Since the late 1970's, end-of-life care has been a growing area of interest for health care consumers, providers, researchers, and policy-makers. Attention has focused on the increasing demand for better care and the need to decrease associated health care costs.

Research suggests that during the final months in a person's life visits and distress calls to physicians' offices escalate, "revolving door" hospitalizations occur, and pharmaceutical and medical supply utilization increases proportionately. All of this translates into exorbitant health related expenditures. As a society we have great difficulty addressing the anxiety of this very delicate time, for it requires measuring success in care rather than cure. This is such a fragile balance for all of us as we diligently work to make quality of time substantial even in the absence of quantity of time.

Fortunately, there is hope in Hospice, a philosophy of care that offers a compassionate, cost-effective approach to caring for individuals with life-limiting illnesses and their family members. An interdisciplinary team of physicians, nurses, social workers, certified nursing aides, and specially trained volunteers work together to establish a plan of care that meets the patient's and family's needs. All too often caregivers are ignored during this process, yet they are the very individuals who are essential to a successful closure. Recognizing the importance of caregivers and family is integral to Hospice philosophy. Simultaneously, team members provide care that might include palliation of pain, management of symptoms, restoration of functional capacity while also facilitating the caregiving system to act in concert to meet the self-determined life goals of their family member. In all matters, Hospice serves as an extension of the physician office, and the physician is kept closely informed of impending changes.

Our success in meeting the patient and family expectations is contingent upon early access. If the referral comes in a timely fashion, when curative measures are no longer realistic and the medical goal changes to comfort, significant success is possible. By minimizing the distress, honoring the relationships, and anticipating difficulties well in advance, Hospice affirms life and enables individuals with life-limiting illnesses to live well until they say their hardest "good bye." Support continues for the caregiver(s) during the fragile time following the death. For as many as 13 months, comprehensive bereavement and family support is available.

While providing quality end-of-life care is often difficult and emotionally draining for everyone involved, it is also extremely important. By working together, the Hospice team, including the patient's physician, can meet the patient's and family's needs, instill respect and dignity to a truly difficult situation, and potentially reduce costs at the same time. There is hope in Hospice.

Catherine Cosgrove, MPA
Executive Director
Hospice of Charleston

September 2002