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Hospice rated best for care at life’s end

Dying Americans are receiving inadequate pain management, little emotional support, and poor communication from their physicians according to the Jan. 7 issue of the Journal of the American Medical Association. This is particularly true for those dying in institutional settings, according to researchers at Brown University. Hospice care at home provided greater levels of satisfaction and fewer problems with pain management, according to this national study examining family perspectives on care at the end of life.

Home-based hospice care received the highest levels of overall satisfaction from respondents. More than 70 percent of family members of patients who received hospice care at home rated care as “excellent.” The authors reported that “bereaved family members of patients with home hospice services (in contrast to other settings of care) reported higher satisfaction, fewer concerns with care, and fewer unmet needs.”

The study stated that “high-quality end-of-life results when health care professionals (1) ensure desired physical comfort and emotional support, (2) promote shared decision making, (3) treat the dying person with respect, (4) provide information and emotional support to family members, and (5) coordinate care across settings.” These characteristics of quality end-of-life care are integral to the interdisciplinary hospice philosophy of care.



“While improvements have been made in the care of the dying, the results of this study attest to the continued need to improve the quality of care for the seriously ill and dying persons,” says lead author Joan Teno, M.D., a professor of community health and medicine at the Brown Medical School. Among the suggested actions for improving care was a call for expanded use of hospice, both in homes and in other settings.

“This important study illustrates the significance of hospice at the end of life,” Commented J. Donald Schumacher, Psy.D., president and CEO of the National Hospice and Palliative Care Organization. “Growth in hospice usage in the U.S. reflects the high quality of care that is provided to patients, families and loved ones. There is much to learn from the hospice model of care that will benefit other health care providers serving persons at the end of life.”




Key findings from the report include:

– One in four people who died did not receive enough pain medication. This was 1.6 times more likely to be a concern in a nursing home than in hospice home care.

– One in two patients did not receive enough emotional support. This was 1.3 times more likely to be the case in an institution than hospice.

– Twenty-one percent complained that the dying person was not always treated with respect. Compared with hospice, this was 2.6 times higher in a nursing home and 3 times higher in a hospital.

– One in four respondents expressed concern over physician communication and treatment decisions.

– One in three respondents said family members did not receive enough emotional support.

– Respondents whose loved ones received hospice in a home setting were the most satisfied. More than 70 percent rated hospice care as excellent. Fewer than 50 percent gave that grade to nursing homes or home health services.

This study reveals that there is a higher level of care for the dying under hospice care, so remember that our local facilities and physicians work closely with Hospice of the Foothills in order to ensure that a higher level of care is provided to all of our patients, whether they are in their home, the hospital, or other health and residential facilities.

While these findings represent the national trend, in our community Hospice of the Foothills strives to provide its services in all settings. With contracts in place, we can serve our patients in the local hospital, in skilled nursing facilities, and in assisted living facilities in collaboration with the professionals in these facilities.

We believe the key to excellent end-of-life care is an early referral to hospice. Anyone can make that referral and we urge everyone to have frank conversations with their physicians in order to decide if a hospice referral is appropriate.

Hospice of the Foothills has been serving Nevada County since 1979. We have served thousands in our community with direct patient care, bereavement, our transitions program, and other community services. Our mission is to affirm life and promote dignity for the terminally ill by providing professional, comprehensive, and compassionate care to the patient, their loved ones, and the community.

Dennis Fournier is executive director of Hospice of the Foothills in Grass Valley.


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