Hospice care is a wonderful choice—a gift, really—for a person who has chosen to stop curative treatments and fully understands that his or her condition will likely lead to dying. That was a key point of last spring’s Chattanooga presentation by Tarron Estes, founder of the Conscious Dying Institute, which provides wisdom-based end-of-life education for clinical professionals, home and family caregivers and healthcare systems.
Almost 100 people gathered at UTC and heard presentations from Estes and other professionals before pairing off in small groups to discuss what we want to have happen at that most precious time of life. Over and over, the point was made that each of us should have a voice in how we want to live at the end of our earthly journey. What emerged from that discussion was agreement that it can be healthy to approach a fatal diagnosis as a new beginning, a time to see and do the things we never have, but always wanted to experience.
Hospice, a type of end-of-life care recommended by a physician, can play a critical part in facilitating that positive vision. The origin of the word goes back to the 11th century, when a “hospice” was a refuge and shelter for weary travelers during the time of the Crusades. So the word hospice derives from the word hospitality.
In the late 1970s, the modern idea of hospice care migrated from England to the United States in clinical settings, where the comfort care concept gained acceptance in parts of the medical community. In 1982, Congress approved the inclusion of hospice as a benefit of Medicare, opening the door for the establishment of hospice organizations all across the United States.
Shortly before that congressional action, a group of Chattanooga volunteers had already established their mission of creating what we now know as Hospice of Chattanooga, which in 2016 celebrated 35 years of service in Southeast Tennessee and Northwest Georgia.
“The focus of the care we provide to thousands of people in this area is based on the belief that each of us has the right to die with dignity, as pain-free as possible, surrounded by our family and friends,” says Greg Phelps, MD, medical director for Hospice of Chattanooga. “Most times, the setting for someone choosing hospice care is their home, though their home could now be a nursing home or assisted living facility.”
Six years ago, the only Hospice Care Center in Chattanooga opened off of Walker Road, just off the Bonny Oaks Drive exit of I-75. “We are unique in that respect,” says Tracy Wood, CEO for Hospice of Chattanooga. “There are other hospice organizations, but none of them offers a facility for patients who need intensive symptom management and which accommodates family members like we do.”
Phelps points to several studies showing that cancer patients are likely to live longer if they choose hospice care rather than simply continuing a regimen of curative treatments. He is also quick to point out that hospice care is not just for cancer patients, but is an option for people suffering from COPD, congestive heart failure and other life-threatening illness.
“We always talk about how a patient can benefit by choosing hospice sooner, but they are scared of it until they find out how we help manage pain and symptoms so that the quality of what is left of life is so much better,” he says.
A relatively new field in medicine is palliative care, which is for patients facing serious but not necessarily life-ending illness. Palliative care helps with what Phelps calls “the three Cs”: comfort, communication and the coordination of care.
Comfort mitigates pain, shortness of breath, depression or whatever else causes the patient to suffer. Communication ensures that the patient and his or her family fully understand the diagnosis and prognosis, and that they have opportunities to discuss their needs and concerns with the palliative care team. “Most important is making sure our team understands the patient’s wishes, because that is what we honor,” Phelps says. Coordination of care is the process of creating a specific care plan around those wishes.
There has been rapid growth in palliative care programs around the United States. Hospice of Chattanooga was one of the first hospice organizations in the country to sponsor a palliative care clinic.
“Palliative care is a choice that can be made at any point in the treatment of a chronic illness, and it is different than hospice,” Phelps says. “Hospice is for those patients who are no longer seeking curative treatments, while palliative care offers treatment of pain and other symptoms, assistance with communication of bad news regarding diagnosis and prognosis, and emotional and spiritual support.”
Hospice of Chattanooga provides services in 18 counties, covering all of Southeast Tennessee and Northwest Georgia. It is the region’s only community-owned, not-for-profit provider of hospice care. It has offices in Chattanooga, Cleveland, Athens, Jasper and Dayton, TN, as well as North Georgia.