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Ra’Quayle L. Cooley
Susan Lester
Adv. Lit/ Comp.
26 September 2011
Hospice: Caring for the Elderly and Terminally Ill
“For 20,000 Washingtonians every year, hospice is an end-of-life care option that
provides dying patients and their loved ones with comfort, compassion and dignity” (Neuberger
4). Hospice is a care facility for individuals who are terminally ill. Hospices all across the world
tend to focus on the care of the individual and the philosophy of care for the individual through
palliative care. Hospice care has been seen as an institution were an individual can die peacefully
in his or her own home. Hospice care however is not just limited to those who are terminally ill.
It is also for the elderly, mentally incapacitated, and for those who are in need of assistance.
However inrecent years a hot topic issue is the care of the very individuals who are the elderly,
mental incapacitated, and those who can’t assist themselves. As a result, care facilities such as
nursing homes, retirement homes, and even hospices have been under scrutiny for the care that
they are giving these individuals. It is not uncommon for nanny cams to be placed in an
individual’s home by the family of an elderly citizen who is being suspected of being abused by
the care facilitator. The burning question for many individuals is that “Have the care for those
who are incapacitated, elderly or can’t fend for themselves have been compromised by the very
individuals who care for them? If so has this been a direct affect from Western Civilization and
medical practices implemented?”

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The first thing to remember with medicine is that the patient always comes first. A
question that many ask is “How have a doctor’s prognosis been compromised when working in a
care facility?”With the condition of the elderly in the United States along with the mentally
incapacitated and individuals who can’t physically help themselves in facilities like a nursing
home, psyche wards, or even in a rehabilitation facility it is very common for doctors to be
responsible for more than fifty patients at one time. In facilities such as a nursing home where
elderly patients are in need of physical rehabilitation are prescribed drugs by doctors can be
overwhelmingly dangerous just as Cruikshank points out, “Although adverse drugs reactions
affect the old who live independently or with families as well as those who are institutionalized,
the problem is especially serious among nursing home residents. Since this population is largely
female, the problem of overmedicating in nursing home residents is a woman’s issue. Some
drugs have similar names, resulting in mix-ups. Many falls in nursing homes result from
overmedication”. (Cruikshank 5). The issue with doctors seeing 50 elderly patients at one time is
that the doctor might overmedicate the patient without even knowing that they did. This is a
result of more than one doctor prescribing one patient at one time due to the lack of
communication that exists between them. A simply way of fixing this issue is passing a state law
that requires for doctors to double check their patients records and current medication. By doing
so and having doctors ask their patients if they are currently seeing more than one doctor will
greatly reduce the risk of the patient overdosing from overmedication. Granted that many doctors
make medical errors when prescribing medication that could be potentially fatal to the patient a
grave mistake that is very common is when doctors often overlook signs and symptoms of
patients that have fatal illnesses. What isn’t a shock to most individuals is that out of any group
of doctors the ones that make the most medical mistakes are the generally the ones that just

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graduated from medical school. As a result some states are beginning to pass laws that require
physicians to obtain more sleep at so that less medical errors are being made on the job. As the
Philadelphia Inquirer points out in the article New rules prescribe shorter hours for young
physicians the author, Gregory Thomas, states that “The mandate is billed as a means of
enhancing patient safety and residents' quality of life by reducing physician fatigue and errors.
But it will also boost hospital costs and further reduce the long hours that some doctors believe
are critical to learning”.Doctors often make mistakes for various reasons some of the top reasons
they make mistakes when making a prognosis with a patient is that they miss common signs.
They are often overwhelmed and stressed because as a doctor they feel the need to not make a
mistake. In their profession it has become a dangerous liability to have too many mistakes with
patients which could lead to a malpractice suit or even worse--- being forced out of practice.
Being blacklisted as a doctor and being forced out of practice is just some of the consequences
that can end a doctor’s career. Some of the mistakes doctors make are not always medical
mistakes but are often sometimes thinking mistakes that can mentally blocking them from
making the correct prognosis for their patient. This can be extremely potent in their field,
especially when they are working with elderly or mentally disabled patients that are unable to
correct doctors on simple mistakes that they might make with their patient. A common mistake
in this area is not discussing preventative measures to elderly patients.Most doctors believe,
“Why should I prescribe this patient medication to lower their cholesterol when their health is
already failing?” The fact of the matter is that every patient can and most likely will benefit from
any programs or medication that the doctor places them on. Usually, it is common for doctors to
see elderly patients who are often on multiple medications and don’t know about their patients’
medical history. One way to prevent the doctor from making a mistake with elderly patients is to

