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HOSPICE CARE: POSITIVE ALTERNATIVES
Since the mid-1970s, hospice programs have grown from a mere handful to more than 2,500, available in nearly every community. Unlike even 10 years ago, families facing terminal illness are often expected to make difficult medical decisions, including where their loved ones will die. Improving the quality of care at the end of life is a top priority of the American Medical Association.
The primary goals of the hospice program are to relieve the dying person\'s pain, to offer emotional support to the dying person and loved ones, and to restore a sense of control to the dying person, the family, and friends. Although home care with maximum involvement by loved ones is emphasized, hospice programs are directed by cooperating physicians, coordinated by specially trained nurses, and fortified with the services of counselors, clergy, and trained volunteers. Hospital inpatient beds are available if necessary. Hospice programs usually include the following characteristics:
1. The patient and family constitute the unit of care, because the physical, psychological, social, and spiritual problems of dying confront the family as well as the patient.
2. Emphasis is placed on symptom control, primarily the alleviation of pain. Curative treatments are curtailed as requested by the patient, but sound judgment must be applied to avoid a feeling of abandonment.
3. There is overall medical direction of the program, with all health care being provided under the direction of a qualified physician.
4. Services are provided by an interdisciplinary team because no one person can provide all the needed care.
5. Coverage is provided 24 hours a day, 7 days a week, with emphasis on the availability of medical and nursing skills.
6. Carefully selected and extensively trained volunteers are an integral part of the health care team, augmenting staff service but not replacing it.
7. Care of the family extends through the bereavement period.
8. Patients are accepted on the basis of their health needs, not their ability to pay.
Despite the growing number of people considering the hospice option, many people prefer to go to a hospital to die. Others choose to die at home, without the intervention of medical staff or life-prolonging equipment. Each dying person and his or her family should decide as early as possible what type of terminal care is most desirable and feasible. This will allow time for necessary emotional, physical, and financial preparations. Hospice care may also help the survivors cope better with the death experience.
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GENERAL HEALTH
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