1. WHY HOSPICE ? Upinder Singh, MD,FACP
2. Patients want to die at home 90% of Gallup survey want to die at home
But deaths in institutions is increasing
Most deaths could occur at home but lack of familiarity with dying process
5. Why is it so hard to talk aboutdying? Donít want to think about it
My father got mad when I brought it up.
We didnít want to take away his hope.
Itís too insensitive.
In my culture, itís an insult.
Letís look at the bright side.
6. Language with unintended consequences
Do you want us to do everything possible?
Will you agree to discontinue care?
Itís time we talk about pulling back
I think we should stop aggressive therapy
Iím going to make it so he wonít suffer
7. Language to describethe goals of care . . .
I want to give the best care possible until the day you die
We will concentrate on improving the quality of your childís life
We want to help you live meaningfully in the time that you have
8. Hospice is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments.
Hospice care neither prolongs life nor hastens death. Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management.
9. The word "hospice" stems from the Latin word "hospitium" meaning guesthouse.
It was originally used to describe a place of shelter for weary and sick travelers returning from religious pilgrimages.
During the 1960's, Dr. Cicely Saunders, a British physician began the modern hospice movement by establishing St. Christopher's Hospice near London. St. Christopher's organized a team approach to professional caregiving, and was the first program to use modern pain management techniques to compassionately care for the dying.
The first hospice in the United States was established in New Haven, Connecticut in 1974.
10. Hospice is not a place but a concept of care.
Eighty percent of hospice care is provided in the patient's home, family member's home and in nursing homes.
Inpatient hospice facilities are sometimes available to assist with caregiving.
13. Curative Model Palliative Model Primary goal is cure
The object of analysis is the disease process
Symptoms are treated primarily as clues to diagnosis
Primary value is placed upon measurable data Relief of suffering
The patient and the family
Entities in themselves
Both measurable and subjective data are valued
14. Deaths in hospice
11% in 1993
17% in 1995
Length of stay in hospice
1995: 36 days
1998: 20 days
15. Comparing Hospice and Standard Home Care