Dignity and comfort for the dying

Some helpful advice in planning for hospice care for yourself or a loved one . . .

Dr. Susan Locke

Throughout our lives, we make plans — for our own life and the lives of our loved ones. But few of us think about the end of our lives — how we can ensure our dignity or the dignity of a loved one.

When the time comes, it’s important to start this conversation with physicians, caretakers and family members. In partnership with the Visiting Nurse Association of Ohio, Healthnetwork Foundation now has the resources to assist you and your family with hospice and in-home nursing care. To help you with this journey, we engaged the assistance of VNA’s hospice medical director, Cynthia Katzan, MD.

How do you know when you or a loved one is ready for hospice?

Usually your primary physician or specialist will bring up the topic of hospice with you if they feel the disease is considered “end-stage.” Some patients inquire about hospice themselves if they decide they don’t wish to continue with aggressive treatment such as chemotherapy or dialysis.

The primary criterion common to all is that a physician believes the patient is within the last six months of life if the illness continues on its course. At any time the patient or their family may call Healthnetwork to discuss hospice options.

How does a family get started?

The patient’s physician typically activates the hospice admission process. However, if you want to explore hospice options, a phone call to Healthnetwork will start a dialogue with hospice specialists at the VNA of Ohio.

If a family chooses hospice care at home, a nurse will assess for eligibility, explain the hospice philosophy and answer all questions. The nurse will also describe the types of support and resources available. Together with the patient and the family, they will prepare a plan customized to the physical, spiritual and emotional needs unique to that family.

Who will be the physician once the patient enters hospice?

Most people who have a rapport with their primary physician or oncologist will continue under their care, focusing on comfort, for the rest of their lives. Many hospices have a medical director who can assist as well.

Does the patient have to sign a DNR (Do Not Resuscitate) form?

Most hospice programs make this request. CPR is not in keeping with the hospice philosophy of a comfortable death with dignity. Performing CPR on someone who has a frail and diseased body never buys quality time.

Will the patient go to the hospital for their care?

Hospice is dedicated to “comfort care.” It’s designed for patients who are not seeking active treatment of their illness. Lab tests, X-rays and procedures are not part of the hospice philosophy.

If they are able to go to their physician’s office, some patients will continue to see their physician for symptom management. However, many terminally ill patients desire to remain at home. Hospice staff will do everything they can to honor that wish. Usually symptoms that arise can be managed by the hospice team.

Can the patient receive intravenous fluids in hospice?

When the patient is not drinking, it may be because they do not have thirst. This is a normal part of the physiologic process of dying. When they are thirsty and unable to drink or receive fluids intravenously, a simple technique called hypodermoclysis may be employed.

If you find yourself contemplating hospice services and in-home nursing care for a loved one, please contact Healthnetwork and allow us to guide you and your loved ones on that path.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: [email protected]