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HOSPICE

Hospice care is a type of care and philosophy of care that focuses on the palliation of a terminally ill or seriously ill patient's pain and symptoms, and attending to their emotional and spiritual needs. In Western society, the concept of hospice has been evolving in Europe since the 11th century. Then, and for centuries thereafter in Roman Catholic tradition, hospices were places of hospitality for the sick, wounded, or dying, as well as those for travelers and pilgrims. The modern concept of hospice includes palliative care for the incurably ill given in such institutions as hospitals or nursing homes, but also care provided to those who would rather spend their last months and days of life in their own homes. It began to emerge in the 17th century, but many of the foundational principles by which modern hospice services operate were pioneered in the 1950s by Dame Cicely Saunders. Within the United States the term is largely defined by the practices of the Medicare system and other health insurance providers, which make hospice care available, either in an inpatient facility or at the patient's home, to patients with a terminal prognosis who are medically certified to have less than six months to live. Outside the United States, the term hospice tends to be primarily associated with the particular buildings or institutions that specialize in such care (although so-called "hospice at home" services may also be available).[citation needed] Outside the United States such institutions may similarly provide care mostly in an end-of-life setting, but they may also be available for patients with other specific palliative care needs. Hospice care also involves assistance for patients’ families to help them cope with what is happening and provide care and support to keep the patient at home. Although the movement has met with some resistance, hospice has rapidly expanded through the United Kingdom, the United States and elsewhere.

History

Early development

Linguistically, the word "hospice" derives from the Latin hospes, a word which served double duty in referring both to guests and hosts. Historians believe the first hospices originated in the 11th century, around 1065. The rise of the Crusading movement in the 1090s saw the incurably ill permitted into places dedicated to treatment by Crusaders. In the early 14th century, the order of the Knights Hospitaller of St. John of Jerusalem opened the first hospice in Rhodes, meant to provide refuge for travelers and care for the ill and dying. Hospices flourished in the Middle Ages, but languished as religious orders became dispersed. They were revived in the 17th century in France by the Daughters of Charity of Saint Vincent de Paul. France continued to see development in the hospice field; the hospice of L'Association des Dames du Calvaire, founded by Jeanne Garnier, opened in 1843. Six other hospices followed before 1900.

Meanwhile, hospices also developed in other areas. In the United Kingdom, attention was drawn to the needs of the terminally ill in the middle of the 19th century, with Lancet and the British Medical Journal publishing articles pointing to the need of the impoverished terminally ill for good care and sanitary conditions. Steps were taken to remedy inadequate facilities with the opening of the Friedenheim in London, which by 1892 offered 35 beds to patients dying of tuberculosis. Four more hospices were established in London by 1905. Australia, too, saw active hospice development, with notable hospices including the Home for Incurables in Adelaide (1879), the Home of Peace (1902) and the Anglican House of Peace for the Dying in Sydney (1907). In 1899, New York City saw the opening of St. Rose's Hospice by the Servants for Relief of Incurable Cancer, who soon expanded with six locations in other cities.

The more influential early developers of Hospice included the Irish Religious Sisters of Charity, who opened Our Lady's Hospice in Harold's Cross, Dublin, Ireland in 1879. It became very busy, with as many as 20,000 people—primarily suffering tuberculosis and cancer—coming to the hospice to die between 1845 and 1945. The Sisters of Charity expanded internationally, opening the Sacred Heart Hospice for the Dying in Sydney in 1890, with hospices in Melbourne and New South Wales following in the 1930s. In 1905, they opened St Joseph's Hospice in London. There in the 1950s Cicely Saunders developed many of the foundational principles of modern hospice care.

Rise of the modern hospice movement

St Christopher's Hospice in 2005

Dame Cicely Saunders was a British registered nurse whose chronic health problems had forced her to pursue a career in medical social work. The relationship she developed with a dying Polish refugee helped solidify her ideas that terminally ill patients needed compassionate care to help address their fears and concerns as well as palliative comfort for physical symptoms. After the refugee's death, Saunders began volunteering at St Luke's Home for the Dying Poor, where a physician told her that she could best influence the treatment of the terminally ill as a physician. Saunders entered medical school while continuing her volunteer work at St. Joseph's. When she achieved her degree in 1957, she took a position there.

Saunders emphasized focusing on the patient rather than the disease and introduced the notion of 'total pain', which included psychological and spiritual as well as the physical aspects. She experimented with a wide range of opioids for controlling physical pain but included also the needs of the patient's family.

She disseminated her philosophy internationally in a series of tours of the United States that began in 1963. In 1967, Saunders opened St. Christopher's Hospice. Florence Wald, the dean of Yale School of Nursing who had heard Saunders speak in America, spent a month working with Saunders there in 1969 before bringing the principles of modern hospice care back to the United States, establishing Hospice, Inc. in 1971.

At about the same time that Saunders was disseminating her theories and developing her hospice, in 1965, Swiss psychiatrist Elisabeth Kübler-Ross also began to consider the social responses to terminal illness, which she found inadequate at the Chicago hospital where her American physician husband was employed. Her 1969 best-seller, On Death and Dying, was influential on how the medical profession responded to the terminally ill, and along with Saunders and other thanatology pioneers helped to focus attention on the types of care available to them.

Hospice care

Hospice Saint Vincent de Paul, Jerusalem

Hospice has faced resistance springing from various factors, including professional or cultural taboos against open communication about death among physicians or the wider population, discomfort with unfamiliar medical techniques, and professional callousness towards the terminally ill. Nevertheless, the movement has, with national differences in focus and application, spread throughout the world.

