Hospice care is a special kind of care designed to release incurable patients with limited remaining days from physical, psychological, social and spiritual pain, so that their last days may be spent with human dignity and in comfort in mind and body. Hospice care should be provided under a common idea and successively either in homes or institutions.
“Home hospice care” refers to hospice care implemented in patients’ homes where they spend their daily lives. Homes are spaces where patients and their families can not only feel most comfortable with relaxation but also realize their will without restrictions of medical staffs. So, home hospice care attempts to support both of patients and their families who wish to spend the patients’ last days at home and grant their wishes.
In home hospice care setting, comprehension and consent of the patient and family should be considered most important. Patients receiving hospice care at home may at any time and freely request to change to institutional hospice care or to transfer to conventional treatment for prolongation of their lives. Medical staffs attending to the care should respect such patients’ wishes as much as possible.
This standard established by Japan Home Hospice Association is the base on which home hospice care is offered to the patients and their families wishing to take it. The purpose of establishing the standard is to provide a definite guideline to team members who are engaged in home hospice care, especially to medical staffs, and realize the wishes of the patient and family selecting home hospice care as much as possible.
1. The Philosophy
1) The most priority is given to “quality of life of the patient and family” and cares are carried out to enable them to spend their lives comfortably at home.
2） One’s life should be respected and the process toward death of the individual should also be respected. Death should neither be hastened nor postponed
3） Hospice provides a care which not only brings palliation of pain and other uncomfortable physical symptoms, but also supports solution of psychological and social distresses and sympathize with spiritual pain, so that patients can find out meaning of their lives.
4） The patient’s self-decision-making and family’s will should be maximally respected.
2. The Basics of Practice
1） The Indications
(1) Incurable patients with limited remaining days mainly due to cancer and their family
(2) Patients and their families who hope hospice care at home.
(3) It is desirable that patients themselves understand their diseases and conditions correctly. It is, however, not an indispensable condition for their receiving home hospice care
2) The Care Offered
(1) Periodical visiting to patients’ homes by physicians and nurses for medical treatments or care. Visiting services by other professionals according to the need.
(2) The care provided on a 24-hour-a-day, seven-days-a-week basis and chiefly in patients homes
(3) Palliative care being mainly concerned with the patients’ distresses.
(4) The programmed care provided to the bereaved family after the death of their beloved one.
(5) In the care, the entire family, not only the patient but the other family members, are considered a “unit ”
(6) The care based on informed consent.
3) Death Education to the Patient and Family.
(1) Home hospice supports patients and their families so that they can achieve not passive lives dependent on the medical staffs but active lives through to the death of the patients.
(2) The family members are educated how to provide routine care at home.
(3) Sufficient explanation about the conditions of patients is made to the patient and family to give them assurance, and the methods to cope with possible changes of the patient’ condition are guided in advance.
(4) The family members are educated on so that they comprehend the process to death of their beloved one and know how to nurse the dying person
4) Team Approach
(1) Hospice care is provided by a team, and the supervisor of the team is decided at the beginning of care. The basic unit of the team in home hospice care comprises physicians, nurses and persons assuming daily care, family for example. Family members are not only caretakers but also important caregivers in home hospice.
(2) Home helpers, pharmacists, volunteers and other members supplying medical equipment or nursing requisites participate in the home hospice team according to the need. In some cases it is also recommended that professionals for psychological or spiritual care join to the team.
(3) A close contact is kept among the team members and the information concerned should be shared. Communication system should be available on a 24-hour-a-day basis.
(4) Team meeting is carried out periodically.
3. Revision of the Text
The text mentioned above may be revised through the formalities based on the rules of the Japanese Home Hospice Association
29th., November, 1997.
Japan Home Hospice Association