As a professional who counsels terminally ill patients on end-of-life issues, I often come across people who ask if I am against Hospice policies and procedures. I can’t help but reply, “No.” It’s not a question of either/or. The fact is that any and all decisions made in determining the best possible care for a loved one are made when a patient is at the very end of their life. In many ways, those making those decisions are experiencing the same feelings and emotions that the terminally ill patient is feeling: desperation, hopelessness, fear, anxiety, and loss of control.
When the end-of-life choices are made by families and friends with the best of intentions, it is important to set the tone for caring for a dying person that is both comforting and effective. I believe the first step in making that happen is through hospice policies and procedures manuals. That’s not to say that families shouldn’t discuss end-of-life decisions or options with their physician and religious leaders. They should, however, utilize all the information they are provided with in creating a document that is comprehensive and clearly states their beliefs and expectations, as well as those of the patient and his or her family.
The goal of Hospice is to offer compassionate care for those who are terminally ill, with symptoms that may not be curable. The policies and procedures of Hospice are designed to give the highest quality medical care in a setting that provides minimal intrusion by doctors and nurses into the patient’s final days and nights. Often, families are worried about what will happen to them when their loved one dies because of the policies and procedures. They want to know that the Hospice program is a thing of the past.
In reality, all patients who are terminally ill and have no chance of recovering have a unique set of circumstances that must be considered and discussed with their physicians and their health care team before any course of treatment is recommended. Hospice is designed to alleviate those problems and to leave behind as much of a comfortable feeling as possible. Many people simply want the comfort of being at home with friends and family, resting and getting well while they still have some resources left. While this is a very important aspect of patient care, it is not the entire focus of the policies and procedures documentation. It’s a way to set expectations, to provide information and to dispel fears that people might have regarding what will happen when they’re no longer on this earth.
The most basic policy and procedure documentation about hospice is an overview of the organization and how it works. It lists the duties and responsibilities of the organization, which direct the actions and resources that are available to care staff and family members when a patient is admitted or begins to receive hospice care. While it might seem quite complicated, it is the gist of all of the policies and procedures. Once a family member or friend is diagnosed with cancer or other terminal illness, he or she will likely be put in the position of deciding whether or not hospice is the right option for them and if they would like to pursue it further.
As the policy and procedures go on, more detailed information about the services offered and how they work becomes available. The more a person knows, the better decisions they can make. One thing that has been noted is that many families do not believe hospice has a negative effect on their lives, so they continue to seek treatments and medications in spite of the fact that their doctor and nurses have told them that it’s a futile and unnecessary pursuit. The truth is, there are things that can be done to help and support a terminally ill patient, but not all of them can be realized until the patient has received hospice care. While the family and friends of a terminally sick loved one should do all they can to provide the best support possible, nothing can diminish the pain of losing a beloved one. Hospice is a relief, not a cure.