Cover_Jan 05 (Page 2) - The Parklander Magazine

A Comfortable End
By Dr. Gilbert N. Silbiger
Often we are asked: “What is Hospice” “What does Hospice
do” “How do I go to Hospice” “Who pays for it” “Who is
eligible for Hospice”
Hospice is a concept, a program of caring for patients near
the end of life. It is a service that provides comfort for the patient
and the family when cure is no longer felt to be an option.
The Hospice concept is a relatively new one, having begun in
England in the 1960s and spread to the United States in the 1970s.
It became a Medicare benefit in 1986. Initially, the greatest number
of patients cared for primarily had cancer and its related diseases.
However, over the years the proportion of patients with diseases
other than cancer has grown to approximately 50 percent —
including end-stages of cardiac, pulmonary, renal and Parkinson’s
disease, dementia, AIDS, and ALS (Lou Gehrig’s disease).
There is a common misconception that Hospice is “a place
you go before you die.” First of all, in most cases Hospice comes
to the patient. Seventy-five to 80 percent of the patients are cared
for in the home or a nursing facility, while the remainder are treated
in a hospital or Hospice Care Center. Services are provided by a
team of caring physicians, nurses, social workers, spiritual counselors,
aides, and volunteers, all of whom have been specially
trained in providing comfort to their patients.
Who pays for Hospice The majority of patients are
covered by either Medicare or Medicaid. These programs provide
a daily allowance for care related to the diagnosis for which the
patient was admitted to the service. This may include visits by
nurses, social workers, clergy, and aides, as well as medications,
oxygen, and durable medical equipment. Other sources include
private insurance, private pay, donations, fundraising events, and
grants. But no one is refused care because of inability to pay.
Although most of the patients are in the “Medicare age
group,” there are no age limits. Children from newborn to their
teens, as well as adults of any age (to greater than 100) receive the
care and benefits of the program. Terminally ill patients often feel
isolated and Hospice helps build a caring community of family,
friends, hospice staff, neighbors, churches, synagogues, and community
resources. Hospice coordinates the plan of care and acts
as a link with this caring community. Hospice is a community
of love.
Often referred to as “palliative care,” the services provided
involve pain and symptom control. The goal is to maximize the
quality of the remaining life through the provision of palliative
therapies when the focus changes from cure to comfort.
The goals may be achieved by counseling the patient and
family, medication to treat and reduce pain and discomfort when
needed, treatment of constipation, sleep difficulty and other
symptoms. In the management of pain it is recognized that total
pain not only is the physical pain felt, but also may include anger,
fear, anxiety and depression. The team is aware of this concept
and directs its care accordingly. Just as all cancer is not treated with
the same chemotherapy, neither do we treat all pain the same.
Each patient’s care is individualized and the plan of care is directed
to his or her specific needs.
The essence of hospice palliative care and management
is summarized in the following statement to our patients.
“You matter because you are you,
You matter to the last moment of your life,
And we will do all we can
Not only to help you die peacefully,
But to live until you die.” ●P
Dr. Gilbert N. Silbiger is medical director of Home Teams at Hospice
By The Sea in Boca Raton.
the PARKLANDER 33