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At least 19 recordsLinked to original sources
PubMed1998

An update on efforts by the hospice community and the National Hospice Organization to improve access to quality hospice care.

More than a year has passed since the Center to Improve Care of the Dying and the Corcoran Gallery of Art sponsored the symposium entitled: A Good Dying: Shaping Health Care for the Last Months of Life. Using the National Hospice Foundation sponsored exhibition, Hospice: A Photographic Inquiry, as a backdrop, the symposium included presentations on the current state of hospice care as well as the obstacles that limit access to hospice care. This article represents an update on many of the activities of the National Hospice Organization and the greater hospice community as we continue to improve access to quality hospice care.

Health Services Accessibility↗
PubMed1995

Access to hospice programs in end-stage dementia: a national survey of hospice programs.

OBJECTIVE: Because care of end-stage dementia is a significant clinical problem for which alternative modes of care are needed, this study examined the extent to which hospice programs served dementia patients. DESIGN: A survey of 1694 hospices with 1184 respondents (70%). PATIENTS: Identified patients had end-stage dementia, with no concurrent terminal illness. MEASURE: The proportion of end-stage dementia patients in hospice was measured. RESULTS: Fewer than 1% of hospice patients had a primary diagnosis of end-stage dementia, and only 21% of the hospices served such patients. However, 7% of hospice patients had a dementia secondary to another terminal illness, and 56% of the hospices served such patients. For 80% of the hospices, the major problem in serving dementia patients was the difficulty in predicting their survival time. A higher proportion of for-profit hospices served dementia patients (42%) compared with non-profit programs (22%) or public programs (15%), P < .001. CONCLUSIONS: A national survey of hospices revealed that few patients with primary dementia are currently treated by these programs, unless they have other terminal illnesses. An inability to predict survival was the major reason offered to explain this phenomenon. The higher percentage of patients with secondary dementia in hospice suggests that dementia per se does not make hospices care unfeasible. Similarly, the high proportion of for-profit hospices that enrolled patients whose dementia was primary implies the fiscal feasibility of providing hospice care for these patients. Further study is needed concerning the determinants of survival time in end-stage dementia.

Dementia↗
PubMedDate not supplied

Not ready for hospice: characteristics of patients in a pre-hospice program.

CONTEXT: There are many patients with terminal illness for whom hospice care would be appropriate, but they either never enroll or enroll very late. In a pre-hospice program designed to help patients make the transition into hospice, we observed that many patients did not make the transition. OBJECTIVES: To understand more about the transition to hospice and the functions of a pre-hospice program, this paper compares patients who enrolled in hospice with those who died in the pre-hospice program. DESIGN, SETTING, AND PATIENTS: Data were collected from a retrospective review of the charts of 123 consecutive patients who enrolled in a prehospice program between January 1, 1995, and December 31, 1996. MAIN OUTCOME MEASURES: The patient's decision to transfer to home hospice or (perhaps, by not making a decision) to remain enrolled in the pre-hospice program until death. RESULTS: At the end of the research period, 38 patients had transferred to hospice and 36 had died without transfer. The remaining 49 patients had uncertain outcomes at the end of the research period. Patients who transferred to hospice were older (P = .02) and more likely to have secondary insurance (P = .05). In addition, those who enrolled in hospice were more likely to live alone (P = .03) and have psychosocial concerns noted by staff on admission (P = .05). CONCLUSIONS: Many patients died in this program that was designed only for transition to hospice. We found statistically significant differences characterizing the groups associated with transferring to hospice. Further studies to find out why these differences exist will be important in order to provide excellent end-of-life care for more people.

Adaptation, Psychological↗
PubMedDate not supplied

Is there congruence in hospice nurses' view of their patients' quality of life and their hospice patients' view of their own quality of life?

Since the development of the hospice movement in the United States, care of the terminally ill has undergone vital change. This change involves the alternative of home care for the terminally ill. It allows the patients, the primary caregiver, and the rest of the family to be in control of care. As stated by Masters, hospice is unique in that the patient and family controls the environment, and lifestyle, including treatment modalities, more than in any other concept in health care. Hospice was developed to give people with a terminal illness an option to traditional medicine. Hospice is a concept of care that has been established to improve the quality of life of the terminally ill. Therefore, the ultimate goal of hospice care is to enhance the quality of life of patients with terminal illness, mainly cancer. In the hospice setting, the nurse applies a holistic approach when planning and providing primary care. The nurse becomes increasingly more knowledgeable about the problems and strengths of the patient and family to whom he/she is caring for. The nurse must make the transition in her philosophy from cure-to-care in hospice, and symptom control being the nurses' priority in order to enhance the patients quality of life. Curtis and Fernsler explain that hospice care focuses on helping patients to communicate effectively and to share life agendas with their primary caregiver and the hospice nurse. These researchers continue to state that these efforts promote congruence between patient, primary caregiver, and the hospice nurses' view of the patients quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMedDate not supplied

[Development of hospice care service program about advanced cancer patient. I--The effect of hospice education programs on the death orientation].

