When most people hear the word "hospice," they think of death. However, hospice is about life! It's about living the best quality of life that you can live for as long as you can live it.

A recent medical study proved that people receiving hospice care live longer than similar patients on aggressive therapies—an average of 29 days longer. Patients can have quantity and quality.

The concept of hospice began in England and migrated to the United States in 1974. In 1982, Medicare began paying for hospice services (100 percent, with no out-of-pocket deductible or co-pays from the patient). There are now more than 4,500 hospice programs in the United States.
Hospice is not a place; it's a philosophy. A recent Gallup poll showed that 90 percent of Americans want to stay at home to die, if possible. For those people, that becomes the goal of hospice.

Hospice is good medical care, but a "cure" is not the goal. There comes a time in everyone's life when a cure is not achievable. At that point, our hopes need to change—perhaps to achieve peace or reconciliation with family or friends or to live long enough to experience a special event. Perhaps the goal becomes pain control, a dignified death, or staying in control of one's life.

Hospice services are intended for persons with terminal illnesses, with a life expectancy of six months or less if the disease runs its normal course. However, life expectancy is hard to determine, even by physicians trained in hospice. As long as the patient meets Medicare guidelines, hospice benefits continue indefinitely. Some people may live for two days while receiving hospice care; some may live two years. The average amount of time on hospice is 29 days.

The most common comment I hear from families is, "I wish I had known about hospice sooner!"

End-of-life care is very individualized and requires a team approach—coordinated services by a physician, nurse, home health aide, social worker, chaplain, and volunteers. As needs vary, a patient may use all these disciplines, or one more than the others.

Medicare and most private insurance companies cover the cost of all medications related to the terminal diagnosis, nursing visits at least every two weeks, physician supervision, home health aide visits, medical equipment (oxygen, hospital beds), social worker and chaplain visits, and volunteer services. Also available are respite care (relief for the caregiver), general in-patient treatment, and crisis intervention. Families are given bereavement support for at least 13 months after the loved one dies.

All hospices are paid the same Medicare amount, whether they are for-profit or non-profit organizations.

How can people choose the hospice that is right for them? Here are some questions patients and families should ask when deciding on a hospice organization:

• How frequent are nursing visits? Medicare requires a visit every two weeks, but each company has its own standard.
  
• What is the nursing case load? Does each nurse care for 10 patients or 30 patients? The answer makes a big difference in how much time can be spent with each patient.
  
• When emergencies occur on weekends or at night, does a hospice nurse answer the phone or do patients and families get a recording or the dreaded "press one, press two" machine?
  
• Does the hospice have a local medical director?
  
• Does the hospice spend money on such things as wound care programs? Does it support education for employees and the community?

Dying is part of the life cycle. It is a time of reflection and tremendous mental, emotional, and spiritual growth. But 70 percent of Americans still die without the support that hospice can offer.

To locate hospice options in the Kansas City area, check your phone directory yellow pages or the Johnson County Senior Directory, available by calling 913-715-8999 or online at http://hsa.jocogov.org and see Senior Directory under Quick Links.