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1. Hospice and End of Life
care
MODERATOR :-
DR. B. SANDILYA,
ASST. PROF.,
DEPARTMENT OF SURGERY
PRESENTOR:-
DR. M. GOWRI SHANKAR,
3RD YEAR PGT ,
DEPARTMENT OF SURGERY

2. Objectives.,
• Introduction
• History
• Myths and Realities
• Hospice - Interdisciplinary care
• Levels of care in Hospice
• D/B Hospice and Palliative care
• Some important symptomatic
management dealt in hospice

3. Dame Cicely Saunders
1918-2005
Founder of the
modern hospice and palliative
care
movement
David Tasma
1911-1948
Inspirer of the
modern hospice and palliative
care
movement

4. Dame Cicely Saunders
1918-2005
Founder of the
modern hospice and palliative
care
movement

5. The Hospice “will try to fill the gap that exists in both research and
teaching concerning the care of patients dying of cancer and those
needing skilled relief in other long-term illnesses and their relatives.”
*Saunders, 1967*

6. OVERVIEW ON HOSPICE
What is Hospice?
 From the word “ Hospes”
Originally, referred to shelter or way station for weary travelers.
Today, means a concept of care that provides comfort and quality
of life to clients (patients) and their significant others who are
facing life’s final journey associated with terminal illness.

7. OVERVIEW ON HOSPICE
What is Hospice?
A type of care/ a philosophy of care, which focuses on palliation of
terminally ill patient’s symptoms.
 Physical
 Emotional
 Spiritual
 Social

8. The primary goals of hospice care are to:
1. Provide comfort,
2. Relieve physical, emotional, and spiritual suffering,
3. Promote the dignity of terminally ill persons.
Care is provided by an interdisciplinary team.
 Hospice care neither prolongs nor hastens the
dying process.

10. Dame Cicely Saunders
1918-2005
Founder of the
modern hospice and palliative
care
movement

11. Hospice-IsItaPlace?
Hospice care is a philosophy or approach to care rather than a place.
Care may be provided in a person’s home, nursing home, hospital, or
independent facility devoted to end-of-life care.

12. Hospice is…,
• (Not necessarily) a place
• A philosophy of care
• A structure for care

13. HISTORY OF HOSPICE
CARE

14. • 11th century, around 1065= the 1st hospice care are believed to have originated when the
first incurably ill were permitted into places dedicated to treatment by Crusaders.
• 14th century – Knights Hospitaller of St.John of Jerusalem church opened the 1st hospice
in Rhodes.
• 17th century - Hospices were revived in France by the Daughters of Charity of Saint
Vincent de Paul.
HISTORY OF HOSPICE CARE

15. Knights Hospitaller

16. The Knights Hospitaller Hospice
Central Area in Rhodes

17. • 19th Century - established also in UK where attention was drawn to the needs of the
terminally ill.
• 1902-1905- hospice care spread to other nations.( Australia, North America, Japan,
China, Russia)
HISTORY OF HOSPICE CARE

18. • Cecily Saunders introduced the idea of specialized care for the dying to
the United States during a 1963 visit with Yale university. Her lecture,
given to medical students, nurses, social workers, and chaplains about
the concept of holistic hospice care, included photos of terminally ill
cancer patients and their families, showing the dramatic differences
before and after the symptom control care.
The Modern Hospice Movement

19. • In the 1950s, as medical technology developed, most people died in hospitals.
The medical profession increasingly saw death as a failure.
• Physical pain associated with terminal illness was not a target of treatment.
• Dame Cicely Saunders, MD, founded St. Christopher’s Hospice in London in the
1967, in an effort to discover practical solutions to alleviating human suffering.
• She introduced hospice in the U.S. in a lecture at Yale in 1963. This contact set off a
chain of events which resulted in the development of hospice care as we know it today.
The Modern Hospice Movement

20. A Swiss psychiatrist, Kübler-Ross first introduced her five
stage grief model in her book On Death and Dying.

21. • 1972: Kubler - Ross testifies at the first national hearings on the subject of death
with dignity, which are conducted by the U.S. Senate Special Committee on Aging.
In her testimony, Kubler - Ross states,
“We live in a very particular death-denying society. We isolate both the dying
and the old, and it serves a purpose. They are reminders of our own
mortality. We should not institutionalize people. We can give families more
help with home care and visiting nurses, giving the families and the patients
the spiritual,emotional, and financial help in order to facilitate the final care
at home.”
HISTORY OF HOSPICE CARE

22. HISTORY OF HOSPICE CARE
• 1996: Major grant-makers pour money into funding for research, program initiatives,
public forums, and conferences to transform the culture of dying and improve care at
the end of life.

