Hospice Care

Hospice care is a type of nursing that doesn't get a lot of attention but it is very important. I interviewed Registered Nurse Karli Pelley about the line of work. Here are her e-mail responses.

Q: What types of hospice care are available?

A: There are a couple different levels of hospice care depending on the patient’s current status. There is respite care which aides in giving the family or caregiver a break by arranging for extra services in the home or simple things outside the home like grocery shopping. There is also general hospice care, which include a team consisting of nurses, social worker/counselor, home health aides, clergy, therapists, and volunteers who all aide in providing comfort care for the patient and family.

Q: What are hospice care centers like?

A: Hospice associations differ by where they are located. Some hospice centers have their own units in nursing homes, hospital hospice units or inpatient hospice centers. However, there are some that have a central office but go to see patient’s in their own homes, which is the kind of hospice I work for. Patients’ are able to live the rest of their lives in their own home with our help rather than having to move to a nursing home. However, some patients need so much physical help that they need to be in a nursing home and if that is the case, we go to see our hospice patient in the nursing home as if it was their home.

Q: why would people choose to stay in a hospice center rather than a hospital?

A: Hospitals are more for temporary or acute problems and diseases. With hospice patients, their diseases are more terminal or chronic and therefore need long term care that hospice can provide if the situation calls for it. Hospice focuses on comfort care which is what a person with a terminal illness would need rather than a hospital setting where their focus is not solely on comfort.

Q: Are most of the people elderly?

A: From my experience yes, the majority of patients have been elderly. However, we have had a few older adults in their early 50’s and 60’s. From my experience it seems as though the younger the patients have been, the harder it is for the family to accept their terminal diagnosis in a healthy manner. I see a lot of denial from the younger patients and their families.

Q: What are the requirements to end up in hospice care?

A: The main criteria for most hospice centers, is accepting patients who have a life-expectancy of six months or less and who are referred by their personal physician. However, many of our patients out-live those six months and that is not uncommon. Life expectancy estimations are easier when cancer is diagnosis because physicians can more accurately estimate a time frame. With other diagnosis such as COPD, kidney failure, or failure to thrive, a physician has to consider many factors to determine whether a patient would fit the hospice criteria.

Q: Is it government funded or do people pay for it on their own?

A: This varies depending on what hospice organization is involved. Some hospice organizations are government funded, non-profit organizations and rely heavily on federal grants and fundraisers. Then there are some hospice associations that are paid for independently through Medicare benefits, Medicaid benefits, and most private insurers.

Q: Do you see more of some terminal illnesses than others?

A: Yes, we see different types of cancers a lot more than anything else. Usually cancer has a pretty definitive diagnosis and life expectancy, so that makes hospice a more obvious tool with terminal cancers. We also see a lot of patients with congestive heart failure. These two diagnoses are common, but with heart failure the patients often out-live their six month time frame and with cancers they usually reach the active dying phase a lot sooner.

Q: What is it like working in hospice care?

A: It is surprisingly enjoyable and extremely rewarding. A big misconception about hospice is that it is all death and sadness everyday, but that is not true. There are a lot of happy times with the patients and they usually do very well for a long time until they reach the last stage of the dying process. Working in this area I get a lot of “thank you’s” and hugs from the patient, and their friends and families which makes the job feel less like a job and more like a rewarding journey.

Q: What is your favorite part of your job?

A: Getting to meet all of the different patients and what they have to say. For being terminally ill and elderly, a lot of our patients have very strong and humorous personalities. Developing strong bonds with the patients and earning their trust is a good feeling even though it makes it harder at the end of their life. I still find the relationships I make to be one of my favorite parts of working in this difficult area of nursing otherwise it could quickly become a very depressing line of work.

Q: Is it hard to build relationships with people who you know are terminally ill?

A: Going into this job I was very nervous about that part and I was very worried that I would get too attached to patients. You learn how to set personal boundaries but it is inevitable that you become very close with some patients and I have learned that’s okay. However, it has made me much more comfortable with the dying process and family grieving. Some families and patients want a strong nurse and some want a nurse that will cry along with them. So, you learn to adjust emotionally with each different family. It can be really emotionally draining at times but really rewarding when it’s all done.

Q: Is there any controversy surrounding assisted suicide or euthanasia?

A: When admitting a new patient, some families have questions about whether or not hospice speeds along the dying process. One of the first things we tell the family is that hospice neither hastens nor postpones dying. We don’t take the patient off of any medications that they are currently on. We care for them as we would with any patient. Hospice focuses on comfort care and we treat any symptoms with appropriate medications. The basis of hospice care is to provide emotional, spiritual, and social support to the patient and the family. The goal of hospice is to provide comfort and care, not "cure" the illness or disease, like they do in a hospital setting. If the patient’s condition improves or does not decline after so long, patients can be discharged from hospice and return to aggressive therapy if that is what they wish.