Thomas A. Welk, DMin

Harry Hynes Memorial Hospice 
 
Hospice programs provide care for patients who are terminally ill (life expectancy of six months or less).    Stated another way, the key point in determining hospice involvement is the patient’s prognosis (life expectancy), not the diagnosis (underlying illness/disease). 

Cancer is the highest represented disease among patients cared for by almost all hospice programs.   For example, 76% of the patients presently being cared for by Harry Hynes Memorial Hospice have cancer.    Heart disease, emphysema, diabetes, kidney failure, liver disease, Alzheimer’s, etc. are some of the other illnesses represented in the patient census. 

For all of these diseases, an attending physician along with one other physician (usually the hospice program’s medical director) must certify that the patient’s illness can be reasonably expected to bring about death in six months or less. It is not necessary for the physician to be absolutely accurate in making this assessment.  If the patient should live longer than six months, a physician must simply re-certify that the patient’s disease is still present, but has not progressed as quickly as usually is the case.  

When patients are told they have a life-threatening illness, the first question most frequently asked is, “How long do I have to live?”    Even though it is practically impossible to give a definite timeline for a patient’s life expectancy, there are some ways in which a general prognosis can be given. 

To assist physicians in certifying that in her/his medical judgment a patient has a prognosis of six months or less, Harry Hynes Memorial Hospice has available a set of “Clinical Indicators for Hospice Appropriateness” for various diseases.   This checklist of guidelines covers such diseases as ALS  (Lou Gehrig’s Disease), various cancers, dementia, CHF (heart disease), HIV (AIDS), liver failure, COPD (emphysema), kidney disease, and CVA (stroke). 

The guiding philosophy of all hospice programs is basically the same. Namely, that even though a hospice patient’s “remaining time” may be limited to six months or less, nonetheless it is a time which should be lived as fully and as well as possible to the last minute.    Hospice is there to provide the support necessary for that to happen.    In effect, every human being has a “limited” prognosis and we all want to live our gift of life as fully as possible, no matter where we are on that life journey.