23. Myths and realities ofHospice
• A place.
• Only for people with cancer.
• Only for old people.
• Only for dying people.
• Can help only when family
members are able to provide care.
• About 80% of hospice care takes place in the
home.
• Hospices are increasingly serving people with
the end-stages of chronic diseases.
• Hospices serve people of all ages.
• Hospice focuses as much on the grieving
family as on the dying patients.
• Alternative locations or
resources may be
available.

24. Myths ofHospice
• For people who don’t need a high level of care.
• Only for people who can accept death.
• Expensive.
• Not covered by managed care.
• For when there is no hope.

25. • Hospice is serious medicine, offering state-of-the-art palliative care.
• Hospices gently help people find their way at their own speed.
• Hospice can be far less expensive than other end-of- life care. Most
people who use hospice are over 65 and entitled to the Medicare
Hospice(in US) Benefit, which covers virtually all hospice services.
*Medicare – Ayushman Bharath of America*
realities of Hospice

26. Principles Underlying Hospice (SAUNDERS - founder of
St.Christopher’s Hospice in London,1967)
1.Death must be accepted.
2.The patient’s total care is best managed by an interdisciplinary team whose
members communicate regularly with each other.
3.Pain and other symptoms of terminal illness must be managed.
4.The patient and the family should be viewed as a single unit of care.
5. Home care of the dying is necessary.
6. Bereavement care must be provided to family members.
7. Research and education should be ongoing.

27. What Services Does Hospice Offer?
For the Patient….
1.Providing care to the patient.
2.Medical care to relieve pain and other symptoms arising from a
life-limiting illness.
3.Basic needs of daily living.
4.Counseling.
5.Assisting the patient with unfinished legal or financial business
and in making funeral arrangements.
6.Religious care.

28. What Services Does Hospice Offer?
For Caregivers/Family Members…
1.Counseling services..
2.Respite care.
3. Health Education.
4.Practical assistance.
5.Assistance with cremation/burial arrangements and with
funeral/memorial services.
6.Bereavement care.

29. Members of the interdisciplinary Hospice Team
1. Primary Physician
2. Hospice physician
3. Nurse
4. Home health aide
5. Social worker
6. chaplain

30. Members of the Hospice Team
1. Primary Physician
Provides the hospice team with medical history.
Oversees medical care through regular communication with the
hospice team.
Provides orders for medications and tests, signs death
certificate, etc.
Determines his or her level of involvement on a case-by-case
basis with the hospice medical director.

31. 2. Hospice Physician
Provides expertise in pain and symptom control at the end of life.
Works closely with the hospice team and primary physician
to determine appropriate medical interventions.
Makes home visits on as needed basis.
May oversee the plan of care, write orders, and consult with patient and
family regarding disease progression and appropriate medical
interventions on a case-by-case basis.

32. 3. Nurse
Visits patient and family in the home or nursing home on regular basis.
May provide on-call services.
Assesses pain, symptoms, nutritional status, bowel functions, safety,
and psychosocial - spiritual concerns.
Educates patient and family.
Educates and supervises nursing assistants.
Provides emotional and spiritual support to patient and family.

33. 4. Home Health Aide
Assists patient with activities of daily living.
Provides a variety of other services depending on assessment of
need.

34. 5. Social Worker
Attends to both practical needs and counseling needs of patient and family.
Arranges for durable medical equipment, discharge planning,
funeral/burial arrangements
Serves as liaison with community agencies.
Assist family in finding services to address financial needs and legal
matters.
Provides counseling.
Assesses patient and family anxiety, depression, role changes, caregiver stress.
Provides general grief counseling.

35. 6.Chaplain
Provides patient and family with spiritual counseling.
Assists patient and family in sustaining their religious
practice and in drawing upon religious/spiritual beliefs.
Ensures that patient and family religious or spiritual beliefs
and practices are respected by the hospice team.
serves as a liaison with the patient/family faith, community.
 May conduct funeral and memorial services.
Provides hospice staff with spiritual care and counseling.

36. 7. Volunteer
 Provides respite care to family members
May assist with light housekeeping or grocery shopping.
Helps patients stay connected with community groups and activities.
 Facilitates special projects.
provide community education and outreach.
 May assist with office work.

