Magazine article Parks & Recreation

Quality during the End of Life

Magazine article Parks & Recreation

Quality during the End of Life

Article excerpt

To be admitted to a hospice program, the patient usually has a prognosis of less than six months to live.

As health care changes, one issue therapeutic recreation professionals may have to address is the expectation that patients receive only the care necessary to maintain or restore health (Sylvester, 1992). Therapeutic recreation interventions have historically focused on rehabilitation or functional skill development. In an attempt to secure financial reimbursement, the goal of facilitating expression of leisure choice and enhancement of quality of life sometimes has been ignored or not articulated. In the early 1980s, Medicare initiated a capitated per diem payment system intended to cover services that enhance quality of life, with no curative or rehabilitative goals, of patients diagnosed with life-limiting illnesses or disabilities. This article will explore the role of therapeutic recreation in hospice care as one of facilitating leisure preference and enhancing quality of life.

What is Hospice?

The term hospice comes from the Latin root related to hotel and hospital; however, according to the National Hospice Organization, the modern term is used to signify a shelter for those journeying through the final months, weeks, and day of their lives. Furthermore, hospice is not simply a place. The hospice service model focuses on the palliative treatment of persons with terminal illness or disability while allowing the patient to maintain the dignity of personal choice and control over medical interventions. Most hospice services occur in the home, allowing the patient to be in familiar surroundings and reduce costs associated with hospitalization. In 1996, approximately 22 percent of all deaths in the United States occurred at home, 17 percent in nursing homes.

The hospice philosophy incorporates reasonable and necessary medical care that neither hastens nor postpones the patient's death. To be admitted to a hospice program, the patient usually has a prognosis of less than six months to live and no longer benefits from curative treatment. Typical diagnoses include AIDS, heart disease, and cancer. Nearly 78 percent of all hospice patients have cancer, according to the National Hospice Organization. A study published in the New England Journal of Medicine found that the median survival for Medicare patients referred to a hospice program was only 36 days, well below he six months of allowable care. Of hospice patients, 15.6 percent died within seven days and 8.2 percent lived more than a year (Christakis & Escarce, 1996, p. 174). These lengths of survival allude to the variance among hospice patients.

Similarly, symptoms differ as the patient approaches death. At one to three months before death, an individual may begin to withdraw from the world and into him/herself, decrease food intake, and reduce communication. Disorientation, agitation, and confusion may occur later, coupled with decreasing blood pressure or respiration irregularities. In the final days, symptoms may intensify toward total ceasing of physical functioning. The symptoms, however, are not linear, and differing patterns or symptoms may be present among individuals. Additionally, it is not uncommon to observe a patient appear to improve within days of death.

Hospice care addresses the physical, emotional, and spiritual pain of terminally ill persons and their family members, with interventions focusing on issues of quality of life. Clinical staff strive to relieve physical and psychological pain and suffering and to make death as peaceful and comfortable as possible for both the patient and the family. Controlling physical and psychological pain and its symptoms is central to the team of nurses, social workers, chaplains, therapists, nursing assistants, counselors, and volunteers. A thorough knowledge of symptoms of advanced illness and strategies to alleviate those symptoms is necessary for effective intervention. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed


An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.