What is Hospice?
Hospice is a philosophy of caring for those living with a life-limiting illness.
The hospice philosophy holds that end-of-life care should emphasize quality of life. The goal is to treat the whole person, and not just the disease. The hospice philosophy focuses on patient/family-centered care that addresses the physical, spiritual, emotional, and practical needs of the patient. An interdisciplinary team of health care professionals works with the patient and family to design and implement a plan of care unique to the patient’s diagnosis. In addition, hospice provides all medications, services, and equipment related to the terminal illness. Hospice care does not end with the patient’s death; it continues with up to 13 months of bereavement support for the family and loved ones.
Can you tell me about the history of Hospice?
The term hospice comes from the same root as the word hospitality. Its origins began when medieval monks would care for ill persons traveling across Europe. Physician Dame Cicely Saunders founded the first modern hospice in London in 1967. She introduced the concept of palliation to an audience of physicians at Yale during a lecture in the 1970’s. What was particularly compelling were the photographs of cancer patients showing marked differences before and after their pain was controlled by a hospice team.
Where are the patients cared for?
Hospice cares for people where they live. Although some hospice care is provided in hospitals, in-patient hospice facilities or nursing homes, the vast majority of patients are cared for in the place they call home.
Does Medicare pay for Hospice?
Hospice is a Medicare benefit.
Congress’s Medicare Hospice Benefit of 1983 was established to ensure that all Medicare beneficiaries could access high-quality end-of-life care. Hospice became an optional Medicaid benefit as a part of the consolidated omnibus Budget Reconciliation Act of 1985 (COBRA ’85). Americans are now promised the opportunity to live the end of their lives free of pain and with emotional and spiritual support. More than 80% of hospice patients are Medicare beneficiaries.
Is Hospice only for cancer patients?
Hospice care is not limited to cancer patients.
Hospices now care for over half of all Americans who die from cancer and a growing number of patients with other chronic, life-threatening illnesses, such as end-stage heart or lung disease, kidney and renal failure and ALS.
What are Advance Directives?
A living will allows you to document your wishes concerning medical treatments at the end of life.
Before your living will can guide medical decision-making two physicians must certify:
- You are unable to make medical decisions,
- You are in the medical condition specified in the state's living will law (such as "terminal illness" or "permanent unconsciousness"),
- Other requirements also may apply, depending upon the state.
A medical power of attorney (or healthcare proxy) allows you to appoint a person you trust as your healthcare agent (or surrogate decision maker), who is authorized to make medical decisions on your behalf.
Before a medical power of attorney goes into effect a person’s physician must conclude that they are unable to make their own medical decisions. In addition:
- If a person regains the ability to make decisions, the agent cannot continue to act on the person's behalf.
- Many states have additional requirements that apply only to decisions about life-sustaining medical treatments.
- For example, before your agent can refuse a life-sustaining treatment on your behalf, a second physician may have to confirm your doctor's assessment that you are incapable of making treatment decisions.
What Else Do I Need to Know?
Advance directives are legally valid throughout the United States. While you do not need a lawyer to fill out an advance directive, your advance directive becomes legally valid as soon as you sign them in front of the required witnesses. The laws governing advance directives vary from state to state, so it is important to complete and sign advance directives that comply with your state's law. Also, advance directives can have different titles in different states.
Emergency medical technicians cannot honor living wills or medical powers of attorney. Once emergency personnel have been called, they must do what is necessary to stabilize a person for transfer to a hospital, both from accident sites and from a home or other facility. After a physician fully evaluates the person's condition and determines the underlying conditions, advance directives can be implemented.
One state’s advance directive does not always work in another state. Some states do honor advance directives from another state; others will honor out-of-state advance directives as long as they are similar to the state's own law; and some states do not have an answer to this question. The best solution is if you spend a significant amount of time in more than one state, you should complete the advance directives for all the states you spend a significant amount of time in.
Advance directives do not expire. An advance directive remains in effect until you change it. If you complete a new advance directive, it invalidates the previous one.
You should review your advance directives periodically to ensure that they still reflect your wishes. If you want to change anything in an advance directive once you have completed it, you should complete a whole new document.
Oklahoma Advance Directive
What is a DNR?
In medicine, a "do not resuscitate" (DNR) or sometimes called a "No Code", is a legal order written either in the hospital or on a legal form to respect the wishes of a patient to not undergo CPR or advanced cardiac life support (ACLS) if their heart were to stop or they were to stop breathing. The DNR request is usually made by the patient or health care power of attorney and allows the medical teams taking care of them to respect their wishes.
In 1991, Congress passed into law the Patient Self-Determination Act that mandated hospitals honor an individual's decision in their healthcare. Forty-nine states currently permit the next of kin to make medical decisions of incapacitated relatives, the exception being Missouri. Missouri has a Living Will Statute that requires two witnesses to any signed advanced directive that results in a DNR/DNI code status in the hospital.
In the U.S., CPR and advanced cardiac life support (ACLS) will not be performed if a valid written DNR order is present. Many U.S. states do not recognize living wills or health care proxies in the pre-hospital setting. Pre-hospital personnel in those areas may be required to initiate resuscitation measures unless a specific state sponsored form is appropriately filled out and cosigned by a physician.
State laws vary, but typically emergency medical services personnel who are presented with a valid DNR form signed by your doctor, or who identify a standard DNR bracelet on you, must comply with the DNR order.
Oklahoma DNR Consent Form