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1
Plotzke, Michael, Thomas Christian, Kim Groover, Zinnia Harrison, Ihsan Abdur-Rahman, and Cindy Massuda. "Construction and Performance of the Hospice Care Index Claims-Based Quality Measure." Innovation in Aging 5, Supplement_1 (December 1, 2021): 62. http://dx.doi.org/10.1093/geroni/igab046.239.
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Abstract As part of the Medicare Hospice Benefit (MHB), hospices submit claims containing information that allows policy makers to assess hospice quality, help policy makers improve the MHB, and increase patients’ experiences of care. We examine ten different hospice quality indicators related to the provision of services and patterns of live discharge. We calculated indicators using 100% Medicare fee-for-service (FFS) claims from October 1, 2018 through September 30, 2019. A hospice’s total score among all ten indicators is referred to as their Hospice Care Index (HCI), with a possible high score of 10. We examined all hospices with at least 20 discharges. After exclusion, we examined 4,155 hospices representing 1,562,003 beneficiaries. Most hospices earn a high HCI score: over 85% of hospices had scores of eight or more. At the same time, there were some lower scoring hospices: one in ten hospices scored seven on the index, and the remaining 4.9% scored six or lower. We find that on average hospices with higher HCI scores have better Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice ratings. Among hospices with a score of ten, 85.1% of caregivers reported they would definitely recommend the hospice vs. 82.9% of caregivers of patients receiving treatment from hospices with a score of seven or less. Using the HCI, the Centers for Medicare and Medicaid Services and hospice patient caregivers can assess hospices across a broad set of indicators. Policymakers and hospices should monitor these ten indicators to understand their performance relative to peers.
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Bedard, Louise, Kelly Marie Procailo, Sam Beusterien, Kleanthe Kolizeras, Cindy Straight, and Jennifer J. Griggs. "Hospice and medical oncology collaboration in a statewide collaborative." Journal of Clinical Oncology 37, no. 27_suppl (September 20, 2019): 83. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.83.
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83 Background: Hospice enrollment (QOPI measure 42) has consistently been lower in practices in the Michigan Oncology Quality Consortium (MOQC), a collaborative of nearly all medical oncology practices. MOQC enrollment has been 47% during CY2014-18 compared to national QOPI, which ranged from 53 to 59% during the same time period. We describe our approach to improve hospice use in the care of oncology patients. Methods: MOQC providers suggested that hospices across the state be involved in facilitating patient-centered approaches to increase enrollment of patients to hospice care. Beginning in Spring 2018, hospices in each of the six MOQC regions were invited to participate in standing regional meetings as well as teleconferences (one per region). Root cause analyses identified barriers universal and specific to that region. Each region was asked to choose at least one hospice-oncology project. Results: Thirty hospices are participating, including the five largest hospices in the state and hospices associated with the largest healthcare systems. Barriers to hospice include lack of hospice services in rural areas, in complete understanding among oncologists about what hospice can provide, resistance from patients and families due to misperceptions, communication issues with oncologists, between practices and hospices, and/or with patients once referred to hospices, lack of appreciation by hospice providers regarding the long standing relationship between patients and oncologists, and variation in use of palliative treatment such as radiation therapy. A total of 13 projects have been selected by the hospices and oncology practices to be developed by the regions. Once harmonized by the Coordinating Center, the projects will be shared across the state. The Coordinating Center is addressing lack of access to hospice in remote rural areas. Conclusions: Our partnership between oncology practices and hospices across a statewide collaborative has been a mutually beneficial relationship that promises to address some of the key systemic barriers to hospice enrollment. Feedback has indicated that communication between oncology and hospice providers is becoming more seamless and that referrals to hospice have increased.
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Hughes, M. Courtney, and Erin Vernon. "Closing the Gap in Hospice Utilization for the Minority Medicare Population." Gerontology and Geriatric Medicine 5 (January 2019): 233372141985566. http://dx.doi.org/10.1177/2333721419855667.
