Hospice of San Joaquin provides several educational topics focusing on end of life care, the continuum of care, pain and symptom management and many other topics. Physician support of hospice care is becoming more widespread, but, the median length of stay after referral is only 20 days (late and thus, less effective). 

Barriers to Care

The use of hospice services can be improved if physicians address:

• Not discussing goals of care with patients and families; “goals are not defined so much by cure rates as by what is important to a patient and the family.”(1)
  
  
• Emphasizing “winning” while not attending to prognosis.  We must, as a team, not view death as a failure.   To do so means 100 percent of patients and 100 percent of physicians will fail—which is not satisfying or fulfilling for patients or for physicians.
  
  
• Perceiving hospice as “giving up” on medical care.  Not all medical care is excluded if it furthers the quality of life for the patient or decreases pain.  An example would be an antibiotic for a UTI.  “Excellent care at the end of life includes both palliative and curative elements.”(1)
  
  
• Being too “locked into” the 6-month time frame—fearing Medicare’s prognosis of a less than 6 month requirement would mean discharge from hospice care (if patient did not die within time frame).  This requirement states “if the disease runs its natural course,” which can differ from patient to patient.  With Medicare, there are unlimited recertification periods provided the condition still fits the eligibility requirements.
  
  
• Believing hospice care is only for cancer patients.  As people are living longer, more elderly patients are dying from chronic diseases such as end stage renal disease, end stage liver disease, or COPD.  According to NHPCO (National Hospice and Palliative Care Organization) in the 2003 year alone, more than half (51 percent) of patients served by hospice had non-cancer diagnoses.
  
  

(1) Source: Quality of Life Matters, Physicians Urged to Guide Patients to More Effective use of Hospice Care.

Hospice of San Joaquin is pleased to join with the physicians and hospitals in our area to help clarify these areas and provide continuum of care for the community.

We offer

Available In-Services

The following are available as a community service, free of charge, from Hospice of San Joaquin to our contracted nursing homes, residential facilities for the elderly (RCFEs), and assisted living facilities:

• Hospice care and services
• Death and dying/ Dying with dignity
• Caring for terminally ill patients/residents
• Working with terminally ill patients/residents—diffusing fear in caregivers
• Commonly used hospice medications, administration and protocol
• Methadone for pain control—myths and misconceptions
• Artificial hydration and nutrition considerations in end-of-life care
• Grief and loss
• Spiritual care at the end-of-life
• Advance health care directive planning
• Non-cancer terminal illnesses
• Compassionate communication—talking with patients/families about dying
• Terminal restlessness
• Signs and symptoms of approaching death, and what to do to add comfort
• Care of the bedbound patient/resident
• Body mechanics for the caregivers
• Care at the end-of-life (with history of hospice movement in U.S.)
• End-of-life Issues (Dying in today’s society)
• Overcoming barriers to effective use of hospice care
• End-of-Life Issues:  An overview of hospice services (discharge planners)
• Hospice philosophy and plan of care yearly review for facilities