Thursday, Aug. 7, 2003 | 8:14 a.m.
Editor's note: In August the Where I Stand column is written by guest writers. Today's columnist, Susan H. Drongowski, is president and CEO of Nathan Adelson Hospice.
DEATH IS an inevitable aspect of the cycle of life. Dying badly is not. However, most of us -- including medical professionals and government and health officials -- are not prepared to confront it. Nevada, like many other states, is still in the process of coming to terms with how to care for its citizens at the end of their lives.
Last year a national study gave Nevada and other states low marks in caring for its terminally ill. Nevada officials recognize the difficulty in dealing with the dying and are working to correct the situation with various education and pain management forums and policies.
Hospice programs are one solution. "Hospice" comes from the same root word as "hospitality" and can be traced to weary or sick travelers on long journeys. The term was first applied to specialized care for dying patients in 1967 at St. Christopher's Hospice in London.
Today, "hospice" refers to the steadily growing concept of humane and compassionate care that is implemented in a variety of settings -- patients' homes, hospitals, nursing homes, long-term care facilities or free-standing in-patient hospice facilities. Hospice offers palliative, or comfort, rather than curative treatment. Under the direction of a physician, hospice uses sophisticated methods of pain and symptom control.
The hospice philosophy encompasses providing quality care and compassionate support for patients of all ages who have been diagnosed with a terminal illness and a life expectancy measured in months, rather than years. A very specialized hospice staff aggressively manages symptoms so that patients live their lives with comfort, dignity and quality -- as they define it -- at home or in a home-like setting.
Studies indicate most people would like to die peacefully at home in the comfort of their bed with loved ones around them. (In Clark County, 40 percent die in hospitals and another 13 percent die in nursing homes.) A hospice team provides expertise to address the patient's medical needs and the emotional and practical concerns of a life-limiting illness for the patient and the family.
One of the biggest misconceptions people have about hospice is that it's for people who have only days or weeks to live. In fact, patients receive the most benefit from hospice when they choose to begin services as soon as possible after learning of a life-limiting diagnosis. Another misconception is that hospice is a place. Hospice is a program of services that helps people die comfortably in their own homes.
In Las Vegas, there are six hospice programs. Two -- Nathan Adelson Hospice and Odyssey Health Care -- have dedicated in-patient facilities in addition to their home care services. It is usually only in the last week or last few days of a patient's life that he or she would come to a hospice facility because more aggressive comfort measures are required and/or providing care becomes increasingly more difficult for family members.
Within the last 20 years the benefits of hospice have become more recognized and accessible.
Medicare and Medicaid now both offer comprehensive coverage for hospice services, including most medications and medical equipment. Most private insurance plans also cover hospice. As a result of a national initiative, the Department of Veterans Affairs is covering hospice services. This benefit will soon be available to Southern Nevada veterans.
There are economic benefits, too. A recent report, commissioned by the National Hospice and Palliative Care Organization, shows that hospice care annually saves Medicaid about $282 million nationally.
Most medical, nursing, social work and pharmacy schools have begun recognizing the need to educate students on caring for the dying and have begun requiring a student rotation through a hospice program.
But there is still work to do. Increasing education and awareness about the value of hospice remains the biggest hurdle. Discussing options for end of life care with their patients is difficult for most physicians and, subsequently, limits the consideration of hospice.
Our health care system was designed to promote curing diseases and ameliorating their symptoms. Sometimes there is no cure. That is when hospice can assist physicians in continuing to offer compassionate care and aggressive symptom management with the goal of helping their patients during what may be the most meaningful and difficult time as they complete life's journey.
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