1. Long-Term Care: Managing Across the Continuum (Second Edition)
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.