In the ideal world, family members should be together in times of happiness, need or distress. They should at least be close to one another or live near each other so they can provide support, help, and encouragement whenever needed. I say this scenario is ideal because families today find it hard to live close to one another. As much as people want to be near their families and relatives, it is at times not practical and not possible due primarily to economic considerations. Job opportunities may be available in other states or cities. There is no other option but to move where a person can make a better living. It could also be possible that family members live near each other but are not economically, emotionally, and physically capable to care for their dying relatives. This being said, it is now a reality that a person may be alone or maybe without the support of family members or close friends in times of need. There is no exception for old age or in cases of terminal illnesses. Some are forced to deal with illnesses and the prospect of dying on their own.
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Owing to this growing trend of aloneness, hospice plays a very important role in addressing the concern of older people dying alone. The present society manifests a gap or a break in familial relationships and support. This gap represents the absence of caring family members and friends during a period leading to death or immediately preceding death. The gap may also represent the incapability of families to care for their terminally ill or dying relatives in their own homes. Hospice fills this gap by attending to the needs of dying people. It acts as a care provider as well as a counselor to the dying person. Hospice is needed in today’s society.
This paper will present a discourse on the importance of hospice in the current societal conditions. The definition and origin of hospice will be presented first followed by a discussion of why there is a need for a hospice in the present state of society. The benefits that hospice presently brings to society and the implications to future conditions will then be laid down. The conclusion will sum up the points of the argument.
Definition and Origin of Hospice
Hospice is a care program that offers a palliative and support services program to persons who are terminally ill or are dying as well as their families, through psychological, social, physical, and spiritual care (Definition of Hospice). The services are provided by professional team members including doctors, nurses, psychologists, counselors, and spiritual advisers, and volunteers who are available to go to the terminally ill person’s home or in specialized inpatient settings.
The primary aim of hospice is to provide medical and emotional care, support, and comfort to patients and their families in times when the illness is no longer responsive to treatments for cure. Hospice aims not to treat the disease but to afford a comfortable experience for the patient in his or her remaining days. A hospice was originally referred to as a travelers’ lodging where tired and sick travelers may rest after going to religious pilgrimages (What is Hospice? – A Definition of Hospice). Hospice is now referred to as a care program or concept of care instead of a specific location or place.
The hospice model currently used in the United States is attributed to a British physician named Dame Caicely Saunders who came to the Yale University in 1963 to give a lecture on the concept of hospice care (The Modern Hospice Movement). The lecture, which included a description of hospice provision at the St. Cristopher’s inpatient hospice in London, was given to medical, social work, chaplaincy, and nursing students. In 1974, the first modern hospice in the United States was set up in Branford, Connecticut. In the latter part of the ’70s, the US Department of Health, Education, and Welfare created a task force that will conduct a feasibility study on hospice care for the terminally ill. After the evaluation of the study, the Department gave the hospice movement eligibility for federal support. In the first stages of hospice in the US, the focus was on terminally ill cancer patients, but the year 2000 saw an expansion of the services of hospice to include terminally ill non-cancer patients.
Since the introduction of the first hospice in 1974, there has been a steady upward trend in the growth of hospice programs. There are now more than 4,100 programs in the United States, most of which are free-standing. The number of patients who have received hospice services is also on the rise with over 1.2 million patients in 2005, which showed an increase of more than 150,000 patients from the figures of the previous year (NHPCO’S Facts and Figures – 2005 Findings).
The Need for Hospice in the Present State of Society
Society is continuously changing as time progresses. Situations, predicaments, opportunities, technological developments, intellectual advancements, and social interactions have remained to be dynamic. Everything is subject to change or some kind of modification that demands society to be responsive and vigilant in dealing with these changes. Hospice may be a concept that is unheard of or unimaginable five decades ago because of the lack of need for it. It may be an idea that is very far from the minds of families, but inventions, innovations, and concepts arise from need. In the present society, because of uncontrollable circumstances and the increasing need for care and specialized services for terminally ill patients, the concept of hospice was put to effective use.
Decades ago family members lived in the same house or the same neighborhood, but families today often live apart due to several reasons including transfer to other locations or areas where there are more educational institutions and job opportunities. Neighborhoods used to be closely knit where friends and neighbors establish long-term relationships. In contrast, neighbors today do not know each other, or if they do, they remain to be acquaintances and nothing more. This is due to constant movement and transfer of residence. Sick persons usually died at home decades ago, but at present time, more persons die in institutions. The doctor attending to the terminally ill patient was often a friend of the family during those times, unlike today where doctors are specialists who do not personally know their patients. Religion and culture used to play a very important role in providing support and a source of strength for dying persons, but in modern times, religion and traditions are not considered as significant in addressing crises and grief.
Hospice today has become not just an option but a necessity for most people so they can deal better with situations where a family member is dying and the family is not capable of providing the needed care and support. Hospice enables the caring process to be carried out at home where family members can spend quality time together minus the stress of providing care and support services. Hospice provides friendly health care providers and other staff who are personally involved in the daily care of the patients and are in close coordination with the families. Hospice services also are not limited to addressing the welfare of the patient, but it also provides emotional and spiritual support to the family members of the dying patient. These services even extend to the period after the patients’ death.
