Chapter 8. Hospice Care

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Chapter 8. Hospice Care

• Long-Term Care Managing Across the Continuum
• (Second Edition)

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Learning Objectives

1. Define hospice care and those who use it
2. Identify sources of financing of hospice care
3. Identify and describe regulations affecting
   hospice care providers
4. Understand and discuss ethical issues affecting
   hospice care
5. Identify trends affecting hospice care and the
   impact of those trends

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What is Hospice Care?

• Program for people with terminal illnesses
• End-of-life care

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How Hospice Care Developed

• Began as a formal program in England in 1967
• First American hospice in Connecticut in 1974
• Has grown rapidly in recent years

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Philosophy of Care

• Not a place, but a philosophy
• Provides support for terminally ill and their
  families
• Neither prolongs life nor hastens death
• Focus on comfort (palliative) care
• Promotes dignity in final days

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Benefits of Hospice Care

• Cost-effective alternative
• Lets patients stay in their homes with their
  families
• Interdisciplinary team
• Treats person, not disease
• Emphasizes quality of life

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Ownership

• Many are affiliated with other health care
  organizations
• Home health care agencies
• Hospitals
• SNFs
• Most are nonprofit
• Some are freestanding

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Services Provided

• Medical Nursing
• Social Services Counseling
• Medical Supplies Therapy
• Pain Management Homemaking
• Personal care Education

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Consumers of Hospice Care

• Terminally ill
• Cancer Diabetes
• Heart disease Kidney disease
• Pulmonary disease Liver disease
• Neurological AIDS
• disease
• Their families

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Market Forces

• Cost-effectiveness
• Desire for control during last days of life

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Regulations

• Medicare certification
• State licensure

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Accreditation

• JCAHO
• CHAP
• ACHC

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Financing

• Medicare
• Benefit periods
• Six months or less to live
• Pays for most services
• Medicaid
• Private insurance
• Self-pay and other sources

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Staffing

• Medical Director Personal Physician
• Nurses Social Workers
• Hospice Aides Clergy
• Bereavement Therapists Counselors
  Nutritionists
• Volunteers Caregiver
• Patient

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Legal Ethical Issues

• Decision to accept hospice care
• Rights of patients
• Advance directives
• Physician-assisted suicide
• Survival past 6 months
• Inequitable access

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Management Qualifications

• Not regularly licensed
• Medicare Conditions of Participation

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Management Challenges Opportunities

• Coordinating professional and volunteer staff
• The emotional element
• Cultural, religious, and ethnic differences
• Community and philanthropic groups

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Significant Trends

• Variation in access and use
• Later admission, shorter stays
• Alternative therapies
• Expansion of eligibility

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In Summary

• Hospice care has a long history, but has become
  increasingly attractive in recent years, and
  should continue to grow.