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Hospice Care

When a "cared-for," a patient, client is diagnosed as terminally ill and the prognosis is that the cared-for is expected to die within 6 months or less..."hospice" care—referred to as just "hospice" as shorthand—is an option for patients and their families.
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Hospice is a multi-part end-of-life care program that assigns a number of professionals, each having a specialty,
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Hospice provides, ideally, limited home care, a visiting nurse, a social worker and a doctor on call 24 hours a day. It also should provide medical supplies, medical equipment, and medication free of charge to the terminal patient.
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Hospice care can be put in place in the patient's own home, or in a nursing home setting that has a Hospice unit. Basically the patient is made comfortable and pain free, but no attempt is made to cure an illness any longer. The patient and family are counseled in end of life issues and coming to terms with the emotional aspects of death and dying.
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If a patient improves or is not considered terminal within 6 months they are removed from Hospice programs. Every three months the patient is evaluated to see if they are losing weight or gaining weight. This is a bench mark for many patients who are on Hospice care. If the patient is losing weight they remain on the program. If the patient improves, gains weight and is not considered terminal they may be removed from Hospice care. This is encouraging for family members to know that Hospice doesn't always mean the certain death of a loved one.
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I have observed during my many years in practice that Hospice care is handled differently in a patient's home as opposed to a medical institutional setting such as a hospital or nursing home setting.
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My mother in law passed away 2 years ago and she had Hospice the last 3 months of her life. It was really a great help to family members and she was almost pain free up to the last days of her life. She had prescription pain pills that she took as needed for pain.
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Hospice in a medical setting is quite different. the pain medication that I have witnessed almost exclusively is Morphine via Intravenous Drip. Morphine is effective for pain relief, but highly addictive. So the medication is increased as the patient needs it. The problem is that many patients have a decreased respiration as the Morphine is increased. Ultimately they just stop breathing entirely. I call this death by Morphine, and I personally consider this to be a legalized version of Euthanasia. I am not saying it is wrong, as such patients are considered "terminal" anyway and at least their last days are pain free. However for patients who want to live longer and aren't really aware of how Morphine medication is administered in terminal patients and ultimately causes death, I think other medication should always be offered first. I feel patients should be given the choice of other less toxic pain medication when they are in Hospice programs in nursing homes and hospitals.
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