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have a relative or care-taker that is current on the individual’smedical history. By doing so, this
will make the physician more aware of the patient’s medical history and as a result the physician
will make less medical errors when speaking with the patient. While some mistakes such as
prescribing the wrong medication and not being knowledgeable on the patient’s history is
primarily the doctor’s fault. What is even worse is the medical quick fix that can often be out of
the doctor’s control. Americans, now more than ever have be known for wanting to have a
medical quick for their health, especially the elderly.
Secondly, compared to other countries and cultures, America, has been known for
wanting to quickly solve things and move on to another topic. To many it seems that this has
occurred in medicine as well. The number one question that is being asked is “How has the direct
link between Americans wanting a quick fix (prognosis) and the elderly affected the quality of
care for individuals in facilities like hospice?Many hardworking Americans place their health
aside and commonly choose to use over-the-counter drug prescriptions for diseases such as the
common cold, the flu or something as a mild as the chicken pox’s.However what are the side
effects to the elderly when the beginning to use over-the-counter medication along with their
prescribed medication. In a CNN report, Dr. Donna Fick, stated that “The number of prescription
medications an older person takes is the strongest predictor of their risk for future drug-related
problems” (Harding). A common problem for elderly patients and taking medication is that in
conjunction with already taking their medication they also take over-the-counter medication. For
example a common medication that people over the age of 57 to 85 take is warfarin. Warfarin is
often used as an anti-coagulant to prevent blood clots from forming or growing in the blood and
in the vessels. If warfarin is used along with aspirin the two medications will counteract each
other causing the patient to severe bleeding hemorrhoids. A great alternative to having elderly

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patients on different medications that could cause them unnecessary pain and suffering is to have
them talk to their doctor and ask questions about what type of medication is acceptable to take
while there are on certain medications. Another issue with the elderly taking their medications is
not the fact that they are mixing medication with nonprescription medication but rather that the
elderly are overdosing on their medication. As a result of overmedication some elderly patients
experience a likelihood of “falls and metal confusion, but nondrug therapies can help reduce the
use of such medications” (Harding). The major issue with elderly patients overdosing on
medication is that it can not only cause them become disoriented and confused but it can also
increase the decline of the health. Many doctors or nurse practitioners would often tell their
elderly patients to take it easy on their medication. Elderly patients should at all times take their
medication with supervision of their caretakers and should also be advised to not take more than
prescribed daily amount. A lasting issue with elderly patients consuming their medication is the
issue of adverse and inverse reactions that comes along with overdosing on mediation Harding
points out that, “while any single drug might help people live longer, healthier lives, experts
worry that combination of drugs, along with over-the-counter products and dietary supplements
could be a recipe for disasters in terms of drug interactions. Statistically, one in three American
adults’ ages 57-85 are taking at least more than five prescription drugs a day. In nursing homes,
if the wrong medication is given to an elderly patient by an orderly an adverse reaction could
occur that could result in that patient’s death. A solution to that problem is to always have the
patient double check their names on the medication bottles when they are asked to take their
prescription this will also cause them to have a daily ritual with knowing what medications they
should be taking. This will cause them to become more aware as to what type of prescription
they are supposed to be taking. For the purpose of teaching the elderly of how to properly take

