Kay Kirkbride, BSN, Hospice and Palliative Care

Although Hospice care was started by Christians during the period of the Crusades, and modern day
hospice care was revived in London in the 1960’s and came to the United States in the 1970’s, many people still do not understand what hospice care truly is. One of the reasons is that Americans are a “death denying society.” Americans are generally uncomfortable talking about end-of- life issues and death.

The word “hospice” means to “provide comfort during a transition.” That is indeed what hospice
care does with an emphasis on helping the dying person live as comfortably as possible until death comes.
Hospice workers do not help people die; they help people live until they die.

Hospices and hospice staff provide care in a number of different settings: patients’ own homes, care
facilities, hospitals, and in-patient hospices. Hospice care has to be ordered by a physician who has
determined as nearly as possible that the patient has six months or less to live. Of course, the patient and
family have to also want hospice care with the understanding that comfort measures will be the focus of
care and not active treatments toward a curative outcome.

Hospice staff includes: a medical director, registered nurses, social workers, spiritual care counselors,
therapists, home health aides, volunteers, pharmacists, and complimentary service providers. They work
together as a cohesive team to provide care and concern not only for the patient but also for the family.
The following issues represent the uniqueness of hospice care and make it a much favored level of care to
many of those patients and families who have experienced it.

Past Traditional Care                                         Hospice Care
Death is abnormal                                               Death is a normal part of life
Curative Care                                                        Palliative (comfort) Care
Technology-oriented                                            Patient/Family oriented
Concern for addiction                                          Addiction not a concern
Emphasis on quantity of life remaining           Emphasis on quality of life remaining
Fragmentation of Care                                        Continuity of Care
Physically-invasive                                                Non-invasive Care
Technological Care                                              Eclectic/Diverse Care
No Volunteer Support                                           Volunteer Support
No Bereavement follow-up                                  Bereavement follow-up offered

Hospice helps people fulfill their last wishes, as much as possible, and even mend some bridges that patients/families may have “burned” throughout their lifetime. The hospice team tries very hard to work together with the patient/family so they know what to expect as care needs change. The hospice team also teaches skills to deal with the needs, signs and symptoms of impending death. Strong emphasis is also put on spiritual issues and if the patient is or has been a member of a faith community and so desires every effort is made to connect/reconnect them with that community. Hospice is well aware that spiritual pain at the end of life may be a strong component in issues needing to be addressed.

The expense of hospice care is now paid for by many health insurances and there is a very generous hospice benefit available for Medicare beneficiaries. Also, hospices should not decline care due to the patient’s inability to pay.

For twenty-eight years I have been associated with Hospice and Palliative Care of Washington County in Oregon. As a past hospice staff member, I have witnessed many families struggling at this very intimate time in their lives to come to terms with what they are dealing with and to learn how to give the loving and compassionate care they so desire for their family member. Hospice helps them succeed in that
endeavor.

Let’s not keep Hospice a secret any longer!

Kay Kirkbride

For more about ministering to those with Terminal Illness, read Chapter 8, written by Kay Kirkbride in the book, Shepherding Women in Pain.