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Background: Medicare spends about 20% more on the last year of life for Black and Hispanic people than White people. With lower hospice utilization rates, racial/ethnic minorities receive fewer hospice-related benefits such as lesser symptoms, lower costs, and improved quality of life. For-profit hospices have higher dropout rates than nonprofit hospices, yet target racial/ethnic minority communities more through community outreach. This analysis examined the relationship between hospice utilization and for-profit hospice status and conducted an economic analysis of racial/ethnic minority utilization. Method: Cross-sectional analysis of 2014 Centers for Medicare & Medicaid Services (CMS), U.S. Census, and Hospice Analytics data. Measures included Medicare racial/ethnic minority hospice utilization, for-profit hospice status, estimated cost savings, and several demographic and socioeconomic variables. Results: The prevalence of for-profit hospices was associated with significantly increased hospice utilization among racial/ethnic minorities. With savings of about $2,105 per Medicare hospice enrollee, closing the gap between the White and racial/ethnic minority populations would result in nearly $270 million in annual cost savings. Discussion: Significant disparities in hospice use related to hospice for-profit status exist among the racial/ethnic minority Medicare population. CMS and state policymakers should consider lower racial/ethnic minority hospice utilization and foster better community outreach at all hospices to decrease patient costs and improve quality of life.
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Townsend, Apollo, Alice L. March, and Jan Kimball. "Can Faith and Hospice Coexist." Journal of Transcultural Nursing 28, no. 1 (July 9, 2016): 32–39. http://dx.doi.org/10.1177/1043659615600764.
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African Americans are twice as likely as Caucasian Americans to choose aggressive hospital treatment when death is imminent. Repeat hospitalizations are traumatic for patients and drain patient and health system resources. Hospice care is a specialized alternative that vastly improves patient quality of life at end-of-life. This study was conducted to determine if hospices partnering with African American churches to disseminate hospice education materials could increase utilization of hospice services by African Americans. Members of two African American churches ( N = 34) participated in focus group discussions to elicit beliefs about hospice care. Focus group transcripts were coded and comments were grouped according to theme. Six themes were identified. Lack of knowledge about hospice services and spiritual beliefs emerged as the top two contributing factors for underutilization of hospice services. Study findings support partnerships between hospices and African American churches to provide hospice education to the African American community.
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Swietlik, E., and A. Doboszynska. "History and organization of palliative care in Poland." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e20749-e20749. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e20749.
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e20749 Beginning of the hospice care in Poland is associated with democratic opposition in the eighties of the XX century and social movement Solidarity. In 1978, C. Saunders visited Gdansk, Warsaw, and Krakow, supporting an organization of palliative care in Poland. Polish hospice care, similarly to other countries,originated from the necessity of special care of terminally ill cancer patients. Palliative care societies, initially informal, then registered formally, emerged in Poland in 1981. Hospices, both institutional and house hospice care, came into being in all larger cities in Poland to the nineties of the XX century. In 1991, National Forum of the Hospice Movement was founded. This Forum, gathering the majority of hospices, is actually transformed into the association of societies: Forum of the Polish Hospices. In the nineties of the XX century, professional palliative care developed. Since 1998, specialization in the palliative care for both physicians and nurses is available. From the very beginning, hospice care based on the volunteers gathered at the Roman Catholic parish and several priests first organized palliative care. In 1991, The Sejm (lower chamber of the Polish Parliament) passed the law Health care institutions, enabling various societies and associations to establish health care institutions, whereas the law The Social Insurance Act (1997) gives an opportunity to get financial means for hospice care from the State. Actually, there are hospices acting on voluntary service (the number of such hospices decreases), partial voluntary service and also paid employees, and institutions which activities are based on full-time employment and financed by the National Health Fund. About 130 non-profit societies and hospice foundations both secular andchurch exist in Poland. Non-public health care institutions founded 99 hospices. About 70 hospices (both public and private) are stationary. No significant financial relationships to disclose.
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Leiter, Richard E., Charles T. Pu, Emanuele Mazzola, and Rachelle E. Bernacki. "A HOSPICE COLLABORATIVE NETWORK TO IMPROVE SERIOUS ILLNESS CARE IN A LARGE HEALTHCARE SYSTEM." Innovation in Aging 3, Supplement_1 (November 2019): S132. http://dx.doi.org/10.1093/geroni/igz038.481.
