by Joan Linsky, RN, and Harry Baggen
There's a cliche that says the only things
inevitable in life are death and taxes. For health care providers
caring for the frail elderly, death is an inevitability that is never
far from sight. Each year, one out of every four nursing home residents
in America dies. And in some states, the rate is much higher. In
Massachusetts, for instance, one in three nursing home residents dies
each year. While the numbers aren't as high in
assisted living residences, death is still common. It's just the nature
of the senior living population: the older and more frail a person is,
the more likely it is that he or she will face the end of life in the
near future.
Unfortunately, many senior living residences aren't
adequately prepared to care for dying residents and their families. The
mission of senior living revolves around providing the highest quality
of care. This means giving residents a pleasant place to live with the
finest amenities, and when they are sick, providing access to the best
health care possible.
But inevitably, seniors with health care issues will
reach a point where even the finest medical care won't cure them. As
hard as it is for caregivers to admit, the time comes when the focus of
care has to shift from treating the disease to providing comfort.
That's where hospice comes in.
The benefits of hospice
Hospice is a centuries-old practice through which a
combination of professional caregivers and volunteers provide the
necessary medical, emotional, and spiritual support to those who are at
the end of life. And in the vast majority of cases, that care is
provided in the patient's home, regardless of whether the person lives
in a nursing home, assisted living, or even a lifelong family home.
Ninety-five percent of all hospice care is home-based, with just a
fraction of hospice care provided in hospitals.
One essential element of hospice is pain management.
Anyone who has watched a loved one die a slow or agonizing death
understands the importance of this. Hospice caregivers manage a
person's medications to assure the patient's dying is as pain-free as
possible. Working with the individual's family, physicians, and
other health care providers, hospice caregivers create a medication
regimen that minimizes the pain associated with the illness or disease.
Another essential element is the emotional support
provided to individuals and their families. Pain isn't only
physical. People who are the end of life, as well as their families and
loved ones, are often overcome with stress because of the uncertainty
that accompanies death. The support that is provided by hospice
providers can play an important role in reducing that stress.
Equally important is the spiritual side of hospice
care. A recent survey conducted by the Massachusetts Commission On
End-Of-Live Care found that 80 percent of respondents feared dying.
Hospice gives people the freedom to talk about the end of life and
prepare themselves and their families. The spiritual component of
hospice also includes the presence of clergy and bereavement
counselors. Even the most faithfully religious people sometimes
experience doubt or fear of the unknown when they approach death.
Finally, and perhaps most importantly, hospice
caregivers try to assure that the patient won't die alone. Death is
often a traumatic and frightening experience. It should never be a
lonely experience. Hospice caregivers spend countless hours with
patients, discussing the patients' fears and hopes, talking about
issues that are affecting loved ones, keeping the person company, and
taking care of his or her basic needs.
Hospice is equally beneficial to the patient's loved
ones. Often, the inevitability of death is harder on family and friends
than it is on the patient. Hospice caregivers also provide support and
spiritual guidance to help ease the emotional pain of loved ones who
may have a hard time accepting their impending loss.
Benefits to the residence
Hospice can also provide a number of important
benefits to senior care residences in which these services are
provided. The most obvious is improved quality of care. The
inevitability of death dictates that each nursing home and assisted
living community have effective programs in place for dealing with
end-of-life issues. Hospice is the most effective way to assure that a
person's death is comfortable and pain-free.
Perhaps the most important role for caregivers is to
be an advocate for the individual. Health care providers often have to
help individuals and their families navigate their benefits and explore
all of their options regarding end-of-life care. Hospice is among the
most powerful of these options, and residences that offer the service
have a huge quality-of-care advantage over those that don't.
The availability of hospice can also provide a
marketing advantage for nursing homes and assisted living communities
that face intense competition for residents. When seniors and their
families are looking for a place to serve as a final residence, having
a hospice option available can be an attractive selling point.
Hospice also provides direct benefits to employees
of the nursing home or assisted living community. Studies have shown
that the hospice philosophy and approach has a positive “spill-over”
effect on senior care staff. Caring for residents who are at the end of
life can also take a toll on caregivers. Additionally, when caregivers
lose a person for whom they have cared, they are subject to the same
grief that affects the friends and loved ones of the person who has
died. Hospice can help those caregivers better deal with their
grief when a resident dies.
Finally, contrary to the fears of some nursing home
administrators, it doesn't cost anything to contract with a hospice
provider. Hospice is a benefit to which every senior is entitled, and
it is part of the federal Medicare program. Hospice providers bill
Medicare directly for their services, and the funds that pay for
hospice are entirely separate from the funds that pay for nursing home
care.
A right to care
Hospice is a benefit that has been earned by seniors
through their lifetimes, and the professionals who care for them –
either in senior living settings or health care settings – have an
obligation to educate them about this right. As much as we may not want
to admit it, death is an inevitable part of caring for seniors. By
providing hospice, we can assure that seniors live their final days in
comfort and with dignity.
Joan Linsky is a registered nurse who serves as senior clinical
liaison for Allegiance Hospice and Palliative Care. Harry Baggen is
executive director of Allegiance's Sagamore, MA, office. Based in
Lowell, MA, Allegiance Hospice is one of the fastest growing hospice
companies in the Northeast.
