What Is the Definition of Hospice

Many new hospice patients and their families ask, “What is the definition of hospice?” Some view hospice as giving up on getting well, and even some doctors view transferring a patient to hospice as a sort of death sentence. However, hospice is intended to be more than a last resort, and is a philosophy of care completely at odds with most of the cure-focused healthcare system. The hospice care philosophy sees death as a normal part of living, instead of something to always struggle against, and seeks to reduce the suffering involved in the dying process for both the dying person and his or her loved ones.

The Sisters of Charity, an order of Roman Catholic nuns in Ireland, started the first hospice in Dublin in 1879. Hospitals at that time did not accept patients with fevers or contagious illnesses, so Our Lady's Hospice was a refuge for the infectious, the poor, and the dying. The Sisters kept patients well nourished and comfortable in their last days, and lent their comforting presence to people who had no relatives or friends to care for them.

The modern hospice movement began in 1967 when Dame Cicely Saunders opened St. Christopher's Hospice in London. St. Christopher's Hospice emphasized a multidisciplinary approach to care for the dying, and provided social, spiritual, and emotional support in addition to relieving pain and other physical symptoms. This team approach to hospice is still used today, although most hospice patients receive care and services at home instead of inpatient hospice facilities.

Hospice care involves an interdisciplinary team of professionals. A physician, social worker, and nurse plan and direct the care of each hospice patient, and home health aides and clergy persons provide additional services. Physicians make the initial referral to hospice care after consulting with a patient and any family members who are caring for the patient. The specific duties for each team member are as follows:

This interdisciplinary approach allows the hospice team to address patient and family needs holistically, treating the patient as a whole person rather than an illness or a set of symptoms.

Medicare pays for hospice services if a doctor certifies that a patient's condition is likely to be terminal within six months. However, the Medicare benefit covers only brief periods of inpatient care for hospice patients, designed to be a respite for family caregivers. Hospice services are usually coordinated from a central agency, sometimes a home health agency. Nurses, social workers, and hospice aides go to the patient's home to provide care, and the patient only leaves the house for doctor's appointments. Inpatient hospice care is available, but it's very expensive without excellent private insurance.

Hospice patients usually remain at home even when they are very close to death, although a hospice nurse may come and stay with the patient and family if death is imminent. Hospice nurses also stay after the patient dies to help with the death certificate and arrange for the body to be transported to a funeral home. Social workers may also be present to support the patient and family at the time of death, or may come shortly afterward to assist family members with feelings of grief and loss. Social workers may also assist the family with making any remaining funeral arrangements.

Almost all dying people and their families ask, "What is the definition of hospice?" Hospice is simply a multidisciplinary approach to care for the dying that sees death as a natural part of life, but does not seek to prolong life or hasten death. Hospice services allow a dying person to be comfortable during his or her last days or hours, and support the family of a dying person before, during, and after the person's death.

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