Hospice Care Thesis

Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.

On May 10, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a Proposed Rule entitled FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting Requirements; and Updates on Payment Reform [CMS-1449-P]. This rule contains important information, including proposed hospice rates for 2014 (no good news here, rates are going down), changes to the hospice quality reporting program, alterations to the cost report, and an update to hospice payment reform options.

Great strides have been made to improve end-of-life care through palliative care and hospice programs, but sometimes that’s just not enough. In America, the care that is offered to the elderly and the chronically ill is less than ideal. Statistics show that an

The importance of end of life issues and decisions are now being discussed at the time of admission to most acute care and long term acute care facilities. More attention is being placed on these specific decisions to ensure that the patient's

A survey was conducted in 2000 on more than 9,000 patients discharged from more than 2,000 hospices on the services they received (Carlson, 2007). It revealed that 22% of them received five major palliative care services, which varied among the hospices. These palliative care services were nursing care, physician care, medication management, psychological care, and caregiver support. Approximately 14% of the hospices provided all five services and 33% provided only one or two services. Only 59% of these patients received medication management services. These included administering medication, dispensing correct dosages, and setting and following dosage schedule.

Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely

Medicare Hospice Benefit also is related to integrity, the benefit provides social workers to the individual, and the patient directly benefits from the social worker. The social worker helps them navigate their new health care choice of hospice, and educates them on their services and rights. They also educated the patients and family on community resources to help fill in the gaps of need. Human relationships are another important value that is observable with the Medicare Hospice Benefit. The benefit allows the patient to develop a working relationship with their personal health care team. The individual is provided with a social worker, and the social worker also helps mediate any issues with the relationship of other team members, and even helps promote healthy relationships between the team, patient, and family. Finally, Social Justice is another component of the hospice benefit; this allows patients of lower income to have access to better health care. Hospice will provide them with care that they might not have known about or that might not have been available in their

In contrast to the costs of standard medical care, hospice care provides an alternative that is both cost effective and caring. Unfortunately, it is actually difficult to quantify the cost savings associated with hospice care due to the fact that comparing costs during the last year of life are impacted by the variability in the length of hospice use. A study at Duke University went to extensive lengths to provide a comparison that provided an effective method for accurate comparisons. The comparison showed a reduced average Medicare expenditure of $2,309 per person from the time hospice care was initiated in comparison to the same situation handled through standard medical methods (Taylor, Ostermann, Houtven, Tulsky, & Steinhauser, 2007). The amount of cost savings varied depending on the primary health condition and the

Medicare covers hospice if you have a terminal illness and aren’t expected to live more than six months. However it doesn’t cover grief counseling.

Hospice care is a model of care that focuses on relieving symptoms and supporting patients with a life expectancy of six months or less (Altshuler, 2013). For most nurses, caring for a dying elder (individual aged 65 years and above) is a discrete, time-limited experience that begins with first contact, often in a hospital, emergency room, or long term care facility, and ends with the death itself (Phillips & Reed, 2008).

Hospice care has not been around for very longs but it is one of the fastest growing medical fields in the country, with over 1.58 million patients being cared for in 2010 alone. Hospice is an important part of caring for terminally ill patients and helps the families and loved ones to grieve.

End of Life Care Planning is a controversial topic that is huge dilemma in healthcare. The average Medicare expenditures per person over the last two years of life was $102, 939.00 (Harter, 2015). One quarter of traditional Medicare spending for health care is for services provided to Medicare beneficiaries in their last year of life (The Henry J. Kaiser Family Foundation, 2016). Nurses deal with ethical dilemmas when caring for patients at the end of life. Nurses are responsible in minimizing unwanted treatment and patient suffering, which can sometimes be interfered by what family members want and the patient wishes (American Nurses Association [ANA], 2012). This paper will go over why end of life care planning should and should be covered as a covered expense.

Many terminally-ill patients give up hope when treatments are no longer available to help them and hospice care is given to them as an option. However, hospice care has proven itself to provide the best quality care for the last six months of the dying. The purpose of hospice is to provide the best care for terminally-ill patients at the end stage of their lives. Hospice offer services to support too many aspects a patient’s life such as medical, legal, spiritual care. Hospice includes art therapists, music therapists, and certified chaplains on the palliative team.

Rather, the hospice staff and the patient understand the patient is going to die and no further treatment options are available. Therefore, hospice care centers direct their attention towards providing a dignified ending to a patient’s life by delivering comfort and emotional support through a palliative care approach designated to alleviate pain and emotional distress. For example, at Hospice of Dayton, each patient residing at the care facility is provided their own room where their family is able to stay with them and the patient is able to receive the pain management and emotional support they need to die a little closer to peace and security. Additionally, at Hospice of Dayton, there are full-time doctors, nurses, counselors, and religious support-staff that provide patients the physical treatment they need to minimize their pain, as well as the emotional support they need to live the last moments of their life with dignity and emotional well-being. Most importantly, Hospice of Dayton because of its volunteers. Volunteers provide the invaluable service of listening, crying, and laughing with those who may not necessarily have someone to spend time with, while they undergo their long, arduous, and painful experience of

Hospice is a component of palliative care. A person does not necessarily have to be dying in order to see a palliative care specialist. This is where the service is often underutilized in the hospital. In the 18 months I have been a nurse, I have cared for many patients with chronic illnesses who have dealt with symptoms that have severely impacted their quality of life. Most of the time, it seems as though the patient’s care providers are interested in treating the patient’s acute problems. My experience has been that the symptoms are often overlooked or are being treated in a manner that is to the dissatisfaction and discomfort of the patient.