Hospice

The hospice movement began in Britain. Its purpose was to provide a service that would enable the terminally ill to die with dignity, sensitive care, and minimum pain. Now hospice services have become very widespread in the United States, organized on a local basis in cities and counties. Whereas the British approach was to provide special-care facilities, in the U.S. the tendency has been for organizations to provide outreach services to whoever is giving the care to the patient.

Most people agree that when it is possible, a person should be able to die in the comfort and familiarity of his or her own home. Hospice services often can make that possible with minimum stress for the family.

In general, hospices provide assistance in three areas: (1) medical service and advice, (2) social services, and (3) emotional support.

MEDICAL SERVICE AND ADVICE

• One of the classic problems of providing pain relief for the terminally ill has been the understandable caution concerning the use of drugs. Hospices help the doctor to differentiate between drug dependence and addiction. They give advice about appropriate dosage and about the most effective medication.

• Some hospices provide a visiting nurse service at regular intervals, as needed, or assist the family to obtain such help through existing agencies.

• Nurses and other caregivers consult with family members to provide tips on terminal patient care for the greater comfort of the patient. They can help the family obtain medical supplies for home care and arrange for rental of needed special equipment such as a hospital bed.

• Medical personnel help the family and the patient make important decisions on the nature of the care the patient is to receive. For example, they help to decide whether heroic measures are to be used in the event of a medical crisis.

1. Social workers know what medical services are available to the patient. They are generally informed about Medicare and Medicaid regulations and can direct the family to information sources to deal with their specific problems.

2. Family members often have questions about insurance, funeral plans, who must be informed, death certificates, etc. Social workers can relieve many of these anxieties. They can also remind the family that certain areas need their attention.

3. Social workers can help the family plan ahead. Are services desired? If they are, do they wish to have a conventional funeral or a memorial service? Do they prefer cremation or burial? Where should services be held? All of these matters are easier to discuss when an informed person is available to answer questions and initiate contacts.

MEDICARE COVERAGE
If a person is eligible for Medicare (Part A), and is terminally ill, they can choose between standard Medicare benefits or hospice care. Medicare pays 100% (except medications) of hospice services. The patient's doctor and the hospice medical director must certify the patient is terminally ill. Then there is no time limit for coverage if the patient is certified as terminally ill each 210 days. The services include: doctor's and nursing services, medical equipment, drugs for pain relief, home health aide, homemaker services, therapies, medical social ser-vices, and short periods of inpatient care. Services include counseling for the patient and family members.

Your local hospice service can generally be located by looking in the white pages of your telephone book, calling United Way offices, or your local health department.

HOSPICE--1-800-331-1620
Hospice-Link/ Hospice Education Institute. Provides a directory of hospices and local referral, answers general questions on principles and practices of the group, and lends a sympathetic ear. Hours: 9 a.m. to 5 p.m. EST, M-F.