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Abstract The quality of hospice care in the United States varies significantly, yet healthcare systems lack methods to comprehensively evaluate and stimulate quality improvement in organizations that serve their patients. Partners HealthCare, an integrated healthcare system located in Eastern Massachusetts, sought to create a high-quality hospice collaborative network based on objective and quantitative criteria obtained from public reporting as well as the hospice itself. Through a modified Delphi procedure, clinicians, administrators, and data scientists developed a set of criteria and a scoring system focused on three areas: organizational information, clinical care quality indicators, and training and satisfaction. All Medicare-certified hospices in good-standing in Massachusetts were eligible to participate in a request for information (RFI) process. We blinded all hospice data prior to scoring and invited hospices scoring above the 15th percentile to join the collaborative for a 2-year initial term. Of 72 eligible hospices, the majority (53%) responded to the RFI, of which 60% submitted completed surveys. Hospices could receive up to 23.75 points with scores ranging from 2.25 to 19.5. The median score was 13.62 (IQR: 10.5-16.75). For the 19 hospices scoring above the 15th percentile, scores ranged from 10.0-19.5 (median: 14, IQR: 11.1-16.9). There was no association between quality score and continuous (Spearman’s correlation 0.24, p=0.27) or dichotomous (Wilcoxon rank sum test p=0.13) measures of hospice size. The hospice collaborative network is one healthcare system’s initial attempt to effectively leverage its influence and relationships to improve hospice quality for the benefit of its seriously ill patients and their families.
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Brody, Abraham A., Shih-Yin Lin, Catherine E. Schneider, Alycia A. Bristol, Kimberly E. Convery, and Victor Sotelo. "DEVELOPING AND IMPLEMENTING ALIVIADO DEMENTIA CARE IN HOSPICES: CHALLENGES ENCOUNTERED AND LESSONS LEARNED." Innovation in Aging 3, Supplement_1 (November 2019): S363. http://dx.doi.org/10.1093/geroni/igz038.1325.
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Abstract Hospice was originally developed to care for individuals with metastatic, solid-tumor cancers. While advanced ADRD is now the primary illness in approximately 19% of the hospice population and presents as a co-morbid condition in many more, little evidence-based work has been performed to retool hospice to care for persons with ADRD and their caregivers. Aliviado Dementia Care-Hospice Edition is a systems level change program consisting of hospice workforce training, an implementation toolbox, and agency-wide workflow changes. Aliviado seeks to improve the quality of life for persons with ADRD and their caregivers receiving hospice, focused specifically on BPSD and pain assessment and management. In developing a coalition of hospice agencies and implementing this pragmatic intervention, we discuss our solutions to overcoming a number of barriers, including varying electronic health records, performing culture change with a disseminated workforce, scaling to 25 hospices, and working with some hospices who lack experience performing research.
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Langen-Datta, Shalene, Helen Wesson, Joanna Flemming, Abi Eccles, Catherine Grimley, Jeremy Dale, Kathryn Almack, et al. "The impact of Covid-19 pandemic on hospices: A systematic integrated review and synthesis of recommendations for policy and practice." AMRC Open Research 4 (October 26, 2022): 23. http://dx.doi.org/10.12688/amrcopenres.13105.1.
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Background: The Covid-19 pandemic resulted in the development of numerous recommendations for practice and policy for specialist palliative care provided by hospices in United Kingdom (UK), as hospices were significantly affected by the pandemic and protections put in place. The aim of this review is to identify and synthesise recommendations or implications for policy and practice that have been generated for adult hospice specialist palliative care during the first 24 months of the Covid-19 pandemic. Methods: AMED, BNI, CINAHL, EMBASE, EMCARE, HMIC, Medline, PsycINFO, PubMed databases were searched for peer-reviewed papers, as well as hand searchers for grey literature. Literature relating to hospices and Covid-19 in the UK were included and a thematic synthesis of recommendations for hospice policy and practice was undertaken. Results: 858 articles were identified with 12 meeting the inclusion criteria. Fifty-eight recommendations or implications were identified: 31 for policy, 27 for practice, and 10 covering both. Recommendations were organised under ten themes. There were several recommendations seeking to secure hospice resources to mitigate the short-term impact of the pandemic, as well as those focused on longer-term implications such as core funding. The impact of the pandemic on the quality of hospice care was the focus for numerous recommendations around improving integration of hospice care in the community, provision of bereavement support and better use of Advance Care Plans (ACP). However, there were significant gaps related to carer visitation in hospices, inequities of palliative care, or hospice-at-home services. Conclusion: The Covid-19 pandemic and protections exposed several ongoing policy and practice needs, especially around hospice resources, while generating novel issues for hospices to address. Significant policy gaps remain to be addressed to mitigate the impact of the pandemic on the quality of hospice specialist palliative care.
