Humanizing nursing home environments: the relevance of hospice principles

At the heart of the rapidly growing American hospice movement is a philosophy of care that emphasizes patient individuality and responsiveness to total needs of the dying and their families. To date, the response to this model of terminal care has been favorable. The hospice is viewed as a humanizing mode of health care with a capacity to enhance the quality of life experienced by persons defined as terminal. Data gleaned from participant observation in an American hospice program by one of the authors supports this view. The hospice has the potential to provide a social context for humane, personalized death in which maximum effort can be made to control pain in all its forms: physical, psychological, social, and spiritual. Sociological literature has been much harsher in its assessment of the quality of life in nursing homes. Such discussions frequently include references to nursing home environments as fostering loss of autonomy and social death. This paper suggests that the hospice approach to care of the dying includes several elements that can be utilized to improve the quality of life in nursing homes: a total needs emphasis, increased patient autonomy, open discussion of death, a community ideology, a team orientation that cuts across levels of staff hierarchy, a role blurring of caregivers, focus on patients and families as the unit of care, and mutually beneficial integration of hospice with the outside community. There are, however, crucial differences between a hospice and a nursing home which may hamper direct transference of humanizing hospice principles, e.g., hospice patients are defined as terminal; staff, thus, can be motivated to put forth their best because of perceived time limits. There are also important differences in the characteristics of patient populations, length of stay, economic constraints, ability to attract volunteers, and emphasis on task-orientation. The time has come to apply increased ingenuity to a adapting humanizing hospice principles to the care of elderly in nursing homes.