Hospice

Hospice care is a type of care and philosophy of care that focuses on the palliation of a chronically ill, terminally ill or seriously ill patient's pain and symptoms, and attending to their emotional and spiritual needs. In Western society, the concept of hospice has been evolving in Europe since the 11th century. Then, and for centuries thereafter in Roman Catholic tradition, hospices were places of hospitality for the sick, wounded, or dying, as well as those for travelers and pilgrims. The modern concept of hospice includes palliative care for the incurably ill given in such institutions as hospitals or nursing homes, but also care provided to those who would rather spend their last months and days of life in their own homes. The first modern hospice care was created by Cicely Saunders in 1967.

In the United States the term is largely defined by the practices of the Medicare system and other health insurance providers, which make hospice care available, either in an inpatient facility or at the patient's home, to patients with a terminal prognosis who are medically certified at hospice onset to have less than six months to live. According to the NHPCO [National Hospice and Palliative Care Organization] 2012 report on facts and figures of Hospice care, 66.4% received care in their place of residence and 26.1% in a Hospice inpatient facility.[1][2] In the late 1970s the U.S. government began to view hospice care as a humane care option for the terminally ill. In 1982 Congress initiated the creation of the Medicare Hospice Benefit which became permanent in 1986. In 1993, President Clinton installed hospice as a guaranteed benefit and an accepted component of health care provisions.[3] Outside the United States, the term hospice tends to be primarily associated with the particular buildings or institutions that specialize in such care (although so-called "hospice at home" services may also be available). Outside the United States such institutions may similarly provide care mostly in an end-of-life setting, but they may also be available for patients with other specific palliative care needs. Hospice care also involves assistance for patients’ families to help them cope with what is happening and provide care and support to keep the patient at home.[4] Although the movement has met with some resistance, hospice has rapidly expanded through the United Kingdom, the United States and elsewhere.

History

Early development

Etymologically, the word "hospice" derives from the Latin hospes, a word which served double duty in referring both to guests and hosts.[5] Historians believe the first hospices originated in the 11th century, around 1065. The rise of the Crusading movement in the 1090s saw the incurably ill permitted into places dedicated to treatment by Crusaders.[5][6] In the early 14th century, the order of the Knights Hospitaller of St. John of Jerusalem opened the first hospice in Rhodes, meant to provide refuge for travelers and care for the ill and dying.[7] Hospices flourished in the Middle Ages, but languished as religious orders became dispersed.[5] They were revived in the 17th century in France by the Daughters of Charity of Saint Vincent de Paul.[7] France continued to see development in the hospice field; the hospice of L'Association des Dames du Calvaire, founded by Jeanne Garnier, opened in 1843.[8] Six other hospices followed before 1900.[8]

Meanwhile, hospices also developed in other areas. In the United Kingdom, attention was drawn to the needs of the terminally ill in the middle of the 19th century, with Lancet and the British Medical Journal publishing articles pointing to the need of the impoverished terminally ill for good care and sanitary conditions.[9] Steps were taken to remedy inadequate facilities with the opening of the Friedenheim in London, which by 1892 offered 35 beds to patients dying of tuberculosis.[9] Four more hospices were established in London by 1905.[9] Australia, too, saw active hospice development, with notable hospices including the Home for Incurables in Adelaide (1879), the Home of Peace (1902) and the Anglican House of Peace for the Dying in Sydney (1907).[10] In 1899, New York City saw the opening of St. Rose's Hospice by the Servants for Relief of Incurable Cancer, who soon expanded with six locations in other cities.[8]

The more influential early developers of Hospice included the Irish Religious Sisters of Charity, who opened Our Lady's Hospice in Harold's Cross, Dublin, Ireland in 1879.[8] It became very busy, with as many as 20,000 people—primarily suffering tuberculosis and cancer—coming to the hospice to die between 1845 and 1945.[8] The Sisters of Charity expanded internationally, opening the Sacred Heart Hospice for the Dying in Sydney in 1890, with hospices in Melbourne and New South Wales following in the 1930s.[11] In 1905, they opened St Joseph's Hospice in London.[7][12] There in the 1950s Cicely Saunders developed many of the foundational principles of modern hospice care.[7] Over the years these centers became more prompt and in the 1970s till now this is where they place people to live out their final day (DeSpelder, 2014).

Rise of the modern hospice movement

St. Christopher's Hospice
St Christopher's Hospice in 2005

Dame Cicely Saunders was a British registered nurse whose chronic health problems had forced her to pursue a career in medical social work. The relationship she developed with a dying Polish refugee helped solidify her ideas that terminally ill patients needed compassionate care to help address their fears and concerns as well as palliative comfort for physical symptoms.[13] After the refugee's death, Saunders began volunteering at St Luke's Home for the Dying Poor, where a physician told her that she could best influence the treatment of the terminally ill as a physician.[13] Saunders entered medical school while continuing her volunteer work at St. Joseph's. When she achieved her degree in 1957, she took a position there.[13]

Saunders emphasized focusing on the patient rather than the disease and introduced the notion of 'total pain',[14] which included psychological and spiritual as well as the physical aspects. She experimented with a wide range of opioids for controlling physical pain but included also the needs of the patient's family.

