thompson
HealthDay Reporter

SUNDAY, Jan. 8, 2007 (HealthDay News) -- Confronting death, even in a hospital, can be a terrifying ordeal.

Doctors scramble this way and that. Machines fill the air with odd sounds. Needles and tests poke and prod. Above all else, there can be a feeling of utter helplessness, a sense you no longer control your life.

But now, taking a page from the work of hospices, more U.S. hospitals are beginning to strive to make the end of life as natural and comfortable as they can. And a dignified death is becoming a greater priority in medical settings, particularly as the huge Baby Boom population faces its own mortality.

The number of hospitals offering hospice and palliative care has increased dramatically in recent years, from 632 in 2000 to 1,027 hospitals in 2003, according to a recent study.

"There's a recognition that it's the right thing to do for the patient and the family, that anyone with a terminal condition deserves good palliative support," said J. Donald Schumacher, president and chief executive officer of the National Hospice and Palliative Care Organization, a charitable organization created in 1992 to broaden America's understanding of hospice through research and education.

This new interest in palliative care -- which strives to sustain the quality of life of patients, even if doctors are still striving to save them -- couldn't come too soon, said Dr. Sean Morrison, lead researcher of the study and vice chairman of research in the department of geriatrics at Mount Sinai Medical Center in New York City.

"It's become clear that the care of people with serious illness in this country needs improvement," Morrison said. "Pain is still markedly under-treated in U.S. hospitals. Patients often receive care that goes against their wishes. Families are increasingly being burdened with the needs of their sick relatives in the setting of an unresponsive health-care system."

For decades, hospice programs have attempted to offer an alternative to dying in a cold, sterile hospital room.

Hospice care is designed to provide comfort and support to patients and their families when a person is stricken with a fatal and incurable illness, according to the National Hospice and Palliative Care Organization. A hospice program addresses all symptoms of a disease, particularly a patient's pain and discomfort. Care also is given for the emotional, social and spiritual impact of the disease on the patient and his or her family and friends.

The first hospice program in the United States, The Connecticut Hospice Inc. in Branford, opened in March 1974. There are more than 4,000 today, with more than 400 hospice programs opening in the last 18 months alone, Schumacher said.

This rise in hospice care makes sense, given America's aging population.

The total population of elderly Americans is expected to double by the year 2030, when more than 70 million people will be over 65, according to the U.S. Department of Health and Human Services' Administration on Aging.

"With more baby boomers needing end-of-life care, palliative care is something that needs to be found acceptable within many hospital settings," Schumacher said. "The number of programs is growing, and the number of patients is growing."

There's a difference between hospice and palliative care, although they both focus on helping a person be comfortable by addressing physical or emotional pain and suffering.

Hospice care focuses on relieving symptoms and supporting patients who are within hours, days or months of death. Their treatment focuses solely on comfort, not cure.

Palliative care can be given at any time during a patient's illness, from diagnosis on, regardless of life expectancy. Patients receive comfort treatments even as doctors also seek to cure their condition.

Morrison said hospitals are ready-made for palliative-care programs, particularly with patients who don't have much time left.

"They are a logical place to look at to improve care for patients with serious illness," he said. "Just because you are trying to cure someone or extend their life doesn't mean they shouldn't have their pain treated, that they shouldn't have their psychological needs met. It shouldn't be one or the other. Modern palliative care recognizes that."

Good palliative care can also provide cost savings to hospitals, since teams providing the care must match their actions to the goals set forth by their patient.

"By doing that, you reduce a huge amount of waste," Morrison said. "Patients get what they want when they want it, and nothing they don't want. It's much more rational care, and it's less expensive for hospitals."

And, in the end, palliative-care programs are making things better for all the people hospitals should be treating.

"Their pain gets better, their other symptoms get better, patients feel better cared for," Morrison said. "Families are significantly more satisfied when patients receive palliative care."

More information

To learn more, visit the National Hospice and Palliative Care Organization.

SOURCES: Donald Schumacher, president and chief executive officer, National Hospice and Palliative Care Organization, Alexandria, Va.; Sean Morrison, M.D., vice chairman of research, department of geriatrics, Mount Sinai Medical Center, New York City; National Hospice and Palliative Care Organization; U.S. Department of Health and Human Services' Administration on Aging

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