Most people know what kind of health care they want at the end of life, but few know that it is called "hospice." The vast majority of Americans say they want to die at home in comfort and dignity, but many are unaware that this is the kind of death hospice can facilitate.

Hospice programs offer dying people medical care that emphasizes comfort; but hospice care extends beyond strictly medical concerns. Using a team approach, hospice also provides emotional and spiritual support to address the needs of the whole family--the dying patient and the grieving relatives. Most hospice care is provided at home, unless that is not possible. When home care is not feasible, (in about 20 percent of cases) hospice care is provided in hospice inpatient facilities, nursing homes, or hospitals.

Despite its many advantages, more than 25 years after its introduction in this country hospice remains a mystery to most Americans. Common myths and misunderstandings often prevent people from exploring this compassionate option for end-of-life care. Here are ten of those myths--and the truth about what hospice really offers.

Myth #1: Hospice is a place.

Hospice care is provided wherever the need exists--usually in the patient's home. Although many communities now offer residential hospice facilities, about 80 percent of hospice care takes place at home.

Myth #2: Hospice is only for people with cancer.

The hospice model is appropriate for anyone facing the end of life. More than 20 percent of hospice patients nation-wide have diagnoses other than cancer. In urban areas, hospices serve large numbers of HIV/AIDS patients. Increasingly, hospices are also serving families coping with the end-stages of chronic illnesses such as emphysema, Alzheimer's, cardiovascular, and neuromuscular diseases.

Myth #3: Hospice is only for old people.

Although the majority of hospice patients are older, hospices serve patients of all ages. A growing number of hospices offer clinical staff with expertise in pediatric hospice care.

Myth #4: Hospice is only for dying people.

As a family-centered concept of care, hospice focuses as much on the grieving family as on the dying patient. In addition, most hospices make their grief services available to the community at large, serving schools, churches, and employers. Talk to your local hospice about the full range of services available to people facing loss.

Myth #5: Hospice can help only when family members are available to provide care.

Recognizing that terminally ill people may live alone or with family members unable to provide care, many hospices coordinate community resources to make home care possible. Or they help find an alternative location where the patient can safely receive care.

Myth #6: Hospice is for people who don't need a high level of medical care.

Hospice is serious medicine. Most hospices are Medicare-certified, requiring that they employ experienced medical and nursing personnel with skills in symptom control. Hospices offer state-of-the-art palliative care, using advanced technologies to prevent or alleviate distressing symptoms.

Myth #7: Hospice is only for people who can accept death.

Everyone facing terminal illness struggles to come to terms with death in his or her own way. Hospice offers no magic formula, but hospice workers are trained to gently help people move at their own speed. Many hospices offer this help even to families who have not yet formally requested hospice assistance. For many families, few decisions are more difficult than determining whether and when to invite hospice in. Recognizing this, many hospices welcome inquiries from families who are unsure about their needs and preferences. Hospice staff are available to discuss all options and to facilitate family decisions.

Myth #8: Hospice care is expensive.

Most people who use hospice are over 65 and are entitled to the Medicare Hospice Benefit. This benefit covers virtually all hospice services and requires few, if any, out-of-pocket expenditures by families. Even for younger patients whose private insurance may not fully cover hospice, end-of-life care within hospice can be far less expensive than the alternative: hospital or nursing home care.

Myth #9: Hospice is not covered by managed care.

Although managed care organizations (MCOs) are not required to include hospice coverage, Medicare beneficiaries can use their Medicare hospice benefit anytime, anywhere they choose. They are not locked into the end-of-life services offered or not offered by their MCO. Those under 65 are limited to their MCO1s services, but are likely to gain access to hospice care upon inquiry.

Myth #10: Hospice is for when there is no hope in sight.

When death is in sight, there are two options: yield to hopelessness or live life as fully as possible until the end. The gift of hospice is its capacity to help families see how much can be shared at the end of life through personal and spiritual connections. Many families look back on their hospice experience with gratitude - as a time of unique connection and sharing. Hospice is designed to help families make the most of this time together and to do everything possible to promote a peaceful death.

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