She disseminated her philosophy internationally in a series of tours of the United States that began in 1963.[15][16] In 1967, Saunders opened St Christopher's Hospice. Florence Wald, the dean of Yale School of Nursing who had heard Saunders speak in America, spent a month working with Saunders there in 1969 before bringing the principles of modern hospice care back to the United States, establishing Hospice, Inc. in 1971.[7][17] Another early hospice program in the United States, Alive Hospice, was founded in Nashville, Tennessee, on November 14, 1975.[18] By 1977 the National Hospice Organization had been formed, and by 1979, a president, Ann G. Blues, had been elected at the national meeting in Washington DC and principles of hospice care had been addressed.[19] At about the same time that Saunders was disseminating her theories and developing her hospice, in 1965, Swiss psychiatrist Elisabeth Kübler Ross also began to consider the social responses to terminal illness, which she found inadequate at the Chicago hospital where her American physician husband was employed.[20] Her 1969 best-seller, On Death and Dying, was influential on how the medical profession responded to the terminally ill,[20] and along with Saunders and other thanatology pioneers helped to focus attention on the types of care available to them.[15]

Hospice care

Mamilla StVincent
Hospice Saint Vincent de Paul, Jerusalem

Hospice has faced resistance springing from various factors, including professional or cultural taboos against open communication about death among physicians or the wider population, discomfort with unfamiliar medical techniques, and professional callousness towards the terminally ill.[21] Nevertheless, the movement has, with national differences in focus and application, spread throughout the world.[22]

In 1984, Dr. Josefina Magno, who had been instrumental in forming the American Academy of Hospice and Palliative Medicine and sat as first executive director of the US National Hospice Organization, founded the International Hospice Institute, which in 1996 became the International Hospice Institute and College and later the International Association for Hospice and Palliative Care (IAHPC).[23][24] The IAHPC, with a board of directors as of 2008 from such diverse countries as Scotland, Argentina, China and Uganda,[25] works from the philosophy that each country should develop a palliative care model based on its own resources and conditions, evaluating hospice experiences in other countries but adapting to their own needs.[26] Dr. Derek Doyle, who was a founding member of IAHPC, told the British Medical Journal in 2003 that through her work the Philippine-born Magno had seen "more than 8000 hospice and palliative services established in more than 100 countries."[24] Standards for Palliative and Hospice Care have been developed in a number of countries around the world, including Australia, Canada, Hungary, Italy, Japan, Moldova, Norway, Poland, Romania, Spain, Switzerland, the United Kingdom and the United States.[27]

In 2006, the United States-based National Hospice and Palliative Care Organization (NHPCO) and the United Kingdom's Help the Hospices jointly commissioned an independent, international study of worldwide palliative care practices. Their survey found that 15% of the world's countries offered widespread palliative care services with integration into major health care institutions, while an additional 35% offered some form of palliative care services, though these might be localized or very limited.[28] As of 2009, there were an estimated 10,000 programs internationally intended to provide palliative care, although the term hospice is not always employed to describe such services.[29]

In hospice care the main guardians are the family care giver and a hospice nurse who makes periodic stops. Hospice can be administered in a nursing home, hospice building, or sometimes a hospital; however, it is most commonly practiced in the home.[30] In order to be considered for hospice care, one has to be terminally ill or expected to die within six months.

Africa

A hospice was opened in 1980 in Harare (Salisbury, at the time), Zimbabwe, the first in Sub-Saharan Africa.[31] In spite of skepticism in the medical community,[21] the hospice movement spread, and in 1987 the Hospice Palliative Care Association of South Africa formed.[32] In 1990, Nairobi Hospice opened in Nairobi, Kenya.[32] As of 2006, Kenya, South Africa and Uganda were among the 35 countries of the world offering widespread, well-integrated palliative care.[32] Programs there are based on the United Kingdom model, but focus less on in-patient care, emphasizing home-based assistance.[33]

Since the foundation of hospice in Kenya in the early 1990s, palliative care has spread through the country. Representatives of Nairobi Hospice sit on the committee to develop a Health Sector Strategic Plan for the Ministry of Health and are working with the Ministry of Health to help develop specific palliative care guidelines for cervical cancer.[32] The Government of Kenya has supported hospice by donating land to Nairobi Hospice and providing funding to several of its nurses.[32]

In South Africa, hospice services are widespread, focusing on diverse communities (including orphans and homeless) and offered in diverse settings (including in-patient, day care and home care).[32] Over half of hospice patients in South Africa in the 2003–2004 year were diagnosed with AIDS, with the majority of the remaining having been diagnosed with cancer.[32] Palliative care in South Africa is supported by the Hospice Palliative Care Association of South Africa and by national programmes partly funded by the President's Emergency Plan for AIDS Relief.[32]

Hospice Africa Uganda (HAU) founded by Anne Merriman, began offering services in 1993 in a two-bedroom house loaned for the purpose by Nsambya Hospital.[32] HAU has since expanded to a base of operations at Makindye, Kampala, with hospice services also offered at roadside clinics by Mobile Hospice Mbarara since January 1998. That same year saw the opening of Little Hospice Hoima in June. Hospice care in Uganda is supported by community volunteers and professionals, as Makerere University offers a distance diploma in palliative care.[34] The government of Uganda has a strategic plan for palliative care and permits nurses and clinical officers from HAU to prescribe morphine.

North America

Canada

Canadian physician Balfour Mount, who first coined the term "palliative care", was a pioneer in the Canadian hospice movement, which focuses primarily on palliative care in a hospital setting.[35][36] Having read the work of Kubler-Ross, Mount set out to study the experiences of the terminally ill at Royal Victoria Hospital, Montreal; the "abysmal inadequacy", as he termed it, that he found prompted him to spend a week with Saunders at St. Christopher's.[37] Inspired, Mount decided to adapt Saunders' model for Canada. Given differences in medical funding in Canada, he determined that a hospital-based approach would be more affordable, creating a specialized ward at Royal Victoria in January, 1975.[36][37] For Canada, whose official languages include English and French, Mount felt the term "palliative care ward" would be more appropriate, as the word hospice was already used in France to refer to nursing homes.[36][37] Hundreds of palliative care programs followed throughout Canada through the 1970s and 1980s.[38]

