What Hospice Care Can Do
Since I’m a regular volunteer at the Community Hospice of Washington DC — and a lot of people I know wonder why I would devote most Friday mornings to tasks they consider “totally depressing” (to quote one of my best friends) — I think I’m in a fairly good position to explain a bit about hospices in general.
In the first place, most people under hospice care never see the in-patient unit. They are cared for at home, under the supervision of hospice volunteers, nurses, and social workers who manage their cases.
The care they received isn’t non-stop. That’s important to remember because as Amy Tucci, who heads Hospice Foundation of America tells me, “The biggest problem hospices face is not a quality issue, it’s a misunderstanding issue. A lot of people think that if they enroll in hospice care, that someone will be at their home 24 hours a day. And that usually doesn’t happen.”
Still, home care under hospice supervision is usually considered the optimum solution. It’s at home that a patient usually feels more comfortable, especially if there is family around. The food there is familiar, and medications can generally be effectively administered.
When does someone who’s terminally ill need in-patient care? Usually if the pain is unmanageable. The one thing above all else that hospice medical personnel really know is how to control bad pain. And they are equally adept at figuring out which medications are most effective at diminishing discomfort for specific conditions.
One of the most important things, for instance, I have learned in hospice work is tha methadone is perhaps among the most effective pain-relievers around. It has the least side effects, it is the most cost effective, and it treats more kinds of pain than any other narcotic. So why don’t more doctors prescribe it for the terminally ill?
Because it has a bad street rep, and for most people, it’s hard to titrate. And of course in the big wide world outside hospice care, there’s always the fool doctor who worries that someone with maybe a month left of life expectancy will become “addicted” to a specific narcotic.
So I’m not saying hospice care is the ideal solution for everybody. But there’s a good reason why one third of the terminally ill choose it.
Next Thursday, I’ll discuss what hospice care cannot do.
September 1st, 2008 at 12:45 am
When my dad died, after really suffering a lot, a medical professional I know actually suggested maybe this happened so his soul will be purified by pain before it leaves his body. While most people would not make a statement like that so blatantly, I wonder if insisting that suffering has some kind of theological benefit is a bad doctor’s excuse for failing to prescribe adequate pain medication?