Hospice Care Vs. Hospital Care

The topic of end-of-life care may seem daunting and uncomfortable, and yet most individuals do have unique desires and concerns regarding their provision for the future. Providing the opportunity for that communication, the advance directive and POLST forms allow an individual to explicitly state their wishes before the future. Developed to lessen the apprehensions concerning patients undergoing any extensive and unwanted measures to preserve life at any cost, these medical directives lighten the decision-making burden for physicians and families alike and help comply with the patient’s utmost end-of-life wishes.

The importance of end of life issues and decisions are now being discussed at the time of admission to most acute care and long term acute care facilities. More attention is being placed on these specific decisions to ensure that the patient's

An Advance directive is a living will, which allows one to document their wishes concerning medical treatments at the end of life. Even though it’s optional, but all health care facilities are required by law to ask patients if they have one, and offer them the appropriate information, and documents to sign if they want it. There are two basic kinds of advance directives, living wills, and

Hospice is compassionate care provided to patients facing terminal illness or illness for which there is no cure. These patients are diagnosed with an illness from which they will never recover and usually have a life prognosis of six months or less (Hospice Foundation of America, 2014). The goal of hospice care is improving quality of life and managing the symptoms of disease and the dying process. The care hospice offers is focused on pain management and emotional and spiritual support for both the patient and family (National Hospice and Palliative Care Organization, 2012). Hospice care can be provided in many different settings, often the patient’s own home. Hospice care can also be provided in hospitals, nursing homes, long-term care facilities and free-standing hospice centers and is available to patients of all ages (NHPCO, 2012). A patient receiving care in a hospice program has a team of healthcare individuals that can consist of the patients own physician, nurses, home health aides, clergy, social workers, and speech and physical therapists (NHPCO, 2012). Usually, a care plan is developed by the hospice team and care of the patient is provided by family members with the support of the hospice staff (NHPCO, 2012). Nurses make regular visits to the patient and family and are on call 24/7. Once enrolled in a hospice program hospice covers everything that will be needed to care for you, from medications to manage pain to

In addition to advance directives, there are other decisions involving end of life care that people should think about and discuss with their loved ones. These are decisions are around the ‘how’ and ‘where’ that people wish to die. These types of measures may be touched on in one’s advance directives, but may not go into great detail. If diagnosed with a terminal disease or if the end of life is imminent, one should decide on the type and amount of treatment they receive. With death as a certainty, most people turn toward either palliative care or hospice

When you are able, you should put thought into the physical process you will go through. All of us love you and want to make sure that when the time comes, we know and can follow your wishes regarding the care you wish to receive. Having your decisions thoroughly and clearly stated in an advance directive will make this possible. (Berger, 2014, p. 590). Your advance directive document may contain a living will, a signed consent for Do Not Resuscitate (DNR), and information identifying your healthcare proxy. Understanding these things now, will help you make clear choices. A living will clarifies what care, or lack of care, you wish to have (Berger, 2014, p. 590). This is helpful for reference if you are ever unconscious or in any way incapable

There are two types of advance directives: a Living Will and the Durable Power of Attorney for Health Care. A Living Will requires a witness or be notarized and consists of a directive that instruct the acting physicians to not utilize medical interventions in an instance that the patient is unable to make their immediate medical decision. The Living Will is the oldest form of advanced directives, requires a patient be terminally ill and it states that its interpretation is only to be assumed by the patient and their physician, there is never to be any family influence or interpretation of a Living Will. Durable Power of Attorney for Health Care is also witnessed or notarized and identifies an ‘agent’ to make health care decisions if the signer is unable to make their own decision. An agent is an individual that the patient chooses with great care, due to the amount of power/authority that is assumed to making such decisions. The Durable Power of Attorney does not require that a patient be terminally ill and is interpreted by the identified ‘agent’. There have also been known to be hybrid documents that combine elements of a Living Will and Durable Power of Attorney for Health Care that acts as an Advanced Directive. (Advanced Directives.,

Planning for end of life care for a loved one can be a very difficult process for some families. Knowing that you are going to lose a loved one and planning for how they will be taken care of can be quite stressful. End of life planning can be used in two different scenarios one of which is for terminally ill patients and the other is for the aging and elderly. Planning for end of life care can be quite expensive with all of the doctor visits and counseling’s. In Obama’s Affordable Care Act there is some hope for the elderly for paying for some of these expenses.

“It is estimated that 75 percent of Americans have never taken the time to discuss their wishes or provided any written guidance to loved ones or health care providers in the event the patient is unable to speak for themselves” (Kottkamp, 2013). This is why patients should decide on having an advanced directive. Advanced directives exits to “encourage and empower patients to be ready for the unexpected, to provide the gift of guidance to their loved ones, and, ultimately, to be sure that patients get the care they want and need if they are ever unable to speak for themselves” (Kottkamp, 2013). Advanced directives are recognized in all 50

Advance Directives allow an individual to state his or her personal end of life health care choices in advance of an incapacitation illness or injury. According to U.S. Living Will Registry (2015), there are two types of directives:

When a patient is expected to live six months or less is when hospice is referred. Although many hospice patients have cancer as their primary diagnosis, hospice provides care to patients of all ages who are dealing with any potentially life-limiting illness, including Alzheimer’s, congestive heart failure, chronic obstructive pulmonary disease (COPD), dementia, and emphysema. Once the patient has been diagnosed and chooses hospice care, this can generally take place at home or as in-patient care. Hospice neither prolongs life nor hastens death, but controls pain and discomfort allowing a person to live as fully and comfortably as possible during life’s final journey (“Career”).

This film explains the legal role of advance directives in end of life issues. An advance directive is “a written document directing how medical decisions are to be made in the future when the patient lacks decisional capacity and is unable to decide and choose” (Hanlon, End of Life Issues, Slide 28, Bullet 1). All three of the cases demonstrate the importance in filling out some form of directive. When there is nothing to go off of, it makes decisions extremely tough for families and medical providers. Having legal documentation of patient wishes helps understand what treatments they would or would not consent to. In cases like

The advance directive also allows individuals to designate an agent to make health related decisions. The decisions might include “Resuscitation, Mechanical ventilation, Tube feeding, Dialysis, Antibiotics or antiviral medications, Comfort care (palliative care), Organ and tissue donations, and body donation for a scientific study.” (Mayo Clinic Consumer Health, 2015). Thus, an advance directive plays an important legal role in the end of life issues.

Advance Directives are our wishes when we are at end of life stages of life that give specific direction of how, who, and when to treat us in our final days and hours. We can have documents drawn up to say what we want in the event we are in a state where we cannot voice our wishes aloud. These documents have legal and ethical basis, and they should be followed unless the legally or ethically unable to do so.

Upon reflection of the Five Wishes, several thoughts came to mind. First and foremost, having a designated advanced directive is critical. There are countless examples of clinical experiences in with which families were overwhelmed with unexpected end-of-life decisions. As an educated caregiver, we should personally take the necessary steps to assure these tough decisions are known to someone who can facilitate the level of care desired. Such consideration of these elements of care in advance can help to support our loved ones during this emotional time. After review of the five wishes, I recognized that I would not want life-support measures if faced with irreversible deleterious outcomes that resulted from