Hospice, a concept that originated in the Middle Ages to set up places of rest for pilgrims and travelers, has since developed into a philosophy of medical care that focuses on physical and psychological support and comfort for people who are dying. Now a formally recognized plan of care, hospice maximizes support to the patient with terminal illness and the patient’s family and caregivers when death is anticipated within six months or so.

I realize most people prefer not to discuss the idea of death and dying and most of us avoid talking about the subject. But in reality, when someone with a terminal illness nears death, talking about it and sharing this most intimate experience with loved ones can produce closeness and warmth that lasts long after death occurs.

At the time a person experiences something as fearful as dying, the people closest to that person often draw away from talking about what’s really happening. This often leads to an emotional void. As ugly as dying is, the experience can provide intimate moments that become cherished memories for family and friends. If loved ones refuse to talk about death and dying, these opportunities can pass.

When is hospice appropriate? Anytime a healthcare provider sees a patient failing from an untreatable illness or an illness for which the patient chooses not to receive treatment, hospice might be appropriate. The most common example is someone diagnosed with cancer that has spread and will not likely be cured with treatment. However, many people die from other illnesses, such as a bad heart or bad lungs, and people suffering from these illnesses need support as well. Whenever a person nears the end of life, hospice should be considered as a care option.

On a formal level, hospice is driven by insurance and requires the dying person and caregivers to agree that they are ready to focus on comfort and ready to forgo aggressive medical treatment. Patients can receive hospice care at home or in nursing facilities. In some areas, free-standing hospice houses exist where dying patients can stay. Unfortunately, that option is not available in our area. Hospice care involves a number of different support people, including nurses, chaplains, social workers, and specialty physicians who provide input on care.

You may have heard that hospice limits treatment options. It’s true that hospice care focuses on the patient’s comfort and tends to limit aggressive treatments that are unlikely to cure. However, hospice will place patients in the hospital for control of symptoms if needed and provide aggressive medications and treatment to make the patient as comfortable as possible during the dying process. And, the decision can be made to go off of hospice care if circumstances change.

I recently was involved in the care of a patient who was diagnosed with cancer and chose hospice care. Her family stayed with her around the clock and helped her as she gave away items dear to her.

They shed tears together as prized possessions were given away or sold in the last month of her life. They also laughed and cried together as they saw the end approaching. After the patient died, the family members still cried and mourned. However, the closeness they found in the death experience will always remain a part of their memories. And, in a year, when funeral and death rituals have passed and life continues for those left behind, family members can remember fondly the final weeks of their loved one’s life and the peacefulness of her passing.

If you think hospice is right for you or someone you love, please contact your healthcare provider or any of the hospice providers in your area. Knowledge is important in making decisions about the last few weeks of someone’s life. Find out if hospice is the right decision for your family.



Debra Buckler, DO, is a Freeman Health System physician specializing in geriatric and nursing home medicine. Additionally, she serves as Medical Director for Joplin Health and Rehabilitation Center, Co-medical Director for National Health Care of Joplin, and Associate Medical Director for Hospice Compassus.