What Is Community Hospice?

Hospice comes from the word "hospis," which means both host and guest in Latin. Over the years, it has come to refer to a place of rest on a journey, a guesthouse, and that's exactly what a modern hospice program attempts to create. Hospice in the 21st century is not a place but a way of responding to and caring for someone who is dying. Community hospice allows for death in the comfort of home.

Community Hospice and Palliative Care

Community hospice is holistic care for the person who is dying and their family provided in the home or in an independent living facility. All patients in hospice receive palliative care. Palliation includes medications for pain, depression and anxiety as well as massage, pastoral care and counseling. Some families elect to use all available hospice services; others just select the one or two that meet their needs.

At the time of death in some states, the hospice nurse can pronounce the death; in others, the medical director of the hospice comes to do this for the family. This eliminates the need to call 911. Most hospices also provide desired counsel to the family for 13 months after the death, and some offer support groups for adults, children and teens.

Open Access Community Hospice

When the hospice movement began in the 1980s, patients had to make a choice between pursuing a cure and entering into hospice care. Constant advances in medical science can mean that a disease that is not curable today could be considered curable in six months; knowing this, patients were once reticent to give up any chance at survival to enter hospice.

Since 2009, the patients of a few major health insurance companies haven't had to make that choice. Open Access Hospice and Palliative Care plans allow patients to pursue a cure and receive comfort care at the same time. This has placed pressure on Medicare, a program of health coverage for senior citizens, and Medicaid, which insures many children in hospice situations, to follow suit.

Demographics of Community Hospice

The 2007 statistics from the National Hospice and Palliative Care Organization reported that 38.8 percent of the 2.4 million deaths in the United States occurred under hospice care, a 3.8 percent increase from the year before. Just as important, the average client received 67.4 days of care, compared with just the 2005 average of 26 days. Among those the care organization studied, 95 percent chose to hospice at home.

Benefits of Community Hospice

Hospice care can prolong life. A study in the March 2007 issue of the "Journal of Pain and Symptom Management," sponsored by the National Hospice and Palliative Care Organization, revealed that patients enrolled in hospice care lived an average of 29 days longer than people with the same diagnosis, predictive lab values, vital signs and age who were cared for in a hospital. This counters the notion that entry into hospice hastens death.

CAM Alternative Community Hospices

An increasing number of Americans are using complementary and alternative medicine, or CAM, to preserve their health and treat disease, and some don't want to convert to the use of medications when they are dying. A study conducted at the Oregon Health and Science University found that 54 percent of those in hospice care had used CAM approaches while they were dying. Of these, 49 percent used CAM for symptom relief, 12 percent in search of a cure and 26 percent for a combination of these two goals.

Only a handful of complementary and alternative community hospice agencies exist because Medicare will not reimburse hospices that do not offer traditional Western medical care, nor will it pay for many of the alternative treatments. One alternative to community hospice for those who do not want to change their approach to health care during their final months is to use the nursing assistants and volunteers that hospice provides to help with day-to-day chores and any physical care needed. People can also pay, out of pocket, for the alternative treatments they want to access.

In 2009, the American Academy of Family Practice issued a policy statement acknowledging that dying patients have the right to be supported by their physicians, through advocacy, for the use of complementary and alternative approaches to care. This type of support could lead the way to full reimbursement for CAM approaches in the future.