Chapter 8. Hospice Care

1. Chapter 8. Hospice Care Long-Term Care: Managing Across the Continuum (Second Edition)

2. Learning Objectives • Define hospice care and those who use it • Identify sources of financing of hospice care • Identify and describe regulations affecting hospice care providers • Understand and discuss ethical issues affecting hospice care • Identify trends affecting hospice care and the impact of those trends

3. What is Hospice Care? • Program for people with terminal illnesses • End-of-life care

4. 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

5. 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

6. 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

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

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

9. Consumers of Hospice Care • Terminally ill: • Cancer • Diabetes • Heart disease • Kidney disease • Pulmonary disease • Liver disease • Neurological • AIDS disease • Their families

10. Market Forces • Cost-effectiveness • Desire for control during last days of life

11. Regulations • Medicare certification • State licensure

12. Accreditation • JCAHO • CHAP • ACHC

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

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

15. Legal & Ethical Issues • Decision to accept hospice care • Rights of patients • Advance directives • Physician-assisted suicide • Survival past 6 months • Inequitable access

16. Management Qualifications • Not regularly licensed • Medicare “Conditions of Participation”

17. Management Challenges& Opportunities • Coordinating professional and volunteer staff • The emotional element • Cultural, religious, and ethnic differences • Community and philanthropic groups

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

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