However, as of 2004, according to the Canadian Hospice Palliative Care Association (CHPCA), hospice palliative care was only available to 5-15% of Canadians, with available services having decreased with reduced government funding.[39] At that time, Canadians were increasingly expressing a desire to die at home, but only two of Canada's ten provinces were provided medication cost coverage for care provided at home.[39] Only four of the ten identified palliative care as a core health service.[39] At that time, palliative care was not widely taught at nursing schools or universally certified at medical colleges; there were only 175 specialized palliative care physicians in all of Canada.[39]

United States

Hospice in the United States has grown from a volunteer-led movement to improve care for people dying alone, isolated, or in hospitals, to a significant part of the health care system. In 2010, an estimated 1.581 million patients received services from hospice. Hospice is the only Medicare benefit that includes pharmaceuticals, medical equipment, twenty-four-hour/seven-day-a-week access to care, and support for loved ones following a death. Hospice care is also covered by Medicaid and most private insurance plans. Most hospice care is delivered at home. Hospice care is also available to people in home-like hospice residences, nursing homes, assisted living facilities, veterans' facilities, hospitals, and prisons. The first hospice in the US was the Connecticut Hospice, located in Branford, Connecticut.[40]

The first United States hospital-based palliative care programs began in the late 1980s by committed volunteers across the country. The first hospital-based palliative care consult service developed in the United States was the Wayne State University School of Medicine in 1985 at Detroit Receiving Hospital.[41] The first United States-based palliative medicine and hospice service program was started in 1987 by Declan Walsh, MD at the Cleveland Clinic Cancer Center in Cleveland, Ohio.[42] The program evolved into The Harry R. Horvitz Center for Palliative Medicine which was designated as a World Health Organization international demonstration project and accredited by the European Society of Medical Oncology as an Integrated Center of Oncology and Palliative Care. Other programs followed: most notable the Palliative Care Program at the Medical College of Wisconsin (1993); Pain and Palliative Care Service, Memorial Sloan-Kettering Cancer Center (1996); and The Lilian and Benjamin Hertzberg Palliative Care Institute, Mount Sinai School of Medicine (1997). By 1995, hospices were a $2.8 billion industry in the United States, with $1.9 billion from Medicare alone funding patients in 1,857 hospice programs with Medicare certification.[43] In that year, 72% of hospice providers were non-profit.[43] By 1998, there were 3,200 hospices either in operation or under development throughout the United States and Puerto Rico, according to the NHPCO.[43] According to 2007's Last Rights: Rescuing the End of Life from the Medical System, hospice sites are expanding at a national rate of about 3.5% per year.[44] As of 2008, approximately 900,000 people in the United States were using hospice every year,[45] with more than one-third of dying Americans using the service.[46]

Hospice plays an important role in reducing Medicare costs. Over the past 20–30 years 27-30% of Medicare's total budget was spent on individuals in their last year of life.[47] Hospice care reduces ER visits and inpatient hospitalization which are costly and emotionally traumatizing for both the patient and their loved ones.

Hospice care may involve not treating illnesses. Patients and family members should understand the care or lack of care that is planned. If one has pneumonia, it may (or may not) be treated.[48] If not treated, this might actually increase suffering. If the illness of the patient is not related to the terminal illness covered under the clinical determination of eligibility, the patient may seek standard treatment to address the cause of the suffering if they request such treatment. Any Medicare services received by a hospice patient are covered under original Medicare including those hospice patients who have a Medicare Advantage plan and also services provided by a primary care physician for unrelated hospice treatments.[49]

United Kingdom

Canterbury 002 St Thomas Hospice
St Thomas Hospice, Canterbury

The hospice movement has grown dramatically in the United Kingdom since Dame Cicely Saunders opened St Christopher's Hospice in 1967, widely considered the first modern hospice. According to the UK's Help the Hospices, in 2011 UK hospice services consisted of 220 inpatient units for adults with 3,175 beds, 42 inpatient units for children with 334 beds, 288 home care services, 127 hospice at home services, 272 day care services, and 343 hospital support services.[50] These services together helped over 250,000 patients in 2003 and 2004. Funding varies from 100% funding by the National Health Service to almost 100% funding by charities, but the service is always free to patients. The UK's palliative care has been ranked as the best in the world "due to comprehensive national policies, the extensive integration of palliative care into the National Health Service, a strong hospice movement, and deep community engagement on the issue."[51]

As of 2006 about 4% of all deaths in England and Wales occurred in a hospice setting (about 20,000 patients);[52] a further number of patients spent time in a hospice, or were helped by hospice-based support services, but died elsewhere.

Hospices also provide volunteering opportunities for over 100,000 people in the UK, whose economic value to the hospice movement has been estimated at over £112 million.[53]

Other nations

Hospice Care in Australia predates the opening of St Christophers in London by 79 years. The establishment by the Irish Sisters of Charity of hospices in Sydney (1889) and in Melbourne (1938). The first hospice in New Zealand opened in 1979.[54] Hospice care entered Poland in the middle of the 1970s.[55] Japan opened its first hospice in 1981, officially hosting 160 by July 2006.[56] The first hospice unit in Israel was opened in 1983.[57] India's first hospice, Shanti Avedna Ashram, opened in Bombay in 1986.[58][59][60][61] First hospice in the Nordics has been operating in Tampere, Finland since 1988. [62] The first modern free-standing hospice in China opened in Shanghai in 1988.[63] The first hospice unit in Taiwan, where the term for hospice translates "peaceful care", was opened in 1990.[21][64] The first free-standing hospice in Hong Kong, where the term for hospice translates "well-ending service", opened in 1992.[21][65] The first hospice in Russia was established in 1997.[66]

World Hospice and Palliative Care Day

Since 2006 the World Hospice and Palliative Care Day is organised by a committee of the Worldwide Palliative Care Alliance, a network of hospice and palliative care national and regional organisations that support the development of hospice and palliative care worldwide. The event takes place on the second Saturday of October every year.[67]

