International Hospice Institute; Academy of Hospice Physicians--a vision for hospice.
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Hospice values, access to services, and the Medicare hospice benefit.
The Medicare benefit has been an important force in shaping the American hospice movement during the 1980's. Hospice reimbursement under Medicare added legitimacy to the movement, increased access to hospice care for some Medicare beneficiaries, and provided financial support to Medicare certified hospice programs. But the increased access for some may come at the cost of decreased access for others, and the price of reimbursement may be the erosion of hospice as a unique form of terminal care in this country. It is up to hospice professionals to balance the fiscal realities of providing hospice care without losing sight of the values and philosophies that have made hospice a "special kind of care."
Health Services Accessibility↗
[Development of hospices and hospice care].
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China↗
[The hospice, death, and aging - the concept of hospice care].
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Aging↗
Hospice in Pennsylvania. PNA nurses active in hospice programs. Part I.
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Family↗
How do local doctors react to a hospice?
Postal questionnaires were sent to general practitioner principals and hospital consultants in Ayrshire a year before and again 13 months after the opening of the Ayrshire Hospice. Seventy-three per cent of 342 doctors replied to the first survey and 62% replied to the second survey. There was initially a fairly strongly felt need for a hospice, with median Visual Analogue Score (VAS) of 16 ('definite need' = 0 and 'definitely no need' = 100). After the opening of the hospice doctors were much more enthusiastic (median VAS 5; p less than 0.0001). Doctors feeling no need for a hospice (VAS greater than 75) became fewer (9.6% before opening, 2% after). Doctors who would refer patients to a hospice, at first 82%, numbered 92% after opening. Seventy-one per cent of general practitioners and 60% of consultants had referred patients to the hospice within a year of opening. After opening, specialist advice with home care was considered the most useful aspect, in-patient beds useful, and day hospice least useful. Seventy-three per cent of referring doctors found the hospice a great help. In both surveys general practitioners and consultants felt the hospice should be run by a mixture of voluntary and NHS finance. Doctors appeared willing to learn about palliative care from hospice doctors, particularly after hospice opening. Doctors were initially rather dissatisfied with palliative care in existing hospitals, but became less so (particularly about pain control) after hospice opening. Surprisingly, in both surveys the attitudes of general practitioners and consultants were virtually identical.(ABSTRACT TRUNCATED AT 250 WORDS)
Attitude of Health Personnel↗
Prevalence and Factors Associated with Receiving a Prescription for a Direct Oral Anticoagulant Among Patients with Atrial Fibrillation on Hospice Admission.
Atrial fibrillation (AF) is prevalent in hospice care, but anticoagulation decisions in this population are not well understood. In this cross-sectional study, we described the prevalence and characteristics associated with direct oral anticoagulant (DOAC) prescription on hospice admission. We used electronic health data from adult decedents with AF in a large, for-profit hospice chain in the United States between January 1, 2017 and December 31, 2019. We used multivariable logistic regression with results reported as adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Among 13,233 decedents, mean (standard deviation [SD]) age was 84.2 (9.9) years, 53.6% were female, 65.1% were White, and 56.1% were referred to hospice from a hospital. Mean (SD) CHA2DS2-VASc score were 3.8 (1.4) for males and 4.8 (1.3) for females, and mean (SD) HAS-BLED score was 2.2 (1.0). Overall, 8% of patients received a DOAC prescription on hospice admission. Characteristics associated with receiving a DOAC prescription included PPS scores of ≥ 20% (compared to scores < 20%), and receiving hospice care at home, nursing home, assisted living facility, or residential care home (compared to inpatient hospice). Further studies about the risks and benefits of DOAC use are needed to optimize decision-making in this population.
DOAC↗
The U.S. hospice movement: issues in development.
A grass-roots hospice care movement is underway in the United States modeled after recently popularized British hospice programs. Hospice care is intended to help the terminally ill maintain a personally acceptable quality of life until death. Attention should be given to ensuring the future viability of this service option by allowing for experimentation with and adaptation of existing models, and by integrating it with the overall health care system. Issues to be considered in integrating hospice care include utilization of existing resources, regional planning, standards and licensure, and reimbursement opportunities. Although hospice care may not have an immediate cost savings impact on the health care system, it could develop this capacity in the future. Such impact would not only assure a stable financial base for hospice care but would also affect bed use generally. Continuing dialogue among providers, consumers, and policy makers of various backgrounds is necessary to the effective and appropriate development of hospice care in the U.S.
Health Resources↗
The routinization of hospice: charisma and bureaucratization.
