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PubMedDate not supplied

Initiating hospice care. Why, when, and how.

Hospice services are under utilized for a variety of reasons, even though such services are efficacious not only for the dying patient, but also for the family. Home healthcare nurses are well placed to encourage hospice-appropriate clients to accept hospice care. The nature and advantages of hospice care are described, and obstacles to its acceptance are identified. Case studies illustrate why, when, and how to initiate hospice care, and strategies are outlined to help home healthcare nurses to promote the timely use of hospice care.

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PubMedDate not supplied

Hospice care.

Hospice of Peel is a community-based hospice serving a population of between 750-800,000. Hospice care evolved to meet the needs of the terminally ill. It can, and does, take many forms, as you will see in the brief case scenarios detailed below. The individuals and situations described are real and typical of day-to-day-hospice care in a large urban environment. Both the sick and their families are in need of support and assistance to enable them to cope during this time of crisis in their lives. Increased awareness of hospice care is resulting in more and more people with a life-threatening or terminal illness and their families turning to hospice care.

Hospice Care↗
PubMed1992

Hospice care.

Hospice care is a philosophy and system of care for the terminally ill patient that accepts death in an affirmative way and provides palliative care and emotional support to dying patients and their families. The primary care physician needs to better understand the hospice concepts, the reasons for and growth of hospice care, and the depth of resources that can assist in equality management of the terminally ill.

Home Care Services↗
PubMed1999

New initiatives transforming hospice care.

Hospice care has been successful in serving a large segment of the terminally ill population in the United States. This article addresses a number of significant trends that may impact the future of hospice care. It is proposed that as many as one-third of those who die will not be in a position to make use of any end-stage program of care. Of the remaining, some will have difficulty being served by hospices due to uncertain prognosis and continued efforts at curative treatment. New models of caring for chronically terminally ill persons are being developed and are reviewed. A clearer definition of who ought to be served by hospice programs is encouraged.

Chronic Disease↗
PubMed1995

Feasible criteria for enrolling end-stage dementia patients in home hospice care.

Hospice care is considered appropriate for end-stage dementia patients (Luchins & Hanrahan, 1993), yet less than 1 percent of hospice patients have a primary diagnosis of dementia (Hanrahan & Luchins, 1995). This pilot study tested the feasibility of providing palliative care for dementia patients. A common eligibility requirement for admission to hospice is that the patient is likely to die within six to seven months. The uncertain survival time of dementia patients thus prevents access to hospice programs. Therefore, enrollment criteria were developed based on the characteristics of advanced dementia and a history of medical complications. With these criteria established, it was then possible to enroll 11 patients over two years. The enrollment criteria proved successful in that the median survival time was five months, with an average of seven months. Eight of the 11 patients died during the study. Hospice care was well accepted by family caregivers and appeared to meet the patient's needs.

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PubMed1997

Advances in hospice care.

Hospice care developed in part as a reaction to the impersonal and technology-dependent end-of-life care offered by modern medicine. Unique approaches to care that emphasize interdisciplinary team management of troublesome symptoms and the promotion of quality of life as defined by the patient, are finding their way into all aspects of health care. Symptom control measures have expanded to include chemotherapy, radiation therapy, and multimodal therapies. Both the development of a unique knowledge base and advances in research have fostered the integration of hospice and palliative care into mainstream medicine.

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PubMed1994

Guidelines for developing a new standard in hospice care.

Hospice care has been overlooked by many in the medical community. This is partly due to the nature of medical training; it could be overcome by the development of industry guidelines by which to measure quality of care.

Guidelines as Topic↗
PubMed1990

Measuring quality of life in hospice care.

Hospice care has developed along different paths in Europe, North America, and other cultures. Even within Britain, there is a diversity of hospice models--in-patient units, hospital support teams, day care and home care, with a broad range of clinical services offered. In assessing the clinical results of a hospice service, it is important to bear these differences in mind. Now that more formal, experimental controlled research is being conducted in hospices, there is an opportunity to evaluate quality of life in the same way that has become accepted in clinical cancer trials. The range of evaluations is reviewed, from purely physical assessment to psychological, social, and spiritual problems and the monitoring of bereavement. It is clear that new measurement instruments are needed, particularly for the social and spiritual problems of hospice patients and their families.

Hospices↗
PubMed1998

Relationships between symptom relief, quality of life, and satisfaction with hospice care.

