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Hospice Care Place Of Death

1688 words - 7 pages

Hospice Care
When a loved one dies, the place of death may have important implications for families’ experience of death and subsequent bereavement, although it may not be the sole factor impacting this experience. (Siden, 2008) Home hospice helps the entire family and family members are encouraged to take an active role in providing supportive care to the patient. In doing so, the family experiences fewer feelings of helplessness and the patient is not relying solely on strangers for all of his/her care. The goal of hospice care is to achieve the best quality of life not only for patients, but also for their families. Enabling death at home, if this is the patient's choice, is often seen ...view middle of the document...

It is not uncommon, however, for patient and family preferences for the location of death to change over time, especially as patients become more ill and family members more tired. Regardless of where palliative care is provided, it has also been noted that "It matters less where we die than how we die" (Fainsinger, 2000).
Hospices were founded to alleviate suffering at the end of life. Quality improvement in hospices should, therefore, target patients’ subjective assessments of their care and its outcomes. Terminally ill patients often have unmet physical, psychological, social and existential needs. Practitioners of palliative care attempt to rectify this problem through a multifaceted approach to relieve suffering. Therefore, because the primary goal of palliative care is to relieve patients’ suffering, its success should be judged by patients’ subjective assessments of the processes and outcomes of care (e.g. physical symptoms, psychological distress, and quality of life) (Tierney, 1998).
Assisted living is the fastest growing type of housing for older adults in the United States. Although originally designed and staffed to care for people with stable and predictable conditions, ALFs are experiencing growth and change as residents are increasingly older, more functionally impaired, and requiring more care than that described in earlier research (Ball et al., 2004). Residents hope to die in their ALF home, and their families support this desire Residents' desires to die "at home" have contributed to the dramatic increase in the proportion of people dying in ALFs in the past 10 years. Increasingly, dying residents are referred to hospice in order to facilitate a high-quality dying experience. In a study of 366 ALFs, the National Center for Assisted Living (1998) found that 65% of ALFs allowed hospice services, and other studies report that ALF administrators support hospice involvement when a resident is terminally ill (Dixon, Fortner, & Travis, 2002; Zimmerman, Sloane, Hansen, Mitchell, & Shy, 2003).
ALF residents who’s dying went well, participants described people with complex dying trajectories (e.g., cardiac disease and end-stage dementia) and a range of comorbidities, functional abilities, care needs, and levels of family involvement. These factors, however, were not necessarily associated with a positive care experience or whether the dying person could stay in the ALF until death. The ALFs provided much complex care such as assistance with all activities of daily living, increased monitoring of symptoms, rapid and frequent changes in medications, skin care, mouth care, and emotional support. Two factors, the length of time the resident had lived in the ALF and whether they were well liked by the staff, were consistently associated with whether the ALF would support the resident's staying in the ALF as levels of care need increased. The more ALF staff knew the resident and liked them, the more likely they were to bend rules or go...

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