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Chapter 8. Hospice Care

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

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Chapter 8. Hospice Care

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  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.

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