Hospice brings quality to end of life

The first hospice in the Northwest began in 1975 yet thousands of Puget Sound residents still are unaware of what hospice is all about. We are working to change this during National Hospice Month.

Patients and their families don't turn to hospice for several reasons: They don't know about it, their physicians don't know about it or they fear death. That needs to change. Late referrals and short hospice stays are two serious issues the medical community must address. Increasing awareness among professionals and the public is an important step to improving access to care.

Hospice is end-of-life care to help manage pain and to increase an individual's quality of life during the last months of their lives. Informing the public about quality hospice and palliative care occurs one family at a time.

Michael's family learned about hospice after Michael was diagnosed with cancer. Two months after his 70th birthday, Michael noticed a dull, nagging pain in his hip. He brushed it off as arthritis brought on by college football injuries. When the pain intensified, his wife, Beverly, insisted he visit his physician. It was cancer.

It had started in his lung and had now metastasized to his bones. At the time of diagnosis it was stage four. There is no stage five.

Neither Mike nor Beverly thought it possible that cancer could exist undetected and then manifest itself so rapidly at the terminal stage. They quickly learned there was much more they didn't know about care for the dying.

Mike followed a course of aggressive radiation and chemotherapy. Nine months later, Mike was convinced that the treatments were causing as much discomfort as the cancer. At the suggestion of one of their children, Beverly called the local hospice. It was only after her call that Mike's physician acknowledged that hospice was an option.

The focus on symptom control, pain management, and emotional and spiritual support seemed ideal for Mike and the family. Unfortunately, Mike died three days after his hospice admission -- insufficient time to take full advantage of the many benefits hospice offered.

"Why didn't we call hospice earlier?" That question echoed in Beverly's mind. Most hospice professionals will tell you this is one of the most frequently heard comments from families they serve.

Predicting the amount of time left for a patient with a life-limiting illness is difficult in the best of situations. No two people respond exactly the same way to medical treatments or the illness itself. Physicians cannot be expected to predict a patient's life expectancy.

Unfortunately, many Americans are unaware of hospice care when facing a serious illness. Educating patients and families about the full scope of their illness and the range of available options is critical if we are to make informed decisions about our health care. We estimate that for every person who receives hospice care, there is another person who would greatly benefit but does not get this special care.

Hospice care is covered under Medicare, Medicaid, most private insurance plans, HMOs and other managed care organizations. While most care is provided in the home, hospice is also available in most nursing homes, adult family homes and assisted living facilities.

Now is an excellent time to learn about choices available for those facing a life-limiting illness. We urge physicians to more strongly support hospice. We urge families to learn to be their own health care advocates. Improving care for the dying is a responsibility that we as professionals and consumers must share.

A clearer understanding of how hospice might have helped her husband earlier might have done so much more for Beverly and her family. The impact good care makes upon a single life can be astounding.

Rick LaFrance is executive director of Providence Hospice of Seattle, the oldest hospice in King County; 206-320-4000 or www.hospiceofseattle.org

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