See also

Notes

  1. ^ https://www.nhpco.org/sites/default/files/public/Statistics_Research/2012_Facts_Figures.pdf
  2. ^ Rossi, Peggy (2003). Case Management in Health Care: A Practical Guide (2 ed.). Elsevier Health Sciences. p. 123. ISBN 0-7216-9558-2.
  3. ^ "Interactive Online Continuing Education for Nurse Professionals". www.rnceus.com. Retrieved 2018-11-28.
  4. ^ Suzanne Myers. "End Of Life Care". N2Information. Retrieved 2017-11-10.
  5. ^ a b c Robbins, Joy (1983). Caring for the Dying Patient and the Family. Taylor & Francis. p. 138. ISBN 0-06-318249-1.
  6. ^ Connor, Stephen R. (1998). Hospice: Practice, Pitfalls, and Promise. Taylor & Francis. p. 4. ISBN 1-56032-513-5.
  7. ^ a b c d e Connor, 5.
  8. ^ a b c d e Lewis, Milton James (2007). Medicine and Care of the Dying: A Modern History. Oxford University Press US. p. 20. ISBN 0-19-517548-4.
  9. ^ a b c Lewis, 21.
  10. ^ Lewis, 23-25.
  11. ^ Lewis, 22-23.
  12. ^ Foley, Kathleen M.; Herbert Hendin (2002). The Case Against Assisted Suicide: For the Right to End-of-life Care. JHU Press. p. 281. ISBN 0-8018-6792-4.
  13. ^ a b c Poor, Belinda; Gail P. Poirrier (2001). End of Life Nursing Care. Boston ; Toronto: Jones and Bartlett. p. 121. ISBN 0-7637-1421-6.
  14. ^ David Clark (July–August 2000). "Total Pain: The Work of Cicely Saunders and the Hospice Movement". APS Bulletin. 10 (4).
  15. ^ a b Spratt, John Stricklin; Rhonda L. Hawley; Robert E. Hoye (1996). Home Health Care: Principles and Practices. CRC Press. p. 147. ISBN 1-884015-93-X.
  16. ^ Lewenson, Sandra B.; Eleanor Krohn Herrman (2007). Capturing Nursing History. Springer Publishing Company. p. 51. ISBN 0-8261-1566-7.
  17. ^ Sullivan, Patricia. "Florence S. Wald, 91; U.S. Hospice Pioneer", The Washington Post, November 13, 2008. Accessed November 13, 2008.
  18. ^ "The Tennessean from Nashville, Tennessee · Page 80". Newspapers.com. Retrieved 2016-04-22.
  19. ^ Blues, Ann G; Zerwekh, Joyce (1984). Hospice and Palliative Nursing Care. Grune and Stratton. pp. 84–85. ISBN 0-8089-1577-0.
  20. ^ a b Reed, Christopher (2004-08-31). "Elisabeth Kubler-Ross: Psychiatrist who identified five stages of dying - denial, anger, bargaining, depression and acceptance". The Guardian.
  21. ^ a b c d Kirn, Marie (June 1, 1998). "Book review". Journal of Palliative Medicine. 1 (2): 201–202. doi:10.1089/jpm.1998.1.201.
  22. ^ Bernat, James L. (2008). Ethical Issues in Neurology (3, revised ed.). Lippincott Williams & Wilkins. p. 154. ISBN 0-7817-9060-3.
  23. ^ Saunders, Cicely M.; David Clark (2005). Cicely Saunders: Founder of the Hospice Movement : Selected Letters 1959-1999. Oxford University Press. p. 283. ISBN 0-19-856969-6.
  24. ^ a b Newman, Laura (2009-09-27). "Josefina Bautista Magno" (327 (7417)): 753. PMC 200824. That vision, fuelled by her drive and gritty determination, led to the International Hospice Institute, soon to metamorphose into the International Hospice Institute and College as the need for education and training became recognised, and finally into today's International Association for Hospice and Palliative Care.
  25. ^ "IAHPC Board of Directors". International Association for Hospice & Palliative Care. Retrieved 2009-02-21.
  26. ^ "IAHPC History". International Association for Hospice & Palliative Care. Retrieved 2009-02-21.
  27. ^ "Standards for Palliative Care Provision". International Association for Hospice & Palliative Care. Retrieved 2009-02-21.
  28. ^ Connor, Stephen (2009). Hospice and Palliative Care: The Essential Guide (2nd ed.). CRC Press. p. 202. ISBN 0-415-99356-3.
  29. ^ Connor, 201.
  30. ^ Villet-Lagomarsino, A (2000). "Hospice and Palliative Care: A Comparison". PBS.
  31. ^ Parry, Eldryd High Owen; Richard Godfrey; David Mabey; Geoffrey Gill (2004). Principles of Medicine in Africa (3 revised ed.). Cambridge University Press. p. 1233. ISBN 0-521-80616-X.
  32. ^ a b c d e f g h i Wright, Michael; Justin Wood; Tom Lynch; David Clark (November 2006). Mapping levels of palliative care development: a global view (PDF) (Report). Help the Hospices; National Hospice and Palliative Care Organization. p. 14. Archived from the original (PDF) on 2011-07-23. Retrieved 2010-02-06.
  33. ^ "What do Hospice and Palliative Care Programs in Africa Do?". Foundation for Hospices in Sub-Saharan Africa. Archived from the original on 2009-11-20. Retrieved 2010-02-06.
  34. ^ Wright et al, 15.
  35. ^ Forman, Walter B.; Denice Kopchak Sheehan; Judith A. Kitzes (2003). Hospice and Palliative Care: Concepts and Practice (2 ed.). Jones & Bartlett Publishers. p. 6. ISBN 0-7637-1566-2.
  36. ^ a b c Feldberg, Georgina D.; Molly Ladd-Taylor; Alison Li (2003). Women, Health and Nation: Canada and the United States Since 1945. McGill-Queen's Press - MQUP. p. 342. ISBN 0-7735-2501-7.
