Hospice care in America

Article Abstract:

The needs of terminally ill patients and their families are administered to in a dignified, comfortable manner in hospices, and these facilities have become an accepted feature of the American medical landscape. However, changes in Medicare practices and poor utilization by clinicians threaten the hospice movement. A review is provided of the history, philosophy, and realities of current hospice care. The goals of hospice care include: effective symptom control; care of the patient and family as a unit; an interdisciplinary team approach; continuity of care, including home care; and follow-up with the family members after the patient's death. The first American hospice appeared in Connecticut in 1974, and in 1983, Medicare began to offer a hospice payment option for patients who met certain criteria. Since then, growth of the industry has been rapid, and there are currently more than 1,700 hospices. But Medicare's emphasis on home care and certain organizational requirements is in conflict with the growth-industry character of the organized hospice movement. In general, patients and family members express either the same or greater satisfaction with hospice care than with conventional terminal care. Medicare regulations regarding hospice care are evaluated. Medicare requires that a patient be expected to die within six months, and prognostic errors are common, especially for diseases other than cancer. Doctors and nurses, on the whole, are not trained to provide terminal care, and many object to administering narcotics based on patient need. Patients who die in nursing homes (an increasing number) often do not have access to hospice care. Recommendations are made for changes in hospice policies, reimbursement, and medical training in order to improve the care of the terminally ill. (Consumer Summary produced by Reliance Medical Information, Inc.)

History, Medicare

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The hospice alternative

Article Abstract:

Hospice care is a philosophy of treatment for the terminally ill during the final stages of their life. The goals are to support the patient and family and relieve pain, rather than treat disease; this approach is called palliative care. The patient is encouraged to remain at home for as long as possible, coming to the hospital when it is not comfortable for the patient to stay at home. The hospice movement attempts to provide personalized support of the terminally ill through a team of physicians, nurses, social workers, clergy, nurses aides and administrators. Because the terminally ill require care 24 hours a day, assistance is given to families for such daily tasks as shopping. The caregiver(s) must be allowed to meet family and job responsibilities while providing care and attention to the dying patient. Volunteers often help with the varied tasks and needs of families. The growth of the hospice movement is demonstrated by the increase from less than 100 programs in 1979 to 1,687 programs in 1988.

editorial

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Access to Palliative Care and Hospice in Nursing Homes

Article Abstract:

Many changes are needed to ensure that nursing home patients receive adequate terminal care. Many nursing homes have no hospice program because quality standards, contractual requirements, reimbursement rules, and concern about fraud provide no incentive for hospice programs.

Analysis, Services, Nursing homes

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