Nancy Lugo: Hospice and caring for our final days

In spite of our sun-splashed Central Florida days, many among us face some pretty dark days. Some of our Central Florida friends, family, and neighbors are dealing with terminal illness, facing the possibility of the end of their days. Death is more unavoidable than taxes, but how would you prepare for it?

Everyone wants to be comfortable. Most of us want to be in control. And the vast majority of us prefer home over medical offices or hospitals. “There’s no place like home,” said Dorothy as she clicked her magic shoes together. Everyone has a different perspective on treatment and difficult decisions. Doctors are trained to treat, as pointed out by physician author Atul Gawande (http://tinyurl.com/266xt7w). Each person may have his or her own sense of how far down the treatment road he or she may want to go.

Hospice is an option for maintaining the highest quality of life possible and preparing for the end of life. More than 44 percent of people who died in the United States in 2011 were under the care of a hospice program at the time of their death, according to the National Hospice and Palliative Care Organization.

Who is hospice for? When the diagnosis is for limited survival, hospice is an option. Patients facing a condition with limited survival can be taken in if they have been medically certified to have less than six months to live, although time-specific predictions can be illusive. Twenty years ago, most hospice patients had cancer, but now end-stage heart, lung, kidney and liver diseases are common reasons for hospice.

A common myth is that hospice is only for the very last days of life. Hospice can provide supportive services for many months and help the patient and family prepare for life’s biggest transition. A multi-disciplinary hospice team, including a nurse, physician, social worker, clergy, and home health aide keep the patient as comfortable as possible. This diverse caregiving team can help control symptoms and pain, guide and support family members providing care, and address issues important to the patient and family. Hospice can also give quick-response care when pain or symptoms flare up. The majority of hospice patients stay in their own home for most of their care, although facilities are also available when intensive care is needed.

Some patients and families see choosing hospice as "giving up." Others see it as regaining control of their lives at a difficult time and staying in the comfort of home as long as possible. Patients have the option of leaving hospice services at any time. Some opt out of hospice if symptoms improve or they decide to pursue treatment. One study found hospice patients lived an average of one month longer than similar people who did not opt for hospice. This may be because the hospice patients’ symptoms were managed, they did not undergo risky last hope treatments, and they did not experience iatrogenic (caused by medical care) complications.

Are all hospice services the same? No, and no two patients are the same. Central Florida has several hospice services, caring for patients in different counties throughout the area. Just like every school and every restaurant is different, each hospice has a different feel. We have nonprofit and for-profit hospices. We have hospices going through transitions along with more stable organizations. If you are considering hospice, you can have several hospices visit you as you decide if it is an option for you and which one fits you best. As difficult as it can be, it is always easier to explore your options early rather than waiting for a crisis. A discussion with hospice is not a commitment; it can provide information and options to consider for some tough questions.

Get more information at www.hospicefoundation.org