In 25 years the number of hospices in Britain has multiplied from under 15 in 1965 to over 430 in 1991. During this period, often working out with the mainstream health system, the hospices actively sought to transform terminal care. More recently a process of diversification and legitimation has meant that hospices have become increasingly subject to mainstream influence. Using Weber's concept of charisma we examine the development of the hospice movement during this period of expansion. We suggest there are a number of factors leading to the routinization of hospice care including the ways in which it was sponsored and developed at the local level, and pressures toward bureaucratization and professionalization. We make links with recent developments in the health services. Finally we consider whether it is possible for the hospice movement to sustain its founding ideals.
Hospices↗
Hospice research: the importance of program participation.
Hospice research is needed in order to understand the complex phenomena of holistic care for terminally ill persons and their families. Hospice program participation is key to future hospice research efforts. The purpose of this article is to encourage hospice programs to participate in hospice research. The discussion includes why research is done, who undertakes a research project, the role of institutional review boards in assuring rights of human subjects and potential strategies for recruitment of research subjects. The authors use their experiences with conducting hospice research to illustrate potential recruitment strategies.
Holistic Health↗
The effects of hospice coverage on Medicare expenditures.
This article reports on the findings of a study of the effects of the hospice program on Medicare Part A expenditures during the first three years of the program. The analysis compared treatment costs between hospice beneficiaries and nonbenefit patients with diagnosis of malignant cancer during their last seven months of life. It was estimated that during the first three years of the hospice program, Medicare saved $1.26 for every dollar spent on Part A expenditures. While the methodology included use of data from Medicare claims to adjust for confounding factors, including self-selection bias, our estimated savings might still have been overstated due to persistent selection effects. The extent of savings also varied according to the hospice's organization. Freestanding hospices, in contrast to those affiliated with either a hospital, nursing home, or home health agency, achieved the greatest savings by utilizing home care more extensively. However, we note that payment rates are increasing and the limits on the benefit period are being lifted, making it possible that the savings related to the hospice program found in this study will not continue. Of greater importance may be the long-term access and quality effects engendered by the benefit's preference for home care.
Age Factors↗
Certification for hospice nurses? Assessment of need.
An assessment of need survey questionnaire sent to the hospice nursing community yielded a substantial return (1,550). The respondents overwhelmingly endorsed a certification process. They also emphasized the value of hospice experience and caring personal attitudes over formal educational preparation both for hospice work and for certification purposes. The preferences of these nurses for various elements of a certification process are compared to those revealed in a Delphi study of 16 hospice nursing leaders. Certain of their experimental and demographic characteristics are related to other research findings about the characteristics of hospice nurses.
Attitude of Health Personnel↗
Providing spiritual support: a job for all hospice professionals.
This research examines spirituality as an aspect of professional practice. A questionnaire on spirituality was sent in 1991 to the hospice directors in New York, New Jersey, and Pennsylvania. The findings strongly indicate that spirituality is important in the hospice setting and plays a prominent role in the treatment of patients. Also, hospice programs were found to be supportive of the spiritual component of care. The spiritual approaches used by the respondents were the more traditionally religious ones such as listening to the patient talk about God or referring to clergy. Approaches such as meditation or guided imagery, which are not necessarily related to religion, were used less frequently. Clergy in the study placed greater importance on spirituality in hospice work and used more traditionally religious approaches than did non-clergy. While some professional caregivers choose to leave spiritual matters to clergy, the findings reveal that many non-clergy hospice professionals are assisting patients with spiritual concerns.
Adult↗
Motor neurone disease: a hospice perspective.
OBJECTIVE: To describe and evaluate the management of patients with motor neurone disease from the perspective of a hospice. DESIGN: Retrospective analysis of hospice medical and nursing notes. SETTING: Established 62 bed teaching and research hospice. SUBJECTS: 124 patients with motor neurone disease cared for by the hospice between January 1980 and November 1990. MAIN OUTCOME MEASURES: Patient profile; functional status; symptom control and use of opioids; insight; mode and management of death. RESULTS: 124 patients (67 women, 57 men) had a mean age 63.9 years. The median length of admission was 61.5 days (range 1 to 2147). 84 patients (68%) were aware of their diagnosis and its implications when first seen by a hospice doctor. Functionally, the patients were very dependent. Symptoms such as pain, dyspnoea, and insomnia were major problems that responded well to opioids. Many patients were noted to deteriorate "suddenly," and in 58% of cases death occurred within 24 hours of this deterioration. When dying, 106 patients (94%) were peaceful and settled. 101 patients (89%) received opioids during this dying period. No patient chocked to death. CONCLUSIONS: Although motor neurone disease is an uncommon disorder, many of its symptoms occur commonly in medical practice and must be actively treated. Opioids are both safe and effective for such treatment. The term chocking is both inaccurate and inappropriate in describing the cause of death in motor neurone disease and its use should be abandoned.
