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WHY HOSPICE

Patients want to die at home. 90% of Gallup survey want to die at homeBut deaths in institutions is increasing1949- 5060- 6180- 74%Most deaths could occur at home but lack of familiarity with dying process. . . Relieve suffering (hospice). . . . Curative / life-prolonging therapy. . . Death.

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WHY HOSPICE

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    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 1949- 50% 1960- 61% 1980- 74% Most deaths could occur at home but lack of familiarity with dying process

    5. Why is it so hard to talk about dying? Don’t want to think about it My father got mad when I brought it up. We didn’t want to take away his hope. It’s too insensitive. In my culture, it’s an insult. Let’s look at the bright side. Why bother?

    6. Language with unintended consequences Do you want us to do everything possible? Will you agree to discontinue care? It’s time we talk about pulling back I think we should stop aggressive therapy I’m going to make it so he won’t suffer

    7. Language to describe the 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 child’s 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

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