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Honolulu Star-Bulletin, Nov. 25, 2009, Hospices Promote Quality of Life 

Hospices Promote Quality of Life

Most of us have been asked the hypothetical question, "What would you do if you knew you only had six months to live?"

Our answers run the gamut: Travel the world, quit our jobs to spend more time with family, volunteer for an organization that we believe in, book the next flight to Las Vegas. The list is limited only by our imagination and values.

For people who have been diagnosed with a life-limiting illness, the response may be no different. At St. Francis Hospice, a program of St. Francis Healthcare System, the goal is to help people live life to the fullest and realize their dreams.

November is National Hospice/Palliative Care Month and is an opportunity to help people understand hospice and palliative care -- both of which focus on improving life for those with serious illness.

St. Francis was the first to introduce hospice care to Hawaii in 1978 and recently launched St. Francis Palliative Care to help fill a vital need for the people of Hawaii.

To participate in hospice, a physician must decide that a person has a life expectancy of six months or less. Because of this restriction, clinicians recognized that many people with serious illness were not getting expert pain and symptom management because they did not qualify for hospice.

Palliative care was created so that patients living with serious illness could receive expert symptom management long before they might qualify for hospice. Some patients who need palliative care may end up being cured of their disease and never qualify for hospice -- or at least not for years or decades. Anyone can receive palliative care at any point regardless of prognosis. Palliative care, like hospice, focuses on relief of suffering for patients and families alike.

Hospice focuses on care for the individual and family, rather than on disease and intensive medical therapies. Emphasis is placed on quality of life for as long as possible. The goal of hospice is to help individuals live life as fully as possible, to offer dignity when there is no cure, and to surround families with support during one of life's most challenging times.

It is estimated that 50 percent to 75 percent of terminally ill people in Hawaii are eligible for hospice care, but only 20 percent are ever admitted to a program. What keeps people from entering into a hospice program? Some mistakenly equate hospice with a death sentence, a place to die, the last resort when there is no hope. Yet, hospice is not a place; it is about living life, providing comprehensive comfort to terminally ill patients by relieving suffering, often right in their own home. Patients who choose hospice care have decided that they do not want to spend their time and energy traveling to receive medical care. Hospice brings that care to them.

Many patients don't know when they qualify and what hospice care can provide. The average length of stay for St. Francis Hospice patients is 43 days but, unfortunately, many patients are referred in their last days or week of life and die before they and their family experience all of the benefits of hospice.

Hospice helps family members come to terms with impending death. It helps them care for their loved one with support from a multidisciplinary team of professionals that includes physicians, nurses, social workers, therapists, chaplains, home health aides, and trained hospice volunteers, all of whom make home visits.

Hospice is also the only way, in the United States, that families can receive bereavement services for up to a year after losing a loved one. This support can mean the difference between accepting and moving on or living with unresolved grief.

Medicare, Medicaid and most insurance recognize the benefits of hospice and will pay for this service at no cost to the patient.

As baby boomers age, they will likely demand the best end-of-life care possible so the need for hospice and palliative care will only increase in the years ahead.

Joy Yadao is executive director of St. Francis Hospice, Hawaii's first and largest hospice program, nationally accredited by The Joint Commission.