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their medication a topic that should be discussed is the caretakers who help them take their
medication.
Lastly, the most important thing to remember with healthcare and the elderly is the
quality of healthcare they might receive. Another question many might ask is “How has the
quality of palliative care compare to other countries around the world in facilities like
hospice?”Considering that, death, is treated and looked upon with much respect. However many
individuals question the amount of respect many Americans have for death. As Julia Neuberger
claims in her article, Caring for the Dying is inadequate in Western Society, she writes that Jews
and Muslims “tend to argue for doing everything to keep people alive, life itself being seen as the
most precious divine gift”.A concern for many individuals who place their loved ones in a
Hospice facility is that they will not be treated with the utmost care as far as their spiritual and
mental well being is concerned. Daily prayers and customs from different religions have become
completely unrecognized for some individuals who are devote Christians, Buddhists, Jews, and
even Taoist. A simple solution to this problem is for the caretakers to undergo extensive training
about different religions. By having the caretakers undergo extensive training on different
religions the will have a better understanding of how to treat patients from different religions.
With a concern to different religions around the world and patients who belong to those religions
is the concern of how those patients will die. How one individual might view death will severely
differ from another person. Kevin Irvine states in his article that the, “quality of life means one
thing for someone who is 42 and has been battling full-blown AIDS for five years, and
something entirely different for a 22-year-old with a spinal-cord injury may live 60 more years.
Different individuals from different religious backgrounds have various perspectives. As a result,
many people want to die differently. Family member or even caretakers can speak to their loved

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about their last rites and talk openly about their last days. Death is rite of passage for all human
beings and should not be revered because it is something that is unknown. More importantly,
when an elderly patient in a hospice facility is preparing their last moments some of them might
choose instead to go to a more controversial route, assisted-physician suicide. For some, it gives
them a sense of control over their last moments when they have long battled cancer and knowing
that they will die soon. As Kevin Irvine points out in his article, “While some people with full-
blown AIDS will not "get better," others with nonterminal disabilities will have symptoms and
life situations that wax and wane. One man with multiple sclerosis said he was seeking the so-
called [euthanasia] services of Dr. Jack Kevorkian to avoid having to go into "a rat-infested
nursing home”.The issue with the elderly and physician-assisted suicide is that some of the
elderly are often not in a healthy-state of mind. Most often they will choose to opt for physician-
assisted suicide instead of having to slowly die in a hospice facility or worse in a nursing home.
An elderly patient should always speak with a psychiatrist and their doctor before they consider
the decision of physician-assisted suicide. Most often, elderly men and woman choose to
decision because they feel neglected in some manner. The issue of euthanasia and the elderly
will always be present especially with those who are in hospice facilities.
With the many controversial issues that are in the medical field it is still worth the risk of
becoming a doctor. Most often the issues in the medical field are commonly moral issues such as
abortion, euthanasia, and even religion. Once an individual takes an oath as a doctor or becomes
a certified register nurse they have a moral obligation to aid the sick, dying, and disabled. The
medical field is not a career option for some who is strongly religious and is set against abortion
because as a doctor that they will encounter female patients opting for abortion. For some
individuals the medical field can and will compromise their faith, morals and who they are as an

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individual human being. As long as some one remembers not to sacrifice who they are as a
person anyone can become a doctor or nurse.

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Works Cited
Cruikshank, Margaret. “The Elderly Are Being Harmed by Overmedication .”Gale Opposing
Viewpoints in Context.Ed. Sylvia Engdahl.GreenhavenPress , 2009. Web. 12 Sept. 2011.
Harding, Anne. “Mixing Multiple Medications Causes Health Problems for Elderly
Americans.”Gale Opposing Viewpoints in Context. CNN, 23 Dec. 2008. Web. 3 Oct.
2011.
Irvine, Kevin. “Legalizing Patient-Assisted Suicide Would Lead to Patient Abuse.” Gale
Opposing Viewpoints in Context.Ed. Gail N Hawkins.Greenhaven Press, 2002. Web. 11
Sept. 2011.
Neuberger, Julia. “Caring for the Dying Is Inadequate in Western Society.” Opposing Viewpoints
Resource Center.Ed. Andrea C Nakaya.Green haven Press, 2005.Web. 12 Sept. 2011.
Thomas, Gregory. “New Rules Prescribe Shorter Hours for Young Doctors.” Gale Opposing
Viewpoints in Context. Philadelphia Inquirer, 1 July 2011. Web. 2 Oct. 2011.