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van Langen-Datta, Shalene, Helen Wesson, Joanna Fleming, Abi Eccles, Catherine Grimley, Jeremy Dale, Kathryn Almack, et al. "The impact of Covid-19 pandemic on hospices: A systematic integrated review and synthesis of recommendations for policy and practice." Health Open Research 4 (January 5, 2023): 23. http://dx.doi.org/10.12688/amrcopenres.13105.2.
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Background: The Covid-19 pandemic resulted in the development of numerous recommendations for practice and policy for specialist palliative care provided by hospices in United Kingdom (UK), as hospices were significantly affected by the pandemic and protections put in place. The aim of this review is to identify and synthesise recommendations or implications for policy and practice that have been generated for adult hospice specialist palliative care during the first 24 months of the Covid-19 pandemic. Methods: AMED, BNI, CINAHL, EMBASE, EMCARE, HMIC, Medline, PsycINFO, PubMed databases were searched for peer-reviewed papers, as well as hand searches for grey literature. Literature relating to hospices and Covid-19 in the UK were included and a thematic synthesis of recommendations for hospice policy and practice was undertaken. Results: 858 articles were identified with 12 meeting the inclusion criteria. Fifty-eight recommendations or implications were identified: 31 for policy, 27 for practice, and 10 covering both. Recommendations were organised under ten themes. There were several recommendations seeking to secure hospice resources to mitigate the short-term impact of the pandemic, as well as those focused on longer-term implications such as core funding. The impact of the pandemic on the quality of hospice care was the focus for numerous recommendations around improving integration of hospice care in the community, provision of bereavement support and better use of Advance Care Plans (ACP). However, there were significant gaps related to carer visitation in hospices, inequities of palliative care, or hospice-at-home services. Conclusion: The Covid-19 pandemic and protections exposed several ongoing policy and practice needs, especially around hospice resources, while generating novel issues for hospices to address. Significant policy gaps remain to be addressed to mitigate the impact of the pandemic on the quality of hospice specialist palliative care.
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Demmer, Craig. "A National Survey of Hospice Bereavement Services." OMEGA - Journal of Death and Dying 47, no. 4 (December 2003): 327–41. http://dx.doi.org/10.2190/e2dy-42c7-7qp6-7052.
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Introduction: Historically, bereavement services have been viewed as the “poor stepchild” within hospice programs. In 1986, a survey was conducted of hospices to examine the nature and function of hospice bereavement services. This article presents the results of a similar survey that was conducted in 2002. The aim of this study was to provide updated information on several aspects of hospice bereavement services including staffing, training, services provided, issues, and obstacles. Methods: A self-administered questionnaire, with items adapted from the 1986 study, was mailed to a random sample of 450 Provider Members of the National Hospice and Palliative Care Organization (NHPCO). The 23-item questionnaire took approximately 10 minutes to complete. There was a 58% return ( n = 260) of the questionnaires. Results: Hospices employed fewer bereavement personnel who served more bereaved individuals than compared to hospices in the 1986 study. Major obstacles were lack of time and too few bereavement staff. Bereavement programs tended to focus on less time intensive services such as mailings of letters and literature on grief versus phone calls and home visits. Bereavement staff expressed a desire to provide more groups and educational programs, as well as make more home visits, if they had more resources. Conclusions: Hospices are faced with difficult choices in an era of increased competition between hospices, insufficient reimbursement, and increased demands to document the effectiveness of services. Against this background, hospice bereavement services will continue to compete for attention and resources with other components of hospice programs.
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O'Connor, Nina R., Rong Hu, Pamela S. Harris, Kevin Ache, and David J. Casarett. "Hospice Admissions for Cancer in the Final Days of Life: Independent Predictors and Implications for Quality Measures." Journal of Clinical Oncology 32, no. 28 (October 1, 2014): 3184–89. http://dx.doi.org/10.1200/jco.2014.55.8817.
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Purpose To define patient characteristics associated with hospice enrollment in the last 3 days of life, and to describe adjusted proportions of patients with late referrals among patient subgroups that could be considered patient-mix adjustment variables for this quality measure. Methods Electronic health record–based retrospective cohort study of patients with cancer admitted to 12 hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network. Results Of 64,264 patients admitted to hospice with cancer, 10,460 (16.3%) had a length of stay ≤ 3 days. There was significant variation among hospices (range, 11.4% to 24.5%). In multivariable analysis, among patients referred to hospice, patients who were admitted in the last 3 days of life were more likely to have a hematologic malignancy, were more likely to be male and married, and were younger (age < 65 years). Patients with Medicaid or self-insurance were less likely to be admitted to hospice within 3 days of death. Conclusion Quality measures of hospice lengths of stay should include patient-mix adjustments for type of cancer and site of care. Patients with hematologic malignancies are at especially increased risk for late admission to hospice.