  37. ^ a b c Andrew Duffy. "A Moral Force: The Story of Dr. Balfour Mount". Ottawa Citizen. Archived from the original on December 15, 2006. Retrieved January 1, 2007.
  38. ^ Feldberg et al., 343.
  39. ^ a b c d "Fact Sheet: Hospice Palliative Care in Canada" (PDF). Canadian Hospice Palliative Care Association. December 2004. Retrieved 2009-02-21.
  40. ^ American Public Media. "The Hospice Experiment - American RadioWorks". publicradio.org.
  41. ^ Carlson, Richard; Devich, Lynn; Frank, Robert (1988). "Development of a Comprehensive Supportive Care Team for the Hopelessly Ill on a University Hospital Medical Service". JAMA. 259 (3): 378–383. doi:10.1001/jama.1988.03720030038030. Retrieved 21 March 2016.
  42. ^ Walsh, Declan (2000) [2000]. "The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Foundation, Pioneer Programs in Palliative Care: Nine Case Studies". The Milbank Memorial Fund. Co-published with the Robert Wood Johnson Foundation.
  43. ^ a b c Plocher, David W.; Patricia L. Metzger (2001). The Case Manager's Training Manual. Jones & Bartlett Publishers. p. 222. ISBN 0-8342-1930-1.
  44. ^ Kiernan, Stephen P. (2007). Last Rights: Rescuing the End of Life from the Medical System (revised ed.). MacMillan. p. 40. ISBN 0-312-37464-X.
  45. ^ Hevesi, Dennis (2008-11-14). "Florence S. Wald, American pioneer in end-of-life care, Is dead at 91". New York Times.
  46. ^ "While Hospice Care Is Growing, Not All Have Access". Archived from the original on 2016-01-27.
  47. ^ Hogan C.; Lunney J. Gabel; Lynn J. (2001). "Medicare beneficiaries' cost of life in the last year of life". Health Affairs. 20 (4): 188–195. doi:10.1377/hlthaff.20.4.188.
  48. ^ "Clinging to the Original Hospice Mission - Part One: Infections in the Terminally Ill". hospicepatients.org.
  49. ^ "How hospice works". medicare.gov.
  50. ^ "Facts and figures". Help the Hospices. Retrieved 2012-10-02.
  51. ^ "Quality of Death Index 2015: Ranking palliative care across the world". The Economist Intelligence Unit. 6 October 2015. Archived from the original on 9 October 2015. Retrieved 8 October 2015; "UK end-of-life care 'best in world'". BBC. 6 October 2015. Retrieved 8 October 2015.
  52. ^ End of life care: 1. The current place and quality of end of life care, House of Commons Public Accounts Committee, 30 March 2009, paragraphs 1-3.
  53. ^ Help The Hospices
  54. ^ Palliative Care in Australia and New Zealand p.1257 Margaret O'Connor & Peter L Hudson 2008
  55. ^ Roguska, Beata, ed. (October 2009). "Hospice and Palliative Care". Polish Public Opinion. CBOS: 1. ISSN 1233-7250.
  56. ^ "Objectives". Japan Hospice Palliative Care Foundation. Retrieved 2009-02-21.
  57. ^ Ami, S. Ben. "Palliative care services in Israel" (PDF). Middle East Cancer Consortium. Archived from the original (PDF) on 2009-01-31. Retrieved 2009-02-21.
  58. ^ Kapoor, Bimla (October 2003). "Model of holistic care in hospice set up in India". Nursing Journal of India. Archived from the original on 2008-01-19. Retrieved 2010-02-06.
  59. ^ Clinical Pain Management. CRC Press. 2008. p. 87. ISBN 978-0-340-94007-5. Retrieved 30 June 2013. In 1986, Professor D'Souza opened the first Indian hospice, Shanti Avedna Ashram, in Mumbai, Maharashtra, central India.
  60. ^ (Singapore), Academy of Medicine (1994). Annals of the Academy of Medicine, Singapore. Academy of Medicine. p. 257. Retrieved 30 June 2013.
  61. ^ Iyer, Malathy (Mar 8, 2011). "At India's first hospice, every life is important". The Times Of India. Retrieved 2013-06-30. The pin drop silence gives no indication that there are 60 patients admitted at the moment in Shanti Avedna Sadan-the country's first hospice that is located on the quiet incline leading to the Mount Mary Church in Bandra.
  62. ^ "Welcome to Pirkanmaa Hospice - Pirkanmaan Hoitokoti". www.pirkanmaanhoitokoti.fi. Retrieved 2018-11-28.
  63. ^ Pang, Samantha Mei-che (2003). Nursing Ethics in Modern China: Conflicting Values and Competing Role. Rodopi. p. 80. ISBN 90-420-0944-6.
  64. ^ Lai, Yuen-Liang; Wen Hao Su (September 1997). "Palliative medicine and the hospice movement in Taiwan". Supportive Care in Cancer. 5 (5): 348–350. doi:10.1007/s005200050090. ISSN 0941-4355.
  65. ^ "Bradbury Hospice". Hospital Authority, Hong Kong. Retrieved 2009-02-21. Established by the Society for the Promotion of Hospice Care in 1992, Bradbury Hospice was the first institution in Hong Kong to provide specialist hospice care.
  66. ^ "Russia's first hospice turns ten". Russia Today. September 21, 2007. Retrieved 2009-02-21.
  67. ^ About World Hospice and Palliative Care Day (visited 24. July 2014