Hospices were founded to alleviate suffering at the end of life. Quality improvement in hospices should, therefore, target patients' subjective assessments of their care and its outcomes. However, little is known about the relationships among subjective measures of care among hospice patients. The aim was to assess the relationships between hospice patients' physical and psychological symptoms, quality of life, and satisfaction with inpatient care. This was achieved with a prospective cohort study of 42 patients admitted to an Australian hospice's inpatient service during a two-month study period. The Edmonton symptom assessment system, McGill quality of life questionnaire, and a new measure of patients satisfaction with hospice inpatient care were used. It was shown that while there were marked variations in symptoms and quality of life scores, most patients were satisfied with their care. Satisfaction on the day after admission was lower among patients with worse quality of life scores (r = -0.40, P = 0.008), but there was no correlation with symptoms (r = -0.12, P = 0.43). Among the 26 patients (62%) with at least one subsequent inpatient interview, satisfaction was correlated with both worse quality of life (r = -0.51, P = 0.01) and symptoms (r = -0.41, P = 0.05). The symptom, quality of life, and satisfaction scales all had sufficient precision to identify patients with significant changes between the two interviews. It can be concluded that satisfaction with hospice care was associated with quality of life more than symptoms, although symptoms became important later during inpatient stays. Patients can assess their care and can provide valuable information for improving palliative care.

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PubMed2004

Ownership status and patterns of care in hospice: results from the National Home and Hospice Care Survey.

BACKGROUND: The number of for-profit hospices increased nearly 4-fold over the past decade, more than 6 times the growth of nonprofit hospices. Despite this growth, the impact of ownership on hospice care is largely unknown. We sought to assess differences in the provision of services to patients of for-profit and nonprofit hospices. METHODS: Using the 1998 National Home and Hospice Care Survey, we examined services used by patients (N = 2080) cared for by 422 hospices nationwide. We used multivariable ordered logistic and logistic regression to assess the effect of profit status on service use, adjusting for potentially confounding patient and organizational characteristics. We calculated point estimates adjusted for sampling weights and standard errors adjusted for the clustering of patients within hospices. RESULTS: In ordered logistic models controlling for organizational and patient factors, patients of for-profit hospices received a significantly narrower range of services (adjusted odds ratio [OR], 0.45; 95% confidence interval [CI], 0.22-0.92) than patients of nonprofit hospices. This result is driven by patients of for-profit hospices receiving significantly fewer types of hospice services that federal regulations term "noncore" or more discretionary services (adjusted OR, 0.34; 95% CI, 0.15-0.75). CONCLUSION: The pattern of care differs in for-profit and nonprofit hospices. As the industry develops a substantial for-profit presence, it is critical for clinicians and other healthcare professionals to be alert to the potential impact of profit status on the care their patients receive.

Female↗
PubMed1990

Goals of hospice care.

Hospice is a service and philosophy of care for terminally ill patients. Its roots extend back to the Middle Ages, but it was developed into its present form by Dr Cicely Saunders at St Christopher's Hospice in London. Hospices use teamwork and careful listening to the patient to achieve the following goals (whether the patient is at home or in an inpatient unit): (a) to relieve the pain and suffering of the terminally ill; (b) to make possible a "good" death; (c) to help the family; (d) to assist in the search for meaning.

Hospices↗
PubMed1997

Special care hospice units in nursing homes.

The emergence of hospice care in the nursing home is a trend about which we have virtually no information. As a first step to a more comprehensive examination of this phenomenon, we provide a descriptive analysis of nursing homes that contain special care hospice units and a preliminary analysis of the determinants of nursing homes with special care hospice units. We found that being small, being a proprietary facility, being part of a chain, and being located in a more competitive environment are significantly related to having a hospice special care unit.

Economic Competition↗
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↗
PubMedDate not supplied

A model long-term care hospice unit: care, community, and compassion.

The purpose of this study was to investigate the factors that influenced the quality of care of terminally ill nursing home residents on a hospice unit in a city and county long-term care facility. The findings disclosed that the hospice team had created a cultural environment in which care, community, and compassion were the predominant components of their philosophy of palliative care. Communication at all levels-among staff, family, friends, and residents-was found to be a core hospice value, essential to community development. The results of this study illustrate that exemplary palliative care can be provided when an interdisciplinary team is dedicated to creating an environment where the principles of palliative care can be fully implemented. The authors conclude that there is a developing role for geriatric nurses to participate in further defining and providing palliative care for older people in their homes, hospitals, nursing homes, and residential care.

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PubMed2004

Measuring hospice care: the National Hospice and Palliative Care Organization National Hospice Data Set.

Hospice has seen rapid growth in recent years, but there is a lack of consistency among hospices when it comes to compliance with standards of care. Consequently, hospices vary in performance and in services they provide. With state hospice organizations, the NHPCO developed a National Data Set (NDS) intended to understand demographics, practices, and outcomes; illustrate industry effectiveness; facilitate communication of industry legislative needs; and to support agency performance and improvement. Our paper describes development of the NDS and data that are being collected, and summarizes key findings from the 2000, 2001, and 2002 NDS. The data collection process, which began in 1999, has evolved substantially over a 4-year period to the point that we believe the 2002 NDS represents a well-designed core that will receive only minor modifications annually. This database will be invaluable for comparative audit, clinical practice and managing services because only that which is measured can be improved.

Data Collection↗