In medieval times, the word "hospice" referred to monasteries and convents where travelers could find lodging and comfort along their journey. Many times, these travelers were ill and spent their final days being cared for by nuns and monks. Today, hospice is a similar concept of care focused on improving the quality of life of terminally ill cancer patients, allowing them to live out their final days in comfort and dignity. Hospice care is usually offered when standard treatments and clinical trials can no longer cure your cancer and you are expected to live six months or less. Hospice care may include palliative treatments to improve cancer pain and symptoms, as well as emotional and spiritual support for you and your family. The goal of hospice care is not to prolong life or hasten death, but rather to provide a caring and supportive community for patients and their families. The hospice philosophy embraces life but recognizes the reality of death. The dying deserve to live comfortably and without pain. At the same time, death and grief are to follow eventually, so it is just as important to offer psychological, emotional, and spiritual support to the patient and family during this difficult time.

Pain Control Using Medications

Doctors often treat hospice care patients with prescription pain medications called opiates. These drugs can help lessen pain and make the patient more comfortable. However, some hospice care patients may require large doses in order to control their pain, which may cause them to become drowsy or sleepy. Some patients may not like this sedating side effect because they want to remain awake and participate in their life as much as possible. It is important for the hospice patient to communicate with the hospice care team to find a balance between pain relief and alertness. There are other medications and treatments that can help further improve pain without causing additional sedation. Doctors often prescribe antidepressants and anticonvulsants to help relieve the burning and tingling pain caused by nerve damage, and steroids to relieve pain caused by inflammation. Additional treatments and procedures can lessen cancer pain by directly treating the tumor causing the problems.

Pain Control Treatments

Hospice care may include treatments that target the tumor causing problems in order to improve symptoms and relieve pain. Your doctor may suggest surgery, chemotherapy, or radiation therapy to remove or shrink a tumor pressing on your organs, nerves, or bones. If your body doesn't respond well to these treatments or prescription pain medications, your doctor may suggest a nerve block or pump to relieve pain. These treatments target the nerves in order to disrupt pain signals between your body and brain. Additionally, supplemental treatments such as meditation, relaxation, biofeedback, hypnosis, and imagery may help you relax and feel better.

Emotional and Spiritual Support

Another main focus of hospice care is to provide support and counseling to the patient and his or her family. Your hospice care team includes counselors, therapists, social workers, and clergy, who are specially trained to help patients and families deal with terminal illness and death. It can be a very difficult and emotional experience to prepare for death. Your hospice care team will help you cope with these difficult emotions and live out your days in the happiest and most comfortable way possible. Your hospice may offer respite care, a service which allows your family members to take a break and get away for a few days while you are cared for in a inpatient setting. Hospices may also offer family conferences, so you and your family members can share your feelings with one another under the guidance of a counselor or social worker. These conferences can be a great source of support and stress relief. Your hospice care team will also provide bereavement counseling to support your family members through the grieving process. Since people have different religious beliefs, your hospice team will provide spiritual support to meet your needs and help you through this difficult time.

At Home:

Most cancer patients receive hospice care in the comfort of their own homes, but hospice care is also offered in special inpatient hospice facilities, hospitals, and nursing homes. Your healthcare team can help you determine which option would be best for you. Your caregiver will play an important role in administering your at-home hospice care. Your caregiver is responsible for supervising and assisting the patient most of the time, but your hospice team will also regularly visit your home to check on you and provide any care or services needed. Additionally, most hospice services have someone on-call 24 hours a day to make house calls and visit the patient for any problems or concerns.

In a Hospital:

Some hospitals have hospice units or programs to cater to the needs of their terminally ill patients. This arrangement differs from hospital to hospital, but it allows patients and their families easier access to doctors, nurses, and support services. This may be a better option for patients needing more treatments and medical procedures.

In a Nursing Home:

Many nursing homes also have hospice care services. They either have a specially trained staff or work with an independent hospice service. This is a good choice for patients who do not want their primary caretaker to have to care for them at home.

In a Hospice Facility:

Many places have independently owned hospices that provide inpatient hospice care as well as home-based care. These facilities are a better option for those who do not have a primary caretaker.

Most private insurance plans, HMO's, Medicare, and Medicaid cover hospice care. Also, contributions and donations often allow hospices to provide services to patients who can't afford it. Hospice care is a very compassionate philosophy, and there are many devoted hospice volunteers committed to making sure terminally ill patients end their life in comfort and happiness. Home hospice care is usually the least expensive option, as family and friends provide much of the care. In order to qualify for Medicare hospice benefits, your doctor must certify that your life expectancy is six months or less, and you must sign a statement agreeing to hospice care. Most states have a Medicaid hospice benefit, which has the same qualification requirements as Medicare.

• Is the hospice program nationally accredited and state certified?
• Is the hospice program certified by Medicare? Does it accept Medicaid?
• What other insurance plans does the hospice accept?
• Does the hospice clearly outline services, eligibility, costs, payment procedures, malpractice, and liability insurance?
• Does the hospice have a good reputation? How long has it been in operation?
• Can the hospice provide references from medical professionals who have used the service before?
• Does the hospice work with each patient and family and cater to their individual situation, or does it impose rigid policies on all patients?
• Does the hospice create a specialized care plan for each new patient? Is the plan developed by a qualified professional with input from you and your family?
• Does the hospice require a designated primary caregiver? How much responsibility is expected of this person?
• How does the hospice handle billing and payment? Will the hospice help you find financial assistance if needed?
• Does the hospice have a 24-hour telephone number you can call with any problems?
• What are the hospice's policies about inpatient care?