The Role of Hospice Philosophy of Care in Nonhospice Settings

Abstract

Many advances in public health and medical technology have contributed to the improved wellbeing and overall longevity of Americans. Such benefits, however, have been offset by a change in the nature and prolongation of the dying process. Daniel Callahan offers a challenge to caregivers in his observation of violent death by technological attenuation, and he sets an agenda to identify a more appropriate approach to the needs of the dying.Over the past quarter century, hospice has increasingly been used as a resource for care at the end of life. However, according to 1995 estimates by the National Hospice Organization (NHO), hospice care presently accounts for only about 15 percent of the care of terminally ill patients in the United States. We will review issues of access and use of hospice services and examine the various institutional, professional, societal, and cultural barriers to hospice principles of care, and consider various options to promote optimal care at the end of life.

Advance Directives Preferences of Functionally and Cognitively Impaired Nursing Home Residents in the United States

“…Many health care providers are advocating a palliative care approach for nursing home residents who have cognitive and functional impairments and little or no rehabilitation potential (Conant & Lowney, 1996). The World Health Organization (1990) describes palliative care as the active total care of patients to achieve the best possible quality of life for patient and their families, affirming that dying is a normal part of life and offering a support system to help the patient live as well as possible until death.…”