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TAKING THE FEAR OUT OF DEATH

It's a situation that happens all too often. Family members learn that a loved one's illness is terminal. Suddenly they must deal with both the news that their loved one is dying while being asked to make crucial decisions about their care.

Given a choice, almost everyone would opt for a good end of life -- and death surrounded by loved ones, at home or in a homelike setting, free of pain, with spiritual needs being met.

Hospice care is a solution that provides the elements for a "good death" and also offer a wide range of services to family members. The National Hospice Organization reports that last year 450,000 patients were cared for in almost 3,000 hospice programs. There are hospice programs in all 50 states and Puerto Rico.

Hospice programs are based on a philosophy that accepts death as a natural part of life and strives to help patients live as comfortably as possible during this time, without the fear of dying in pain, dying alone or losing control. Hospice care includes support for all family members and bereavement care after the patient dies.

There are three types of hospice care available: home-based hospice, in-patient residential facilities and, less prevalent, palliative care units. With a home-based hospice program, the patient can remain at home. Residential hospices are separate facilities that operate independently and are not part of the hospital. Patients live full time in residential hospices. Palliative care units are similar to residential hospices but are located inside the hospital.

Each program includes doctors, nurses, nurse's aides, social workers and clergy. One of the goals of hospital-based programs is to train staff in care for the dying, so they will have a greater understanding that death is a part of the life process. At the moment, there are fewer than a dozen hospital palliative care units nationwide. Most patients choose home-based care, in which family members receive extensive support from the hospice program while still being active care-givers.

Here's what you can expect from a hospice program:

Comfortable surroundings. Most in-patient residential hospices are designed to be as homelike as possible.

Relief of pain and discomfort. Management of physical symptoms, as well as an understanding that psychological and spiritual pain are as significant as physical pain, are cornerstones of hospice care.

Around-the-clock visiting hours.

Respect of a patient's wishes. One study reported in the Journal of the American Medical Association found that one of the most important aspects of hospice care is that it provides a way for patients to exercise their autonomy over end-of-life decisions. If a patient wants medical care, even high-tech therapies, it is available. But no one will force intrusive treatments on patients without their request. For many patients, this fact alone is the most important benefit of hospice care. Access to doctors for questions in safe, peaceful surroundings and care that permits the patient to maintain dignity.

Another benefit of hospice care is that it is less expensive than hospital care. The same study found that in-home and residential hospice care was 25 to 40 percent cheaper than hospital care. Most hospice programs accept Medicare and many private insurers provide coverage.

The National Hospice Organization is another source of information. Its toll-free hot line can be reached at (800) 658-8898.

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