The purpose of this study was to investigate what effect providing the hospice care team with hospice education programs had on the death orientation. The subjects of study were 28 volunteers, 14 nurses, 30 clergies who registered on hospice education programs from Aug. 6th, 1996 to May 20th, 1997. The data were analysed by descriptive analysis, ANOVA, Duncan test, paired t-test. The results of the study can be summarized as follows: 1. The degrees of death orientation were 85.70 in volunteers group, 84.31 in nurses group, and 73.00 in clergies group. So, clergies group has more positive death orientation than others (F = 6.33, p = .000). The degree of death orientation showed significant differences between age groups (F = 5.78, p = .002), and religiosity (t = 3.92, p = .000). There were no significant differences between the degree of death orientation and the others general characteristics of subjects. 2. The mean of death orientation was 80.04 before hospice education programs, but was 75.56 after hospice education programs (t = 3.92, p = .000). In conclusion, the subjects who received the hospice education programs showed the positive change in the degree of the death orientation. Therefore, it has been judged that education programs has been prerequisite in positive death orientation for hospice care. Furthermore, all of the hospice care members those who complete the hospice education program, will be performed efficient hospice care intervention for dying patients and their families.

Analysis of Variance↗
PubMed2001

Family caregiving in hospice: effects on psychological and health functioning among spousal caregivers of hospice patients with lung cancer or dementia.

INTRODUCTION: Caregiving stress has been found to lead to depression and poor health among caregivers compared with age-matched non-caregiving controls. However, most of these studies have focused on dementia caregivers, and have not included hospice caregivers. The aim of this project was to assess the impact of caregiving stress on psychological and health functioning among spousal caregivers of hospice patients, in contrast to demographically matched non-caregiving controls. A secondary aim was to compare the caregiving stressors and psychological and health functioning between spousal caregivers of hospice patients with dementia versus lung cancer. METHODS: Forty spousal caregivers of hospice patients with dementia, and 40 spousal caregivers of hospice patients with lung cancer, were compared on admission to hospice, using measures of caregiving stressors, depression, life satisfaction, and physical health, with a sample of 40 demographically equated control subjects. RESULTS: Both groups of caregivers showed higher depression, lower life satisfaction and poorer physical health (p < .05) compared with non-caregivers. Over half of all caregivers evidenced clinically significant levels of depression, with rates of depression about three times the prevalence found in community samples of older adults. CONCLUSIONS: While family caregivers of hospice patients with dementia and lung cancer face very different objective stressors, the negative psychological and health impacts on the caregiver are marked and comparable across diagnosis. Hospice family caregivers are at high risk for both psychological and physical health disorders, and caregiver depression and health problems should be systematically assessed and treated by the hospice team.

Aged↗
PubMed1994

Hospice for aged persons without cancer: the experience of the Hampshire County (MA) hospice.

Hospice is an option for patients with terminal illness of all types. The advent of the Medicare hospice benefit has led to a rise in numbers of hospice programs as well as hospice expenditure. Terminal care provided through hospice has a demonstrable cost advantage over conventional terminal care. This difference may dissipate as Medicare hospice expenditure continues to rise. An individual hospice program can define its mission within broad guidelines. A program electing to serve all terminally ill patients regardless of diagnosis can occasionally expect to be cast in the role of long term care-provider when six-month survival is exceeded. Precision in prediction of six-month survival would benefit patients and remove one major obstacle to participation by many primary care physicians. Prognostic techniques are being developed that, thus far, have proven no better than physician judgement in assigning risk or predicting survival. Hospice may provide a setting for clinical research of prognostication. The interdisciplinary team can facilitate hospice care and provide support to individual team members. Care of terminally ill non-cancer patients may require added human resources and alteration of team structure to cope with increased service needs and lengths of stay which may be likely to exceed those of cancer patients.

Aged↗
PubMed1998

Comparison of the high-tech service delivery experiences of hospice and non-hospice home health providers.

This study examined the degree to which national samples of hospice and non-hospice home health care agencies (N = 154) present different organizational profiles and grapple with different patient capacity issues when delivering technology-enhanced services to incapacitated elderly. Hospice agencies employ more part-time staff, make more in-home visits, see more high-tech patients, and provide a wider range of high-tech services than non-hospice providers. Factor analysis of index data confirms that hospice staff have more experience (p < .05) addressing the legal/ethical dimensions of care. Specifically, hospices deal with "right to die" issues more often (p < .05), but not with "delegation of authority" and "patient rights" issues. More agencies of both types have policies for handling decisions about life-sustaining treatment than for dealing with patients having questionable decision-making capacity. Needed agency policies for dealing with limited patient decision-making capacity in hospice and non-hospice home care agencies are reviewed.

Decision Making, Organizational↗
PubMed1998

Issues in prison hospice: toward a model for the delivery of hospice care in a correctional setting.

This paper examines issues in prison hospice care based on the author's nine years experience as a prison hospice worker and trainer and on data gathered by the National Prison Hospice Association (NPHA) from a number of federal and state prison medical facilities with operational or developing hospice programs, including both scatter-bed and hospice unit models, employing inmate hospice volunteers and the services of outside community hospice agencies and volunteers. The paper discusses DNR orders and curative vs. palliative care decisions, pain management, AIDS care, interdisciplinary care teams, staff and volunteer training and supervision, and the need for compassionate early release and community placement programs. The author proposes a set of preliminary guidelines for the delivery of hospice care in the correctional setting.