Adult↗
Training our future physicians: a hospice rotation for medical students.
A required 16 hour hospice clinical rotation was developed as part of a medical student family practice clerkship. The effect of the hospice rotation on student beliefs and attitudes towards the care of dying patients was measured by pre- and post-test questionnaires using a Likert scale. Sixty-five completed pre- and post-tests were analyzed using a paired t-test. It was determined that there were statistically significant changes in responses to 15 of 23 items. The rotation positively affected student attitudes about hospice care, student attitudes about a hospice rotation, and beliefs concerning palliative care. The authors believe that qualified hospice programs can, and should, serve an active role in teaching medical students about the physical and psychosocial aspects of caring for the dying.
Attitude↗
Hospice care: a unique clinical experience for MSN students.
There are several preconceived notions among members of the nursing profession about hospice care. Among graduate students in nursing, there remains a belief that going to a hospice for clinical experience would be depressing and unrewarding. This paper discusses the learning experiences in the hospice setting and how consistent these are with graduate course objectives, and highlights the positive outcomes of the clinical experience unique to hospice care. This unprecedented recognition that hospice clinical experience brings a re-examination of previous knowledge, values, and concepts among Master of Science in Nursing (MSN) students underscores the importance of faculty role in this process. However, these casual observations require systematic characterization and quantification. Indeed, there is tremendous need for educational research in this area.
Education, Nursing, Graduate↗
Who needs a hospice?
OBJECTIVE: Rapid evolution of palliative care programs in Australia over recent years has brought the role of traditional inpatient hospices under review. This study attempts to define the clinical characteristics of patients referred for inpatient palliative care. DESIGN: A retrospective chart survey was performed of 432 consecutively referred patients. SETTING: The study was undertaken in a 60-bed hospice providing intensive nursing and medical care to patients with terminal illness. OUTCOME MEASURES: Demographic characteristics, diagnosis, length of stay, outcome and use of analgesics are presented. Patients not using regular analgesia at admission were studied to determine their major symptom complexes and their use of medication. RESULTS: Public hospitals referred 67.6% of patients and 25% came from home. While 83.8% of patients died in hospice care, 16.2% were discharged, usually to home or a nursing home. At admission, 16.9% of patients could walk unassisted, 20.6% were chair-bound and 62.5% were bed-bound. The median length of stay in the hospice was 16 days. Ambulant status, female sex, non-use of opioids and a diagnosis of brain or breast cancer were all associated with longer stay. At admission, 39.1% of patients were taking potent opioids regularly, 22.9% were taking mild analgesics and 38.0% were taking no regular analgesia. Of those taking no analgesia, cachexia (55.9%), confusion (35.4%), impaired conscious state (19.9%) and impaired motor neurological function (21.7%) were the major clinical problems. CONCLUSIONS: The data show that patients selected for hospice care were highly dependent, with major functional impairments and short life expectancy. The medical, social and economic implications of these findings are discussed.
Activities of Daily Living↗
Care of cancer patients in a home-based hospice program: a comparison of oncologists and primary care physicians.
BACKGROUND: The purpose of this study was to describe a group of patients cared for in a home-based hospice program and to determine if there was a difference in patients' experiences dependent on whether the attending physician was a primary care physician or an oncologist. METHODS: Information about cancer patients admitted to the Burlington Visiting Nurse Association (VNA) Hospice program from January 1986 to December 1990 was reviewed to compare the experiences of the patients of the oncologists with those of the patients of the primary care physicians. RESULTS: There was no difference in average length of stay or overall ambulatory status between the patient groups. The patient group cared for by oncologists had more hospitalizations than the group cared for by primary care physicians though there was not a significant difference in the percentage of hospital vs home deaths. There was a significant difference between the groups in the use of controlled-release morphine, with oncologists using this approach more often than primary care physicians. Oncologists also had more patients on continuous parenteral morphine infusions during hospice care. CONCLUSIONS: Primary care physicians as well as oncologists provide effective cancer care and pain control in this home-based hospice program. The hospice interdisciplinary team can be a valuable resource for physicians in supplying information on appropriate narcotics dosages and routes of administration for their dying patients.
Adult↗