Preamble and Philosophy
The following statements were originally published in the 2000 edition of NHPCO’s Standards of Practice for Hospice Programs. The current edition of NHPCO’s Hospice Standards of Practice for Hospice Programs (2010) is written to reflect the ten components of Quality Partners. The statements from 2000 are still relevant and helpful to the field.
Preamble to NHPCO Standards of Practice
Hospice affirms the concept of palliative care as an intensive program that enhances comfort and promotes the quality of life for individuals and their families. When cure is no longer possible, hospice recognizes that a peaceful and comfortable death is an essential goal of health care. Hospice believes that death is an integral part of the life cycle and that intensive palliative care focuses on pain relief, comfort and enhanced quality of life as appropriate goals for the terminally ill. Hospice also recognizes the potential for growth that often exists within the dying experience for the individual and his/her family and seeks to protect and nurture this potential.
Terminal illness is frequently defined as the point where nothing more can be done to cure someone. This limited focus and lack of concern for caring issues such as pain and symptom control can lead to increased suffering and isolation for patients and family members. In reality, supportive, positive care directed toward comfort and growth can be offered to individuals and their families during the end of life.
Hospice addresses the needs and opportunities during the last phase of life by including the individual and family, trained volunteers, caregivers and clinical professionals in the caregiving team. This interdisciplinary approach to care focuses on the individual’s physical symptoms and the emotional and spiritual concerns of the patient and family. The team works together to develop a plan of care and to provide services that will enhance the quality of life and provide support for the individual and family while respecting their wishes during the terminal phases of the illness and the bereavement period.
The following quote by Eric Cassel, M.D. from the March 30, 1989 issue of the New England Journal of Medicine captures the patient-centered focus of hospice care:
As sickness progresses toward death, measures to minimize suffering should be intensified. Dying patients require palliative care of an intensity that rivals even that of curative efforts even though aggressive curative techniques are no longer indicated, professionals and families are still called on to use intensive measures B extreme responsibility, extraordinary sensitivity and heroic compassion.
Hospice provides support and care for persons in the last phases of an incurable disease so that they may live as fully and as comfortably as possible. Hospice recognizes that the dying process is a part of the normal process of living and focuses on enhancing the quality of remaining life. Hospice affirms life and neither hastens nor postpones death. Hospice exists in the hope and belief that through appropriate care, and the promotion of a caring community sensitive to their needs that individuals and their families may be free to attain a degree of satisfaction in preparation for death. Hospice recognizes that human growth and development can be a lifelong process. Hospice seeks to preserve and promote the inherent potential for growth within individuals and families during the last phase of life. Hospice offers palliative care for all individuals and their families without regard to age, gender, nationality, race, creed, sexual orientation, disability, diagnosis, availability of a primary caregiver, or ability to pay.
Hospice programs provide state-of-the-art palliative care and supportive services to individuals at the end of their lives, their family members and significant others, 24 hours a day, seven days a week, in both the home and facility-based care settings. Physical, social, spiritual, and emotional care are provided by a clinically-directed interdisciplinary team consisting of patients and their families, professionals, and volunteers during the:
- Last stages of an illness;
- Dying process; and
- Bereavement period.
The National Hospice and Palliative Care Organization (NHPCO) defines palliative care as treatment that enhances comfort and improves the quality of an individual’s life during the last phase of life. No specific therapy is excluded from consideration. The test of palliative care lies in the agreement between the individual, physician(s), primary caregiver, and the hospice team that the expected outcome is relief from distressing symptoms, the easing of pain, and/or the enhancing the quality of life. The decision to intervene with active palliative care is based on an ability to meet stated goals rather than affect the underlying disease. An individual’s needs must continue to be assessed and all treatment options explored and evaluated in the context of the individual’s values and symptoms. The individual’s choices and decisions regarding care are paramount and must be followed at all times.
National Hospice and Palliative Care Organization Alexandria, Va