Hospice: care with comfort and dignity
“It was hard to see him go, he could hardly speak. I was so glad to have him here at home. One night I watched the kitty jump up on the bed near his head and Dick said very clearly ‘Hi Zackie.’ I knew then Dick knew he was home”. – June Juelson, widow of Richard Juelson, Anchorage.
At any age, we must all face the possibility of a serious illness that we or our family and friends will not survive. Hospice helps patients and families focus on living by offering a family-centered team of trained professionals who provide care in the home, hospital or assisted living facility with medical care, pain management and emotional and spiritual support specific to patient goals.
The patient and family drive the plan of care to best meet their goals: the most common are patient comfort, quality of life, dignity and remaining safe and comfortable at home. Ninety-nine percent of the time hospice care allows the patient to stay safely and comfortably at home. More than 1.65 million patients in the U.S. receive hospice care annually.
The term “hospice” was first used during the 4th century when European religious orders welcomed travelers and those who suffered into their residences. Considered the founder of the modern hospice movement, Dame Cicely Saunders, a nurse, social worker, physician and writer, founded St. Christopher’s Hospice (London, 1967). Dame Saunders inspired former Yale University Nursing School Dean Florence Wald to establish the first U.S. Hospice (Branford Conn. 1974).
In the 1970s, the U.S. hospice movement was primarily volunteer-based. Volunteer hospices charge no fees to individuals or third-party payers. Funding is primarily through memorial contributions, donations, fundraisers and private grants.
When the Medicare Hospice Benefit was created 1982, many volunteer hospices became Medicare-certified. For families that choose a Medicare-certified hospice, the hospice benefit may be covered under Medicare, Medicaid, U.S. Department of Veterans Affairs, private insurance plan or HMO. A Medicare-certified hospice has the ability to increase the intensity of care from routine home care to more intensive home care or short hospital stays while still on hospice for pain and other symptoms that cannot be managed at home.
“Hospice is different from treatment-based medical care where you make an appointment, see your doctor and get treatment,” says Jean M. Snyder, MD and medical director at Providence Hospice. “Hospice is not medically driven; it is a team of caregivers delivering goal-based care. From its inception, hospice has been nurse-driven with the doctor providing guidance and facilitation. Our primary goal is to give the patient and family comfort and guidance. The patient sets the goals and the team makes it happen.”
Hospice of Anchorage is the oldest Alaska hospice, started in 1980. It is currently a volunteer hospice.
In 2006 Providence Hospice opened and today is the only Medicare-certified hospice serving the Anchorage community with all levels of hospice care that Medicare assigns to patients.
Medicare-certified hospices must provide a written plan of care maintained by an interdisciplinary group of physicians, nurses, social workers, chaplains and volunteers. The plan outlines the services provided to meet patient and family needs. The patient may end the hospice benefit at any time and return to their former medical benefit plan.
Medicare-certified hospices are required to submit quality data to the Centers for Medicare and Medicaid Services; the Hospice Quality Reporting Program (HQRP) is mandated in the Affordable Care Act. The Medicare benefit also requires a hospice provide bereavement services and utilize trained volunteers. Bereavement counseling is provided to the patient and family while in-service and to family members for at least one year after their loved one’s death. Volunteers visit patients and families and assist with hospice events.
“Our Hospice program offers professional nursing and other skilled care toward the goal of pain-free medical care and comfort at home in the company of friends and family,” says Jean Strafford, executive director at Catholic Community Services in Juneau. “With the help of hospice care, members of our community are able to focus on comfort and on living their lives to the fullest in their own home.”
The Alaska DHSS Division of Health Care Services Health Facilities Licensing has certified five volunteer and four Medicare-certified hospices in Alaska. In 2012 the Alaska Health Care Commission recommended the governor or legislature foster communication and education regarding end-of-life planning and health care for seriously and terminally ill patients by supporting a program to sponsor an ongoing statewide public education campaign regarding the value of end-of-life planning, and establish and maintain a website for end-of-life planning and palliative care resources, including Alaska-specific information.
November is National Hospice/Palliative Care Month and we encourage you to contact any of the organizations listed below to learn more about this special kind of care that provides comfort, love and respect at the end of life.
Vanessa Salinas is the Providence Hospice Volunteer Coordinator.
Fairbanks Memorial Hospital Hospice* 907-458-3090
Hospice & Home Care of Juneau* 907-463-6111
Hospice of Anchorage 907-561-5322
Hospice of Haines 907-766-3645
Hospice of Homer 907-235-6899
Hospice of the Central Peninsula 907-262-0453
Mat-Su Regional Hospice* 907-352-4800
PeaceHealth Ketchikan Hospice 907-225-8914
Providence Hospice* 907-212-4409
Centers for Medicare & Medicaid Services 800-633- 4227
Alaska Health Care Commission 907-334-2474