Hospice seeks to meet all the needs of terminally ill patients in terms of providing the best quality of life and comfort in their remaining days. There are instances though where hospice is unable to meet all the personal needs of a patient. A study was conducted by Mayfield Arnold, Abbott Artin, Griffith, Lund Person, and Graham to examine the unmet needs of patients at the end of their lives through surveys that were mailed to hospice social workers. The results of the study showed that patients have different unmet needs which are evident at the time of admission and the most common unmet need was the decreased ability or inability to participate in activities that make life more enjoyable. The reasons reported behind the unmet needs were family issues or conflicts, and patient-related psychosocial concerns. Hospice addresses these unmet needs through different interventions which are successful but are at times likewise hindered by various barriers. Hospice continues to strive for the development of procedures by coordinating with different experts.
Hospice does not only intend to ease physical pain caused by the illness, but it also intends to help the dying patients achieve peaceful closure and forgiveness. Social workers use skilled psychosocial interventions to facilitate closure for both the patients and the families (Baker, pp. 83-95). Inappropriately addressing the psychosocial needs of patients and families, social workers should undergo training and skill development.
Addressing the Existing Barriers to Hospice Care to Promote its Continuous Development
The continued success of hospice in terms of its effectiveness in delivering the needed care and support services can be maintained well into the future through the cooperation and help of various agencies and fields. Information on the services provided by hospices should be disseminated not only to medical professionals and staff, but also to social workers, community leaders, schools, and to the general public so families may be aware that hospices exist and may be enlightened as to the services offered.
Lack of information dissemination regarding hospice led to the underuse of hospice services in the United States. The main referral base for hospice services use is the primary care physicians. If the main referral base remains to be inactive then this would hinder the growth of the use of hospice services. Ogle, Mavis, and Wang (41-51) conducted a mail survey with 131 primary care physicians as respondents. The survey focused on the physicians’ knowledge about, attitude toward, their perceived barriers to hospice care, and benefits gained from it. Generally, the physicians showed positive attitudes towards hospice and they had correct knowledge on most of the aspects of hospice. They cited several benefits and gave one major barrier to hospice referrals. The barrier was the readiness of patients and families. Another barrier mentioned was the problems with interacting or coordinating with the hospices. The findings of the survey implicated that better cooperation and communication between hospices and primary care physicians would lead to a better provision of end-of-life care to more people. The results likewise showed that families should be provided more information as to the services offered by hospices and the conditions involved which need hospice care.
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A study conducted by researchers from the Brown University revealed that one in ten patients is referred to hospice services too late (Brown University). This late referral results in unmet needs including emotional support and sufficient pain relief. Surveys were conducted with bereaved family members as the respondents. The surveys aimed to measure the quality of hospice service programs in terms of providing social, emotional, and spiritual support, and medical care. With late referrals, families of the patients tended to be dissatisfied with the overall facilitation of the hospice program including the pain management problems, and lack of coordination in the provision of care. Late referrals meant that the average length of stay of patients is less than two months, which is short of the minimum three months stay recommended by experts. The significant finding of the study showed that there is a direct relationship between the length of stay and the perceived quality of care. A decrease in the length of stay results in a perceived decrease in the quality of care. A short stay for the dying patients would eventually result in unhappy families.
By the year 2030, the older adult population in the United States or those who will be 65 years old and older will number to about 71.5 million, and the population of those who will be 85 years old and older will reach 9.6 million (Leone). Basing on the current conditions of older adults where they have at least one chronic condition, and some even have multiple conditions, the projected increase in the number of the older adult population would necessitate a growth in the number of hospices to address their needs for care and in-home assistance.
The future of hospice care is one of development and continuous improvement as the need for care assistance and support for terminally ill or dying patients have grown and is still growing due to the perceived holistic benefits from it. There is a significant need for a hospice in today’s society due to the evolving personal needs and circumstances of patients and their families. Families are now open to outside assistance for making the remaining days of their loved ones comfortable. This openness stems from the families’ lack of resources in terms of medical care and other needs such as psychosocial and spiritual needs. Extension of care and support to dying family members means a provision of a better quality of life before reaching the end of life. Receiving assistance and guidance from experts in different fields aiming to ease both the physical and emotional suffering and pain of the terminally ill person leads to a more peaceful closure for the patient as well as the family.
As much as hospice services are needed by society, care providers should also do their part in improving their knowledge and skills so they can better help dying patients and their families. Collaboration among medical professionals and personnel, social workers, counselors, spiritual advisers, and hospices are important in the development of the hospice movement. Information dissemination is likewise significant in increasing awareness and enlightenment on the benefits of hospice care.
- Baker, Marjorie. “Facilitating Forgiveness and Peaceful Closure The Therapeutic Value of Psychosocial Intervention in End-of-Life Care.” Journal of Social Work in End-of-Life & Palliative Care, Volume 1, Number 4 (2006): pp. 83-95.
- Brown University. “One in Ten Hospice Patients Referred Too Late, Study Shows.”2007. Science Daily.
- “Definition of Hospice.” About.com.Web.
- Leone, Linda. “Time to think about growing need for home care.” 2007.
- Mayfield Arnold, Elizabeth, et al. “Unmet Needs at the End of Life: Perceptions of Hospice Social Workers.” Journal of Social Work in End-of-Life & Palliative Care, Volume 2, Number 4 (2007): pp. 61-83.
- “NHPCO’S Facts and Figures – 2005 Findings.” 2006. National Hospice and Palliative Care Organization.
- Ogle, Karen, Brian Mavis and Tammy Wang. “Hospice and primary care physicians: Attitudes, knowledge, and barriers.” American Journal of Hospice and Palliative Medicine®, Vol. 20, No. 1 (2003): 41-51.
- “The Modern Hospice Movement.” 2007. Medscape. Web.
- “What is Hospice? – A Definition of Hospice.” About.com. Web.