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Dunbar, Helena, Bernie Carter, and Jayne Brown. "‘Place bonding’ in children’s hospice care: a qualitative study." BMJ Supportive & Palliative Care 10, no. 3 (August 14, 2018): e25-e25. http://dx.doi.org/10.1136/bmjspcare-2018-001543.
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BackgroundLimited knowledge exists of parents’ perceptions and experiences of children’s hospices and how these contribute to the varied access and uptake of services.AimThis study aimed to explore parents’ perspectives and experiences of a hospice, to understand the barriers and/or facilitators to accessing a hospice, and what characteristics parents wanted from hospice provision.MethodsA two-phase qualitative study underpinned by a constructivist grounded theory methodology was employed. Phase 1 used focus groups to collect data from parents of children already accessing the hospice (n=24). Phase 2 used in-depth semistructured interviews with parents of children who did not use the hospice (n=7) and with parents who had previous experience of using a hospice (n=7).ResultsA grounded theory of place bonding was developed which illustrates the cognitive journey taken by parents of children with life-limiting conditions considering/receiving hospice care for their child.ConclusionsFinding a place where they belonged and felt at ‘home’ made the decision to accept help in caring for their child with a life-limiting condition more acceptable. The theory of place bonding offers children’s hospices a new perspective from which to view how parents access, accept and build relationships at the hospice.
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Wang, Xiaochuan, Susanny Beltran, Denise Gammonley, Norma Conner, and Milo Leon. "Examining the Relationship Between Hospice Agency Characteristics and Complaint Deficiencies." Innovation in Aging 5, Supplement_1 (December 1, 2021): 1003. http://dx.doi.org/10.1093/geroni/igab046.3598.
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Abstract The U.S. hospice industry has expanded over the last decade. Similar to nursing homes, research guided by the Donabedian framework has documented quality differences in hospice based on agency characteristics, including profit status and rural status. Yet, compared to nursing homes, quality oversight and transparency in hospice remain limited. When families report substandard care, a complaint survey is launched to investigate allegations. Using publicly available regulatory oversight data (e.g., CMS QCOR, Medicare PACPUF, CAHPS HIS, Hospice Compare), and guided by the Donabedian framework, this study describes hospice agency structure and process characteristics associated with care complaint deficiencies (outcome). Of the 4,415 hospice facilities examined, 453 (or 10.3%) have had complaint survey deficiency citations between January 2018 and December 2020. Chi-square and ANOVA tests were conducted to compare facility characteristics (e.g., ownership status, percentage of Medicare beneficiaries in rural zips), nursing and social work involvement, and CAHPS scores between hospices with and without complaint survey deficiencies. Results indicated that the average proportion of beneficiaries with a rural zip for Medicare correspondence was significantly lower in hospices with deficiencies (p<.001). Finding also suggested that weekly total nursing and social work minutes were significantly higher in hospices with deficiencies. Additionally, family ratings of hospice team communication, symptom management, and overall satisfaction were higher in facilities without complaint survey deficiencies. Future research and practice implications will be discussed.
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Christian, Thomas, and Michael Plotzke. "AN EXAMINATION OF MEDICATION UTILIZATION DURING MEDICARE HOSPICE ELECTION: A NATIONAL STUDY." Innovation in Aging 6, Supplement_1 (November 1, 2022): 42. http://dx.doi.org/10.1093/geroni/igac059.160.
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Abstract In addition to drugs received through the Medicare hospice benefit, each year Medicare hospice beneficiaries receive nearly $700 million in medications through Medicare Part D. Little is known about the nature of these medications. To explore this issue, we identified all beneficiaries who were enrolled in Part D and elected hospice during Calendar Year (CY) 2020. We cross-walked hospice dates of service to Part D medication fill dates. We also collected information on drugs hospices themselves provided and voluntarily reported on hospice claims. Nationally, 1.2 million out of 1.8 million beneficiaries had some drugs provided, through hospice alone (406,423), Part D alone (412,810), and also from both sources (348,659). Medications from Part D tended to be more expensive, upwards of $40 per fill, compared to medications from hospices, which were about $15 per fill or less. Moreover, we found that 98,561 of beneficiaries (8.4%) received the exact same drug from both sources. Across diagnoses, the daily rates of pre-hospice Part D utilization were nearly identical to Part D utilization after electing hospice, and there was no relation to prior Part D use and hospice election duration. Categorically, the greatest amount of Part D expenditures during hospice are for diabetic therapies ($100.2 million), followed by anticoagulants ($97.8 million) and bronchodilators ($57.2 million). CMS should continue to monitor the provision of medications during hospice to maintain the integrity of the benefit and to ensure beneficiaries receive adequate care.
