A case for hospice care – a new study and a personal story

Dealing with the dying of a loved one is tough business.

Last week I was privileged to spend time with my father, in the hospital, as his health steadily declined.

All of his biological systems were breaking down – except his mind. He was able to recognize his kids and, with a low, weak voice express his love for us.

He went in with shortness of breath and pneumonia before his, cardiovascular,  gastro-intestinal, urinary and muscular system regressed rapidly. The cocktail of heavy drugs were not working.

My siblings and me had to make the decision of resorting to hospice care for our frail and immobile father.

There was much confusion about hospice to all of us: what is it? How does it work? Cost? etc. Being in health care and having visited a friend in a hospice setting a few years ago I thought my understanding of hospice was solid – I was wrong.

Briefly, hospice is a type of medical care for those that are dying. It provides a smooth and confortable transition for the patient.

For more detailed information on hospice go HERE

This recent study on the Journal of the American Medical Association (JAMA) suggests that hospice care is offered more often but offered too late.

Study details:

• The study reviewed a random sample of about 800,000 Medicare recipients who died in 2000, 2005 and 2009.

• Each year, fewer people died in the hospital, according to the study.

• In 2000, 32.6 percent died in the hospital.

• In 2005, 26.9 percent died under hospital care, and 24.6 percent did so in 2009.

• The use of the intensive-care unit (ICU) in the last month of life increased for each time period.

• In 2000, 24.3 percent of people were in the ICU in their last month.

• By 2005, that number was 26.3 percent

•  2009 it had risen to 29.2 percent.

• During that same period, the use of hospice care also increased significantly.
  • In 2000, 21.6 percent of people received hospice care at the time of their death.

• That number was 32.3 percent in 2005 and 42.2 percent in 2009.

• In 2009, however, 28.4 percent of hospice care was for three days or less, according to the study. And 40 percent of those short hospice stays came on after ICU care.

• “This was not what I expected to see,” Dr. Teno said. “We’ve done a good job improving the numbers of people receiving hospice care, but the pattern of care we see in this study suggests that hospice has become an add-on treatment to aggressive care.” (Dr. Teno is the primary investigator of the study)

– Tedo et al. 2013, JAMA

My take on this:

Hospice care, as is naturopathic medicine, is not yet part of the medical culture.  Additionally, as in naturopathic medicine, people still don’t know what hospice care is or when is the right time take

Personally, there were times when we thought our dad was going to bounce back, a glimpse of hope – “maybe is not the end, “ we thought. But reality would soon set in as his pain exacerbated and his appetite lessened.

There was confusion between us, his kids – Is hospice a euphemistic form of euthanasia?

Hospice care provided a nurse to be with my dad 24 hours a day – assuring comfort and no pain.

When the prognosis is dim; advanced cancer, elderly person with steadily declining health (as was the case with my father, age 86) the decision is made between family members and doctors, although doctors do not always offer this as an option. You the family of the loved need to be an advocate for hospice care.

For yourself, maybe it is something you want to incorporate in your will. I know I am.

What do you know about hospice care?

Please share this note with friends and family as I think it would be valuable information for them.

RIP Papá.