In recent years hospice care has gone from a little-known medical alternative to a major movement in health care. By emphasizing palliative care and pain management rather than curative treatment, hospices allow the terminally ill to spend the last days, week, or months of their lives in their own homes, cared for by their families under the supervision of a team of specially trained hospice workers that includes doctors, nurses, social workers, and volunteers. The Hospice Handbook assures us that the terminally ill do have options, and the quality of their lives can still be within their control.
Once way-stations run by religious orders to give respite to those on pilgrimages, today hospices provide care for dying people. Their philosophy of care is dedicated to the physical comfort and emotional support of the terminal patient. The hospice movement also affirms the idea that the patient deserves to be completely informed about his or her medical condition and treatment alternatives. Beresford, a San Francisco-based health policy writer, provides a complete, if somewhat dry, account of the hospice movement. But this is more than an intellectual discussion of a health-care policy; it also addresses practical questions. Beresford devotes the first two chapters to an explanation of hospice care and how to know when it is needed. In subsequent chapters he describes a typical hospice team (social worker, nurse, personal care aide and chaplain) and enumerates additional services, such as in-patient care. He explains the differences between community- and home health agency-based hospice programs and those that are based in hospitals or nursing homes. He also tackles insurance coverage, and his rundown of Medicare's hospice benefits is clear and concise (unlike most insurance forms). Finally, he reminds us that death, though inevitable, is rarely easy. His guide may make some of the tough decisions about choosing a hospice a little bit simpler. (Mar.)