Hospice Care

I have a strange job. As a social worker for a hospice agency everyday I meet with men and women who will soon be dead. Occasionally, we have a patient that is discharged for extended prognosis but those are few and far between. The vast majority will be gone soon leaving behind grieving family, friends, and significant others.

I believe in hospice. It has been proven not only good for the patient (they live on an average of 29 days longer) but it is cost effective too. Over the past year I have spoken with probably a couple hundred people that are no longer on this earth and that realization has put me in a reflective mood.

Don’t get me wrong, like any job mine has downsides. I have finished my day many times saying to myself, “My job sucks.” But I get up the next day and go back to work because there is a possibility I might help someone that needs it and that makes the effort worth it. Plus my job is never dull.

Anyway, I wanted to share a few of my observations and maybe correct a few myths that might exist regarding hospice care.

• Most patients are at home and we provide intermittent care. Others live in nursing homes. Hospice is not necessarily a place although some pass away in our small, short-term hospital unit.

• Sadly were all going to die and some of us die at an earlier age than others. The youngest I have served was 20 years old (brain tumor) and the oldest turns 105 next week.

• In order to begin hospice care a patient’s physician must write an order giving the patient no more than 6 months to live. Naturally some live much longer while others are gone within days, even hours. Point is hospice is an option and helpful tool for those who want it, if someone wants to stay receiving aggressive treatment up to the day they day it is their right.
  

• God bless the only form of socialized medicine in this country. Medicare and Medicaid do a great job paying for hospice care and they realize some patients will not be dead within 6 months. However, private insurance frequently gives a patient 180 days and if they are not dead within that time their paying their own bills (I’m proud to say we have never discharged a patient because they were non-funded).

• Some idiot right-wing politicians started spreading rumors that if the new healthcare bill passes someone will come to their home and ask how they would like to die. Well, they were talking about Advanced Directives and Do Not Resuscitate Orders if they want one. If they want to call 911 they are more than welcome to do so but most patients are ready to face their maker when that day arrives and would prefer not having their chests crushed and tubes stuck into their bodies.

• The most attentive families in my experience and the last ones to put their loved ones in nursing homes are first place Asians, then Hispanics, followed by African-Americans, and in last place are Caucasians.

• Right now our daily average is about 70 patients. About 17% have a tobacco related illness, 10% are diet related, the biggest group is dementia patients at 34%, 3% have an alcohol related diagnosis, and 27% have some form of cancer. Among patients under sixty years old most have a tobacco or diet related illness.

Fun stuff! In many ways it is a rewarding job but I have come across a lot of dysfunction too. I don’t think I’ve been brought to tears but I do get choked up on a regular basis. I have had the privilege of meeting people of every faith imaginable, all sexual preferences, the mentally challenged, mentally ill, and the very well educated and some who can barely read. Point is were all going to die, only my patients have been warned that their days are numbered. I can’t wait to see what tomorrow brings!