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CARE
Hospice care provides medical care and support
services to a patient with a terminal illness where
the focus is on quality of life rather than life
prolongation or cure. The hospice philosophy
embraces the general principle of a comfortable death
with dignity: the care and treatment provided are based
on the patient and familys goals and values. The hospice
model is one of interdisciplinary team care that provides
comprehensive care by addressing the physical,
psychological, social, and spiritual aspects of suffering.
HOSPICE SETTINGS
Hospice care can be provided in
1.Hospital
2.nursing homes,
3. freestanding hospice inpatient facilities.
4.patients own home
HOSPICE AS A PALLIATIVE CARE
Palliative care focuses on preventing and relieving
suffering and on supporting the best possible
quality of life for patients and their families facing
serious illness. Within an integrated model of medical
SERVICES PROVIDED
While symptom control is one of the most important
services provided by hospice, other services include
nursing care and support at home, psychosocial and
spiritual care, respite care, and bereavement care.
In the US, home hospice care for patients over 65
years of age or for those who have been disabled
for longer than two years is covered through
Medicare. Medicaid and most private insurers also
cover hospice care. Eligibility for hospice under the
Medicare program requires the
Medicare-approved hospice
1.The patient must sign a statement choosing
hospice care instead of regular Medicare.
The patient's personal physician and the hospice medical
director both must certify that the patient has a terminal
CV illness and is likely to live for fewer than six
DISCUSSING PROGNOSIS
When to discuss prognosis Ideally, prognosis
discussions should take place when the patient is not ill
and is therefore better able to process and understand
information, and is not overwhelmed by anxiety due to an
acute medical event. Unfortunately, these discussions too
often are initiated after acute deteriorations or
progression of disease Patients may be overwhelmed with
anxiety and there is evidence to suggest that patients
tend to opt for highly aggressive therapies when
they are anxious or experiencing strong emotions].
A study of 1231 patients with stage IV lung or colorectal
cancer found that patients who have end-of-life
discussions with their physician prior to the last
month of life were less likely to receive highly
aggressive care, such as hospitalizations and
chemotherapy .
SUMMARY
HEART FAILURE
Palliative care should be provided throughout the course
of HF care, based upon patient and family needs,
rather than upon an estimate of prognosis.