Further reading

  • Saunders, Cicely M.; Robert Kastenbaum (1997). Hospice Care on the International Scene. Springer Pub. Co. ISBN 0-8261-9580-6.
  • Szeloch Henryk, Hospice as a place of pastoral and palliative care over a badly ill person, Wyd. UKSW Warszawa 2012, ISSN 1895-3204
  • Worpole, Ken, Modern Hospice Design: the architecture of palliative care, Routledge, ISBN 978-0-415-45179-6

External links

Media related to Hospices at Wikimedia Commons

Bababaghi Hospice

Bababaghi Hospice (Persian: اسايشگاه باباباغي‎ – Asāīyeshgāh-e Bābābāghī) is a village in Esperan Rural District, in the Central District of Tabriz County, East Azerbaijan Province, Iran. At the 2006 census, its population was 409, in 150 families.

Barry (dog)

Barry der Menschenretter (1800–1814), also known as Barry, was a dog of a breed which was later called the St. Bernard that worked as a mountain rescue dog in Switzerland and Italy for the Great St Bernard Hospice. He predates the modern St. Bernard, and was lighter built than the modern breed. He has been described as the most famous St. Bernard, as he was credited with saving more than 40 lives during his lifetime, hence his byname Menschenretter meaning "people rescuer" in German.

The legend surrounding him was that he was killed while attempting a rescue; however, this is untrue. Barry retired to Bern, Switzerland and after his death his body was passed into the care of the Natural History Museum of Bern. His skin has been preserved through taxidermy although his skull was modified in 1923 to match the Saint Bernard of that time period. His story and name have been used in literary works, and a monument to him stands in the Cimetière des Chiens near Paris. At the hospice, one dog has always been named Barry in his honor; and since 2004, the Foundation Barry du Grand Saint Bernard has been set up to take over the responsibility for breeding dogs from the hospice.

Chaplain

A chaplain is, traditionally, a cleric (such as a minister, priest, pastor, rabbi, purohit, or imam), or a lay representative of a religious tradition, attached to a secular institution such as a hospital, prison, military unit, school, labor union, business, police department, fire department, university, or private chapel.

Though originally the word chaplain referred to representatives of the Christian faith, it is now also applied to people of other religions or philosophical traditions, such as the case of chaplains serving with military forces and an increasing number of chaplaincies at U.S. universities. In recent times, many lay people have received professional training in chaplaincy and are now appointed as chaplains in schools, hospitals, companies, universities, prisons and elsewhere to work alongside, or instead of, official members of the clergy. The concepts of a multi-faith team, secular, generic or humanist chaplaincy are also gaining increasing use, particularly within healthcare and educational settings.

Death education

Death education is education about death that focuses on the human and emotional aspects of death. Though it may include teaching on the biological aspects of death, teaching about coping with grief is a primary focus. Death education is formally known as thanatology. Thanatology stems from the Greek word thanatos, meaning death, and ology meaning a science or organized body of knowledge. A specialist in this field is referred to as a thanatologist.

Death education refers to the experiences and activities of death that one deals with. Death education also deals with being able to grasp the different processes of dying, talk about the main topics of attitudes and meanings toward death, and the after effects on how to learn to care for people that are affected by the death. The main focus in death education is teaching people how to cope with grief. Many people feel death education is a taboo and instead of talking about death and grieving, they hide it away and never bring it up to others. With the right education of death, the less of a taboo it will be.

English College, Rome

The Venerable English College (Italian: Venerabile Collegio Inglese), commonly referred to as the English College, is a Catholic seminary in Rome, Italy, for the training of priests for England and Wales. It was founded in 1579 by William Allen on the model of the English College, Douai.

The current Rector is Monsignor Philip Whitmore.

Florence Wald

Florence Wald (April 19, 1917 – November 8, 2008) was an American nurse, former Dean of Yale School of Nursing, and largely credited as "the mother of the American hospice movement". She led the founding of Connecticut Hospice, the first hospice program in the United States. Late in life, Wald became interested in the provision of hospice care within prisons. In 1998, Wald was inducted into the National Women's Hall of Fame.

Grange-over-Sands

Grange-over-Sands is a town and civil parish located on the north side of Morecambe Bay in Cumbria, England. Historically part of Lancashire, the town was created as an urban district in 1894. Since 1974, following local government re-organisation, the town has been administered as part of the South Lakeland district of Cumbria, though it remains part of the Duchy of Lancaster. It had a population of 4,114 at the 2011 Census.Travelling by road, Grange Over Sands is 13.1 miles (21.1 km) to the south of Kendal, 25 miles (40 km) to the east of Barrow-in-Furness and 28.1 miles (45.2 km) to the west of Lancaster.

Greater Baltimore Medical Center

Greater Baltimore Medical Center (GBMC) is a hospital located in the Baltimore suburb of Towson, Maryland. GBMC serves more than 20,455 inpatient cases and approximately 52,000 emergency department visits annually. GBMC’s main campus also includes three medical office buildings—Physicians Pavilion East, Physicians Pavilion West and Physicians Pavilion North I. In addition to its main campus located in Towson, GBMC’s care can be found in several facilities located throughout the community including Hereford, Hunt Manor, Hunt Valley, Owings Mills, Perry Hall, Lutherville, Phoenix and Timonium.GBMC HealthCare is a private, not-for-profit corporation that owns and operates Greater Baltimore Medical Center. GBMC HealthCare also owns and operates Gilchrist Hospice Care (formerly known as Hospice of Baltimore and Gilchrist Center for Hospice Care), the largest not-for-profit hospice organization in the state of Maryland. The organization also includes the GBMC Foundation, which supports the GBMC mission by managing fundraising efforts.