37. Volunteers - ABSTRACT – Timelink US
In 2019, the U.S. Census Bureau reported that by 2035 there will be 78 million people 65 years
and older compared to 76.4 million under the age of 18, marking an important demographic
turning point. In Long Beach, a city in Los Angeles county, 11.7% of its population is
65 years and older, and adding to this, by 2025 22% of Long Beach’s senior
citizens will be living below the poverty line. TimeLinks US aims to help and support these
people in a holistic way by providing services that go beyond clinical care. Specifically, we aim
to provide in-home support to seniors with daily chores, picking up medicines, buying groceries,
or just keeping companionship in the face of growing prevalence of Alzheimer's and dementia.
Our mission is to promote giving and receiving through time banking credits that will help
support families, neighborhoods, and the community by empowering seniors. Time credits/dollars
is something that TimeLinks US will use to exchange services with other
members, save it for future needs, or they can also be donated to other members
who cannot earn their own Time credits. We believe that no one should have to feel helpless and
alone in this crowded world by building strength, support, trust and creating networks in the
community. This proposal will give a detailed overview on how we shall achieve these

39. How hospice works??
Hospice care can be provided onsite at some hospitals, nursing homes, and
other health care facilities, although in most cases hospice is provided in the
patient’s own home. With the support of hospice staff, family and loved ones are
able to focus more fully on enjoying the time remaining with the patient.
When hospice care is provided at home, a family member acts as the primary
caregiver, supervised by the patient’s doctor and hospice medical staff.

40. The hospice team makes regular visits to assess your loved one and provide
additional care and services, such as speech and physical therapy or to help with
bathing and other personal care needs.
As well as having staff on-call 24 hours a day, seven days a week, a hospice
team provides emotional and spiritual support according to the wishes and beliefs
of the patient. They also offer emotional support to the patient’s family,
caregivers, and loved ones, including grief counseling.
How hospice works??

41. LEVELS OF CARE
ROUTINE HOME CARE-
- most common level of care provided.
- interdisciplinary team members supply a variety of services during routine
home care, including offering necessary supplies. ( diapers, bed pads, gloves,
& skin protectants)

42. CONTINUOUS CARE
- Is a service provided in the patient’s home.
- Intended for pts. who are experiencing severe symptoms & need
temporary extra support.
- Provides services in the home a minimum of 8 hours a
day.

43. -Is an intensive level of care which may be provided in a nursing
home.
-intended for pts. who are experiencing severe symptoms which require
daily interventions from the hospice team to manage.
-Often, patients on this level of care have begun the “ active phase” of dying.
GENERAL INPATIENT CARE

44. addnl - RESPITE CARE - ( referred as respite inpatient)
- Is a brief & periodic level of care a patient may receive.
- A unique benefit in that the care is provided for the needs of the family,
not the patient.
- Is provided for a maximum of 5 days every benefit period.

45. hospice and home health nurse and
palliative care

46. Is Hospice the Same as Home Health Nursing?
Two primary differences between hospice care and home health nursing:
1. Any patient with a skilled medical care need is qualified to receive home
health nursing care. Hospice care, on the other hand, is limited to persons with a
terminal illness, with a life expectancy of six months or less, and with a focus
on palliation not cure.
2. Patients in home health care receive visits primarily from a nurse while
patients in hospice care receive the services of an entire interdisciplinary team
whose area of expertise is end-of-life care.

47. Palliative vs.Hospice
• Both focus on improved qualify of life
• Both are delivered by specialists
• Both have been shown to improve survival
• Both tend to be delivered by a team of individuals with knowledge of
complex symptom management
• Both work with the patient’s other clinicians to provide an additional layer of
patient care

48. Palliative vs.Hospice
• Hospice is a medical insurance benefit, with its own set of regulations
• Hospice care is typically provided in the home, whereas palliative tends to be
hospital or clinic based
• Hospice specifically cares for patients with terminal conditions where survival is
typically <6 months
• Palliative medicine is delivered irrespective of prognosis
• Both are provided regardless of diagnosis

50. Palliative vs.Hospice

51. Palliative
vs.
Hospice

54. Five Most CommonSymptoms
Pain
Nausea/vomiting
Breathlessness
Weight loss
Weakness / fatigue

59. • Shanti Avedna Sadan in Mumbai, a hospice, in 1986 . Over
the next five years, it established two more branches, one in
Delhi and one in Goa;
• Guwahati Pain and Palliative Care Society in Assam
• the Jivodaya Hospice in Chennai,
• Cansupport in Delhi
• Lakshmi Palliative Care Trust in Chennai
• Karunasraya Hospice in Bangalore
Some Hospice centres in INDIA

60. Thank you
“as the body
becomes weaker,
so the spirit
becomes stronger”