In 1984, Dr. Josefina Magno, who had been instrumental in forming the American Academy of Hospice and Palliative Medicine and sat as first executive director of the US National Hospice Organization, founded the International Hospice Institute, which in 1996 became the International Hospice Institute and College and later the International Association for Hospice and Palliative Care (IAHPC). The IAHPC, with a board of directors as of 2008 from such diverse countries as Scotland, Argentina, Hong Kong and Uganda, works from the philosophy that each country should develop a palliative care model based on its own resources and conditions, evaluating hospice experiences in other countries but adapting to their own needs. Dr. Derek Doyle, who was a founding member of IAHPC, told the British Medical Journal in 2003 that through her work the Philippine-born Magno had seen "more than 8000 hospice and palliative services established in more than 100 countries." Standards for Palliative and Hospice Care have been developed in a number of countries around the world, including Australia, Canada, Hungary, Italy, Japan, Moldova, Norway, Poland, Romania, Spain, Switzerland, the United Kingdom and the United States.

In 2006, the United States based National Hospice and Palliative Care Organization (NHPCO) and the United Kingdom's Help the Hospices jointly commissioned an independent, international study of worldwide palliative care practices. Their survey found that 15% of the world's countries offered widespread palliative care services with integration into major health care institutions, while an additional 35% offered some form of palliative care services, though these might be localized or very limited. As of 2009, there were an estimated 10,000 programs internationally intended to provide palliative care, although the term hospice is not always employed to describe such services.

In hospice care the main guardians are the family care giver and a hospice nurse who makes periodic stops. Hospice can be administered in a nursing home, hospice building, or sometimes a hospital; however, it is most commonly practiced in the home. In order to be considered for hospice care, one has to be terminally ill or expected to die in six months.

United States

Hospice in the United States has grown from a volunteer-led movement to improve care for people dying alone, isolated, or in hospitals, to a significant part of the health care system. In 2010, an estimated 1.581 million patients received services from hospice. Hospice is the only Medicare benefit that includes pharmaceuticals, medical equipment, twenty-four hour/seven day a week access to care and support for loved ones following a death. Hospice care is also covered by Medicaid and most private insurance plans. Most hospice care is delivered at home. Hospice care is also available to people in home-like hospice residences, nursing homes, assisted living facilities, veterans' facilities, hospitals, and prisons. The first hospice in the US was the Connecticut Hospice.

The first United States hospital-based palliative care programs began in the late 1980s by committed volunteers across the country. A handful of institutions such as the Cleveland Clinic and Medical College of Wisconsin were among the early programs. By 1995, hospices were a $2.8 billion industry in the United States, with $1.9 billion from Medicare alone funding patients in 1,857 hospice programs with Medicare certification. In that year, 72% of hospice providers were non-profit. By 1998, there were 3,200 hospices either in operation or under development throughout the United States and Puerto Rico, according to the NHPCO. According to 2007's Last Rights: Rescuing the End of Life from the Medical System, hospice sites are expanding at a national rate of about 3.5% per year. As of 2008, approximately 900,000 people in the United States were using hospice every year, with more than one-third of dying Americans using the service. Hospice Care is growing bigger and bigger every year.

Hospice plays an important role in reducing Medicare costs. Over the past 20–30 years 27-30% of Medicare's total budget was spent on individuals in their last year of life. Hospice care reduces ER visits and inpatient hospitalization which are costly and emotionally traumatizing for both the patient and their loved ones.

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Geography That Stroke Survivor Caregiver in Orange County Covers:

Aliso Viejo 92656, 92698,
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Brea, 92821, 92822,92823,
Buena Park, 90620 ,90621,90622, 90624, Capistrano Beach, 92624,
Corona del Mar, 92625,
Costa Mesa, 92626, 92627, 92628,
Cypress, 90630,
Dana Point, 92629,
East Irvine, 92650,
El Toro, 92609,
Foothill Ranch, 92610,
Fountain Valley, 92708, 92728,
Fullerton, 92831, 92832, 92833, 92834, 92835, 92836, 92837, 92838,
Garden Grove, 92840, 92841, 92842, 92843 ,92844, 92845, 92846,
Huntington Beach , 92605, 92615, 92646, 92647, 92648, 92649,
Irvine, 92602, 92603, 92604, 92606, 92612, 92614, 92616, 92617, 92618, 92619, 92620, 92623, 92697,
La Habra, 90631, 90632, 90633,
La Palma, 90623,
Ladera Ranch, 92694,
Laguna Beach , 92651, 92652,
Laguna Hills ,92653, 92654,92607,92677,
Laguna Woods, 92637,
Lake Forest, 92630,
Los Alamitos, 90720, 90721,
Midway City, 92655,
Mission Viejo, 92690, 92691, 92692,
Newport Beach , 92658, 92659, 92660, 92661, 92662, 92663, 92657,
Orange, 92856, 92857, 92859, 92862, 92863, 92864, 92865, 92866, 92867, 92868, 92869, Placentia, 92870, 92871,
Rancho Santa Margarita 92688,
San Clemente, 92672, 92673, 92674,
San Juan Capistrano, 92675, 92693,
Santa Ana , 92701, 92702, 92703, 92704, 92705 ,92706, 92707, 92711, 92712, 92725.92735, 92799,
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Silverado 92676,
Stanton, 90680,
Sunset Beach 90742,
Surfside 90743,
Trabuco Canyon, 92678, 92679,
Tustin ,92780, 92781,92782,
Villa Park, 92861,
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Yorba Linda, 92885, 92886, 92887

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