Hospice care in the United States

Hospice care in the United States is a type and philosophy of end-of-life care which focuses on the palliation of a terminally ill patient's symptoms. These symptoms can be physical, emotional, spiritual or social in nature. The concept of hospice as a place to treat the incurably ill has been evolving since the 11th century. Hospice care was introduced to the United States in the 1970s in response to the work of Cicely Saunders in the United Kingdom. This part of health care has expanded as people face a variety of issues with terminal illness. In the United States, it is distinguished by extensive use of volunteers and a greater emphasis on the patient's psychological needs in coming to terms with dying.

Under hospice, medical and social services are supplied to patients and their families by an interdisciplinary team of professional providers and volunteers, who take a patient-directed approach to managing illness. Generally, treatment is not diagnostic or curative, although the patient may choose some treatment options intended to prolong life, such as CPR. Most hospice services are covered by Medicare or other providers, and many hospices can provide access to charitable resources for patients lacking such coverage.

With practices largely defined by the Medicare system, a social insurance program in the United States, and other health insurance providers, hospice care is made available in the United States to patients of any age with any terminal prognosis who are medically certified to have less than six months to live. In 2007, hospice treatment was used by 1.4 million people in the United States. More than one-third of dying Americans use the service. Common misperceptions regarding the length of time a patient may receive hospice care and the kinds of illnesses covered may result in hospice being underutilized. Although most hospice patients are in treatment for less than thirty days, and many for less than one week, hospice care may be authorized for more than six months given a patient's condition.

Care may be provided in a patient's home or in a designated facility, such as a nursing home, hospital unit or freestanding hospice, with level of care and sometimes location based upon frequent evaluation of the patient's needs. The four primary levels of care provided by hospice are routine home care, continuous care, general inpatient, and respite care. Patients undergoing hospice treatment may be discharged for a number of reasons, including improvement of their condition and refusal to cooperate with providers, but may return to hospice care as their circumstances change. Providers are required by Medicare to provide to patients notice of pending discharge, which they may appeal.

In other countries, there may not be the same distinctions made between care of those with terminal illnesses and palliative care in a more general setting. In such countries, the term hospice is more likely to refer to a particular type of institution, rather than specifically to care in the final months or weeks of life. End-of-life care is more likely to be included in the general term "palliative care".

Marie Curie (charity)

Marie Curie is a registered charitable organisation in the United Kingdom which provides care and support to people with terminal illnesses and their families. It was established in 1948, the same year as the National Health Service.

In financial year 2014/15 the charity provided care to 40,000 terminally ill patients in the community and in its nine hospices, along with support for their families. More than 2,700 nurses, doctors and other healthcare professionals help provide this care.

At the nine Marie Curie Hospices, quality of life for patients is actively promoted as is providing much needed support for their carers. Marie Curie provides the largest number of hospice beds outside the National Health Service.

Palliative care

Palliative care is an interdisciplinary approach to specialized medical and nursing care for people with life-limiting illnesses. It focuses on providing relief from the symptoms, pain, physical stress, and mental stress at any stage of illness. The goal is to improve quality of life for both the person and their family. Evidence as of 2016 supports palliative care's efficacy in the improvement of a patient's quality of life.Palliative care is provided by a team of physicians, nurses, physiotherapists, occupational therapists, speech-language pathologists and other health professionals who work together with the primary care physician and referred specialists and other hospital or hospice staff to provide additional support. It is appropriate at any age and at any stage in a serious illness and can be provided as the main goal of care or along with curative treatment. Although it is an important part of end-of-life care, it is not limited to that stage. Palliative care can be provided across multiple settings including in hospitals, at home, as part of community palliative care programs, and in skilled nursing facilities. Interdisciplinary palliative care teams work with people and their families to clarify goals of care and provide symptom management, psycho-social, and spiritual support.

Physicians sometimes use the term palliative care in a sense meaning palliative therapies without curative intent, when no cure can be expected (as often happens in late-stage cancers). For example, tumor debulking can continue to reduce pain from mass effect even when it is no longer curative. A clearer usage is palliative, noncurative therapy when that is what is meant, because palliative care can be used along with curative or aggressive therapies.

Medications and treatments are said to have a palliative effect if they relieve symptoms without having a curative effect on the underlying disease or cause. This can include treating nausea related to chemotherapy or something as simple as morphine to treat the pain of broken leg or ibuprofen to treat pain related to an influenza infection.

Pitié-Salpêtrière Hospital

The Hôpital universitaire Pitié-Salpêtrière (French: [opital ynivɛʁsitɛʁ pitje salpɛtʁijɛʁ]) is a teaching hospital in the 13th arrondissement of Paris. Part of the Assistance publique – Hôpitaux de Paris and a teaching hospital of Sorbonne University, it is one of Europe's largest hospitals.

Rectal administration

Rectal administration uses the rectum as a route of administration for medication and other fluids, which are absorbed by the rectum's blood vessels, and flow into the body's circulatory system, which distributes the drug to the body's organs and bodily systems.A drug that is administered rectally will in general (depending on the drug) have a faster onset, higher bioavailability, shorter peak, and shorter duration than the oral route. Another advantage of administering a drug rectally, is that it tends to produce less nausea compared to the oral route and prevents any amount of the drug from being lost due to emesis (vomiting). In addition, the rectal route bypasses around two thirds of the first-pass metabolism as the rectum's venous drainage is two thirds systemic (middle and inferior rectal vein) and one third hepatic portal system (superior rectal vein). This means the drug will reach the circulatory system with significantly less alteration and in greater concentrations. Finally, rectal administration can allow patients to remain in the home setting when the oral route is compromised. Unlike intravenous lines, which usually need to be placed in an inpatient environment and require special formulation of sterile medications, a specialized rectal catheter can be placed by a clinician, such as a hospice nurse or home health nurse, in the home. Many oral forms of medications can be crushed and suspended in water to be given via a rectal catheter.

