in 1960s and 1970s, studies conducted in Great Britain, Canada, and the United States indicate
- caregivers did not always realize the pain experienced by dying
- did not have or think they had resources to help the dying
- dying worried that their wishes would be ignored
the Hospice Philosophy: 10 central principles
- Is a philosophy, not a facility
- It affirms life, not death
- strives to maximize present quality in living
- offers care to the patient and family unit
- holistic care
- offers continuing care to family members
- combines professional skills and human presence thru interdisciplinary teamwork
- 24 hr a day 7 days a week
- participants support other participants
- can be applied to life threatening illness, dying, death, or bereavement
four programs of care for persons who are coping with dying
- Acute care: hospitals
- Chronic care: long-term care facilities
- Home care: Home health care programs
- End-of-life care: Hospice programs
Acute Care: Hospitals
- short term facilities
- treat specific diseases and return ppl to society
- medical professionals who see themselves involves with curing ppl
- where 37% of people died
Chronic care: Long-term facilities
- provide place to live with help
- nurses 24 hour care
- paid for by medicare, medicaid, private insurance, and out of pocket payments
- less than 3% of older adults
- 20% of all deaths
Home care: home health care programs
- rapid growth over the past
- services in the home
- medicare, medicaid, and personal resources mostly pay for services
- offer care for dying but don’t claim specialized expertise
end of life care: hospice programs
- recent addition
- In London England first
- began in Connecticut in US
- 6,100 programs in all 50 states, District of Columbia, Puerto Rico, Guam, and virgin islands
Hospice programs in the United States?
- independent freestanding agencies
- hospital based
- home health agencies
- long term care facilities
Types of agencies of hospice in the US?
28 % nonprofit
68% for profit
4% governmental
medicare benefit in hospice programs
federal entitlement for 65 years or older
private insurance, medicaid, and charitable donations cover costs
bundled services in hospice programs
reimbursement is on a prospective flat rate
only services in the care plan are reimbersed
admission criteria for hospice programs
physician order
life limiting illness with 6 months or less to live
four basic categories of hospice services
- routine home care
- general impatient care
- continuous in home care
- short term in patient respite care
hospice programs served between _____ patients
1.5 and 1.6 million
about ____ American died while receiving hospice care
about ___ % died in a hospice facility
only ____ % dies in acute facility
1.2 million
32%
9.3%
about ___ % of patients in hospice were discharged alive
15%
about ____% of patients in hospice died in a place they call home
59%
average length of enrollment in hospice was ____ days
median length was ____
- 3 days
17. 4 days
hospice care patients were
% male %female
_____% were older than 65
____% were Caucasian
_____% were minority
- 3% male
- 7% female
84%
76%
24%
leading diagnosis in hospice programs
advanced cancer 36.6% dementia 14.8% heart disease 14.7% lung disease 9.3% debility unspecified 5.4%
volunteers of hospice
about 430,000 volunteers that worked 19 million hours giving support to patients and families.
bereavement car in hospice programs
provided for one year minimum to an average of 2 family members
92% of programs provide bereavement
finding in hospice care in the US
- extends life
- reduces medicare costs
- improved quality of care
- African Americans perceived disparities in care
pediatric palliative and hospice care
- a philosophy and organized method for delivering care to ill children and families
- focused on minimizing suffering
- provided with concurrent disease modifying therapy or as the main focus
