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About 30 years ago, caregivers in England began tinkering
with a new approach to dying. They started to offer
patients the option of hospice care via residential
hospice facilities, where families could send their
loved ones. But the trend shifted slightly as it migrated
to the United States. Here, home hospice care rose to
popularity rather than residential facilities.
Now, more than 3,000 hospice programs operate throughout
the country, and 96 percent of those programs provide
routine home care, according to the National Hospice
and Palliative Care Organization. In order to qualify
for hospice, most programs follow Medicare's requirement
that a patient must have a prognosis of six months or
less if the illness were to run its natural course.
To help families cope with the reality of losing a
loved one, hospice programs usually provide not only
a nurse, but also a social worker, a chaplain and other
volunteers who can do everything from massages to housecleaning.
For many nurses who now work in hospice, this new philosophy
is a brilliant alternative to the mentality they've
seen in hospitals.
"Hospice acknowledged that dying is as much a
medical specialty as birth," said Virginia Shubert,
MN, CHPN, RN, executive director of Yolo Hospice in
Davis, Calif. "It is about making dying a natural
part of the life cycle. Dying is not a medical problem."
About 600,000 Americans died while in hospice care
in 2000, which is about one out of every four deaths,
according to the NHPCO. But hospice administrators expect
this number to swell significantly as the baby boomers
continue to age.
Some hospices already are feeling the pressure because
demand is increasing at the same time that nurses are
harder to come by. Hospice of the Valley in San Jose
recently had two nurse openings, and advertised the
positions for six months before they were filled. Usually,
it takes about a month to six weeks, said Jessica Klinghoffer,
MA, RN, executive director of the hospice.
"In the [San Francisco] Bay Area, there are a
number of hospitals that are just crying for nurses,
so we are all looking at the same candidates,"
she said.
Although it can be difficult to fill positions, most
hospice administrators agree that they have one advantage
over hospitals: low turnover rates. Klinghoffer said
that once nurses discover the hospice field, few leave.
"It's one of the places a nurse can do what he
or she went to nursing school for in the first place,"
Klinghoffer said. "In hospice, they have the tools,
time, respect and support to be treated as professionals.
They work independently and can make crucial decisions."
These reasons are why Fabricius never looked back once
she discovered hospice nursing. She also cherishes the
occasional chance to deliver something unexpected.
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