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INTRODUCTION

Hospice, a type of palliative care, is considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury. Hospice and palliative care involves an interdisciplinary team-oriented approach to expert medical and nursing care, pain and other symptom management, and emotional and spiritual support expressly tailored to the patient’s unique needs and wishes (National Hospice and Palliative Care Organization [NHPCO], 2015a). Another special difference is that support is provided to the patient’s loved ones as well. At the center of hospice and palliative care is the belief that each person has the right to die with dignity and in comfort. Families receive the necessary support to allow that to happen (NHPCO, 2015a). The patient, family, friends, and designee are the unit of care, not solely the patient. This is a very different and special construct seen primarily in hospice and palliative care.

The Centers for Medicare and Medicaid Services (CMS), the largest payer for hospice, defines hospice care as, “a comprehensive set of services identified and coordinated by an interdisciplinary group (IDG) to provide for the physical, psychosocial, spiritual, and emotional needs of a terminally ill patient and/or family members, as delineated in a specific patient plan of care” (CMS, 2008, p. 18).

The hospice philosophy of care asserts the concept of palliative care, which promotes quality of life by enhancing comfort for individuals and their families, whom hospice considers the unit of care. Hospice focuses on care versus cure. When a cure is no longer an option, hospice recognizes and provides support for a comfortable death with dignity as a fundamental goal of care. The hospice philosophy also recognizes that death is a part of the life cycle, and the provision of comprehensive palliative care that addresses pain relief and comfort enhances quality of life for the terminally ill. Hospice also acknowledges the possibility for growth of the individual and his/her family, and during the dying experience, the hospice team works to protect and nurture this potential (NHPCO, 2013b). The hospice team assesses the needs of the individual and the individual’s family in the last phase of life and works with them collectively to develop a care approach that encompasses the physical, emotional, spiritual, and cultural concerns and wishes of the individual and the individual’s family. Hospice provides palliative care to all individuals regardless of age, gender, cultural background, beliefs, diagnosis, availability of a caregiver, or ability to pay. Care is generally provided in the late stages of an advanced illness, during the dying process, and in the bereavement period.

Hospice core values include:

  • Patient- and family-centered care

  • Holistic relief of suffering

  • Interdisciplinary team approach

  • Ethical behavior

  • Service excellence (NHPCO, 2013a)

HISTORY OF HOSPICE

The word hospice can be traced back to the medieval era when it referred to a place of rest or shelter ...

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