Acquired Immunodeficiency Syndrome↗
PubMed1990

What do hospices do? A survey of hospices in the United Kingdom and Republic of Ireland.

OBJECTIVE: To obtain baseline information about hospice clinical activity. DESIGN: Survey of hospices by postal questionnaire and telephone interview. SETTING: 98 Hospices in the United Kingdom and Republic of Ireland of 111 that had a named matron or senior nurse, including 17 funded by NHS and 81 independent units. PARTICIPANTS: Hospice matrons or nursing sisters in charge, to whom the questionnaire was addressed. RESULTS: Median age of hospices was 7 years, and those built during the past seven years had a median of 12 inpatient beds. All NHS hospices had some input from a medical consultant whereas 12 (15%) of independent units did not. 72 Hospices had home care teams and 12 of 20 of these randomly contacted by telephone provided 24 hour cover. The median number of whole time equivalent nurses was four, but 6 (30%) of teams did not include a doctor. Wide variations were found in discharge rates (range 1-76%) and throughput (1.7-31.8 patients/bed/year). In units with a full time consultant or medical director throughput was greater and more patients had palliative surgery and became organ donors than in units without (45/48 v 38/50 and 45/48 v 25/50, respectively). With the exception of pulmonary function tests and insertion of nasogastric tubes and indwelling epidural catheters, tests and procedures were used by over 90% of hospices, although sometimes the patient had to be transferred elsewhere. CONCLUSIONS: Respondents from units with a full time consultant or medical director were more likely to choose a "technical" description of their unit, such as "a pain relief centre" than those without, who favoured non-technical descriptions. These differences are likely to increase with the appointment of more fully trained consultants in palliative medicine.

Home Care Services↗
PubMedDate not supplied

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↗
PubMed1998

An overview of home health and hospice care patients: 1996 National Home and Hospice Care Survey.

OBJECTIVE: This report presents numbers and percents of home health and hospice care agencies, their current patients, and their discharges. Agency characteristics include type of ownership, region, certification, location, and affiliation. Patient and discharge characteristics include age, sex, race, marital status admission diagnoses, and procedures. METHODS: The data used for this report are from the National Center for Health Statistics' 1996 National Home and Hospice Care Survey. This is a sample survey through which data are collected on the use of home health and hospice care agencies in the United States. RESULTS: During 1996, there were an estimated 2.5 million current patients and 8.2 million discharges from 13,500 home health and hospice care agencies in the United States. The agencies tended to be proprietary, certified by Medicare and Medicaid as a home health agency, and located in a metropolitan statistical area. Almost half were part of a chain or group of agencies. The home health and hospice care patients and discharges tended to be 65 years of age and over, female, white, and married or widowed. The most common diagnoses for home health care patients were diseases of the circulatory system, and the most common diagnoses for hospice care patients were malignant neoplasms. About a third of the home health care patients and about a fifth of the hospice care patients had a surgical or diagnostic procedure related to their admission for care. The most common procedures for home health care patients were operations on the musculoskeletal system, and for hospice care patients they were miscellaneous diagnostic and therapeutic procedures.

Adult↗
PubMed1999

Hospice in nursing homes: a facility-level analysis of the distribution of hospice beneficiaries.

Since 1989, the Medicare hospice benefit has been available to terminally ill individuals residing in nursing homes. We first describe the evolution and nature of hospice care for nursing home residents. We then utilize recent On-line Survey and Certification of Automated Records data on a national sample of Medicare/Medicaid certified nursing homes, merged with hospice Provider of Service and Area Resource File information, to examine the distribution of hospice beneficiaries in nursing homes. Bivariate analyses provide descriptive comparisons of homes with 0%, 0.1-4.9%, and 5%+ residents on the hospice benefit. Multinomial logistic regression reveals the influence of organizational, market, and environmental factors on the proportion of beneficiaries in nursing homes. Results indicate that significant numbers of homes have hospice patients and that these institutions may have strong incentives to convert residents to the Medicare hospice benefit.

Hospice Care↗
PubMedDate not supplied

A longitudinal study of pain in hospice and pre-hospice patients.

Pain continues to be a very formidable foe in the care of the hospice patient. The incidence among hospice admissions may range from 50 to 80 percent. With such a high initial incidence of pain, the rapidity with which pain can be controlled becomes a very high priority for the hospice effort. The assessment and management of pain in a home-based hospice program presents some unique problems--and opportunities, in that much of this work is done by hospice nurses on site, rather than by the physician, who might remain quite removed from the process. In the study described below, 250 consecutive admissions to either a hospice, or pre-hospice (bridge) program were assessed for pain on admission. Those with pain scores of 5 or greater (on a 1 to 10 scale) were followed daily for 15 days by phone to reassess pain and treatment effects. Of the 250 consecutive patients surveyed, 41 (16 percent) gave pain scores of 5 or greater. Mean pain scores for the 41 patients dropped to < 5 within 24 hours of admission.

Aged↗