General Purpose of the Department:

As we have learned, the hospice idea is not new. Literally meaning "given to
hospitality," hospices provided comfort, kindness, and nourishment to people in
need hundreds of years ago. Today, hospices offer comfort to people as they
near the end of life\'s journey.

Hospice is a special way of caring for people with terminal illnesses and their
families. It is a multidisciplinary health care program that is responsible
for palliative and supportive care with consideration of the patient\'s and
families wishes. Hospice focuses on care, not cure.

Hospice care is important because it provides many benefits that aren\'t possible
in a traditional acute or long-term health care setting. Within hospice, the
family of the patient is directly involved in making decisions and helping their
loved one. Hospice also gives the patient to have a great amount of control by
deciding where they want to spend the rest of their lives. It can also help
make choices about advanced directives which we will discuss shortly.

Major Functions of the Department:

Hospice is a very unique department because it truly looks at the "big picture"
and treats a spectrum of patient needs equally. Special attention is given to:

Physical needs - this is the first and foremost function. Within hospice you
are dealing with a patient that has been given a diagnosis of having 6 months or
less to live. For many patients, relieving pain through medication is an
important part of hospice care. I have provided you with a list of ways that
patients are made more comfortable. A goal of hospice it to help patients use
their physical abilities as fully as possible.

Social Needs - Sometimes little things make all the difference to people.
Although these patients may not be as active as before their illness, you can
see on your handout a list of things that they probably still enjoy. Hospice
can help to make these things happen, as well as provide assistance with
practical issues like putting finances in order.

Emotional Needs: Hospice can help patients cope with loneliness, isolation, and
the fear of being abandoned. This is outlined on your handout as to how the
hospice staff accomplishes this. Hospice also helps friends and families of the
patient express their emotions through group and bereavement counseling.

Spiritual Needs - the realization that a person\'s spirituality is of a daily
concern to the patient has led hospice care to this area. Hospice tries to
organize the types of care outlined on your handout. Members of the clergy can
also help family and friends who are in need of spiritual support.

As you can now see, there are many areas of patient care that hospice has a
direct focus on. This now brings me to the subject of the people involved: the
staff. Staffing of the Department:

As with all departments, the actual number of staff will vary by facility.
However, there are required members of the staff that must have certain
qualifications. For instance, there must be nurses to do in-home care. These
nurses can be either RN\'s or LPN\'s depending on the level of patient care
involved. In addition is a staff physician who consults with the patient\'s
primary care physician and helps to oversee the patient care plan. In addition,
there are is a staff psychiatrist and a psychologist who do individual and
family counseling, volunteer visits, holiday programs, support groups, and
learning about loss and grief. Some hospices help with funeral arrangements.
Also part of the hospice team are the hospice coordinator or director, other
consulting physicians and specialists, a member of the clergy, a social worker,
a dietitian, a pharmacist, therapists who perform physical and occupational
therapy. Also there are home care aides and volunteers. Hospice members offer
care for patients on-call 24-hours a day.

Depending on the patient\'s needs at the time, hospice care is provided in a
variety of settings including the patient\'s home, inpatient facilities including
a nursing home, or a combination of venues.

Special Requirements:

Staff needs to be oriented in the special situations that arise in dealing with
a patient in their own home. Respect for the patient and their surroundings is
of utmost importance. Being empathetic to even the smallest of concerns is the
mark of a well-trained care-giver. There must be an emphasis on maintaining a
quality of life that the patient as well as the family feel comfortable with.

Since the patient is treated by such a wide variety of workers, there are weekly
case management meetings which are mandated by Medicare, but often also
influenced by hospital policy to ensure quality of care. It is