The rectal route of administration is useful for patients with any digestive tract motility problem, such as dysphagia, ileus, or bowel obstruction, that would interfere with the progression of the medication through the tract. This often includes patients near the end of life (an estimated 1.65 million people are in hospice care in the US each year). Because using the rectal route enables a rapid, safe, and lower cost alternative to administration of medications, it may also facilitate the care of patients in long-term care or palliative care, or as an alternative to intravenous or subcutaneous medication delivery in other instances.

Simplon Pass

The Simplon Pass (French: Col du Simplon; German: Simplonpass; Italian: Passo del Sempione) (2,005 m or 6,578 ft) is a high mountain pass between the Pennine Alps and the Lepontine Alps in Switzerland. It connects Brig in the canton of Valais with Domodossola in Piedmont (Italy). The pass itself and the villages on each side of it, such as Gondo, are in Switzerland. The Simplon Tunnel was built beneath the vicinity of the pass in the early 20th century to carry rail traffic between the two countries.

The lowest point of the col, and the lowest point on the watershed between the basins of the Rhone and the Po in Switzerland lies in marshland about 500 m (1,640 ft) west of the Simplon Pass settlement at an altitude of 1,994 m or 6,542 ft.Rotelsee is a lake located near the pass at an elevation of 2,028 m (6,654 ft).

There are several great peaks around that can be climbed directly from the pass. These include Wasenhorn, Hubschhorn, Breithorn (Simplon), and Monte Leone.

St. Bernard (dog)

The St. Bernard or St Bernard (UK: , US: ) is a breed of very large working dog from the western Alps in Italy and Switzerland. They were originally bred for rescue by the hospice of the Great St Bernard Pass on the Italian-Swiss border. The hospice, built by and named after Italian monk Bernard of Menthon, acquired its first dogs between 1660 and 1670. The breed has become famous through tales of alpine rescues, as well as for its enormous size.

Terminal illness

Terminal illness or end-stage disease is an incurable disease that cannot be adequately treated and is reasonably expected to result in the death of the patient. This term is more commonly used for progressive diseases such as cancer or advanced heart disease than for trauma. In popular use, it indicates a disease that will progress until death with near absolute certainty, regardless of treatment. A patient who has such an illness may be referred to as a terminal patient, terminally ill or simply terminal. There is no standardized life expectancy for a patient to be considered terminal, although it is generally months or less. Life expectancy for terminal patients is a rough estimate given by the physician based on previous data and does not always reflect true longevity. An illness which is lifelong but not fatal is a chronic condition.

Terminal patients have options for disease management after diagnosis. Examples include caregiving, continued treatment, hospice care, and physician-assisted suicide. Decisions regarding management are made by the patient and his or her family, although medical professionals may give recommendations or more about the services available to terminal patients.Lifestyle after diagnosis largely varies depending on management decisions and also the nature of the disease, and there may be living restrictions depending on the condition of the patient. Oftentimes, terminal patients may experience depression or anxiety associated with oncoming death, and family and caregivers may struggle with psychological burdens as well. Psychotherapeutic interventions may help alleviate some of these burdens, and is often incorporated in palliative care.Because terminal patients are aware of their oncoming deaths, they have more time to prepare advance care planning, such as advance directives and living wills, which have been shown to improve end-of-life care. While death cannot be avoided, patients can still strive to die a good death.

Thanatology

Thanatology or deathlore is the scientific study of death and the losses brought about as a result. It investigates the mechanisms and forensic aspects of death, such as bodily changes that accompany death and the post-mortem period, as well as wider psychological and social aspects related to death. It is primarily an interdisciplinary study offered as a course of study at numerous colleges and universities.

The word is derived from the Greek language. In Greek mythology, Thanatos (θάνατος: "death") is the personification of death. The English suffix -ology derives from the Greek suffix -logia (-λογια: "speaking").

Trinity Hospice (Blackpool)

Trinity Hospice is a purpose built hospice on Low Moor Road (formerly Low Moor Lane) in Greenlands, Bispham, Blackpool, Lancashire, England. It is set in landscaped gardens and it has a central courtyard. It was opened in 1985 after several years of planning and fund raising led by Dr David Cooper. Built on a former horse paddock and marsh land and stream. It has grown from the original in-patient unit to include a day-patient unit, a children's unit, a study centre and a community care centre.

All of the hospice's patient areas are on the ground floor. The Hospice includes two wards for the in-patient palliative care of 28 adults in three or four bedded bays and single rooms. It also includes Brian House which is a separate unit for the in-patient palliative care of five children in single rooms. There are also 24 day-patient places.

Veterinary medicine

Veterinary medicine is the branch of medicine that deals with the prevention, diagnosis and treatment of disease, disorder and injury in animals. The scope of veterinary medicine is wide, covering all animal species, both domesticated and wild, with a wide range of conditions which can affect different species.

Veterinary medicine is widely practiced, both with and without professional supervision. Professional care is most often led by a veterinary physician (also known as a vet, veterinary surgeon or veterinarian), but also by paraveterinary workers such as veterinary nurses or technicians. This can be augmented by other paraprofessionals with specific specialisms such as animal physiotherapy or dentistry, and species relevant roles such as farriers.

Veterinary science helps human health through the monitoring and control of zoonotic disease (infectious disease transmitted from non-human animals to humans), food safety, and indirectly through human applications from basic medical research. They also help to maintain food supply through livestock health monitoring and treatment, and mental health by keeping pets healthy and long living. Veterinary scientists often collaborate with epidemiologists, and other health or natural scientists depending on type of work. Ethically, veterinarians are usually obliged to look after animal welfare.

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