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Pawłowski, Leszek, Monika Lichodziejewska-Niemierko, Iga Pawłowska, Wojciech Leppert, and Piotr Mróz. "Nationwide survey on volunteers' training in hospice and palliative care in Poland." BMJ Supportive & Palliative Care 9, no. 3 (July 29, 2016): e25-e25. http://dx.doi.org/10.1136/bmjspcare-2015-000984.
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BackgroundVolunteers working in hospice and palliative care facilities in Poland undertake various activities which are performed in accordance with legal regulations and the individual policies of each hospice. The aim of this study was to explore the roles and training of volunteers working in hospice and palliative care settings.MethodsA cross-sectional survey was carried out that investigated the services performed by volunteers and their preparation for work within residential hospices. Questionnaires were distributed to volunteers and hospice representatives, and the responses obtained underwent statistical analysis.ParticipantsA total of 180 volunteers and 28 hospice representatives from 29 residential hospices participated in this survey.ResultsAll hospices surveyed were supported by volunteers. 79% of volunteers worked alongside patients and performed the following services: accompanying patients (76%), feeding patients (61%), cleaning rooms (48%), dressing and bathing (42%) and organising leisure time (40%). Fewer volunteers were involved in activities outside of patient support—for example, charity work and fundraising (34%), cleaning hospice buildings (23%) as well as providing information and education (22%). According to volunteers, prior to undertaking their duties, 64% participated in theoretical training and 37% took part in a practical course. The majority attended courses relating to general knowledge of hospice and palliative care (64%) and volunteer rights and duties (55%).ConclusionsOverall, proper training was an essential requirement needed to be fulfilled by volunteers, particularly when involved in direct patient support. Most volunteers were simultaneously involved in various areas of service; therefore, their training should be comprehensive.
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Felderhoff, Brandi, Angela Alvarado, and Valerie Alvarez. "RURAL HOSPICE SOCIAL WORK: SUPPORTING PRACTITIONERS IN END-OF-LIFE WORK WITH LIMITED RESOURCES." Innovation in Aging 6, Supplement_1 (November 1, 2022): 43. http://dx.doi.org/10.1093/geroni/igac059.163.
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Abstract Rural areas and the agencies, including hospice, that serve them face immense challenges in terms of accessibility, and service delivery. Small hospices face an enigmatic combination of higher operating costs and lower reimbursement payments, forcing higher caseloads on staff, and straining already limited available resources. Multiple cost benefit studies indicate that Medicare hospice reimbursement rules are well suited to the expense structure of large volume hospices, usually in urban, population dense areas; however, it is not clear that they apply as abundantly to smaller volume, rural hospices. This study sought to garner a deeper understanding of the roles and challenges required for rural hospice social work practice. Individual interviews with 9 rural hospice social workers across organizations in Texas and New Mexico were conducted. A maximum variation sampling technique was used to purposefully sample social workers from hospice agencies in areas deemed as rural by the Association of Rural Communities in Texas, with fewer than 200,000 occupants in their counties. Using emergent thematic analysis, key themes materialized including the challenge of dual relationships, required tasks beyond the scope of practice, issues of autonomy, and meeting them (patients/families) where they are at. Results demonstrate the complexities of rural hospice social work practice, the culture of rural communities, and the need for research into evidence-based intervention strategies specific to rural hospice social work, that will guide practitioners through navigating these challenging conditions.
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Halli-Tierney, Anne D., Gregg Bell, and Rebecca S. Allen. "ETHNIC AND DEMOGRAPHIC DIFFERENCES IN THE UTILIZATION OF ANCILLARY HOSPICE SERVICES." Innovation in Aging 3, Supplement_1 (November 2019): S133. http://dx.doi.org/10.1093/geroni/igz038.483.
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Abstract Background: Research shows that ethnic differences exist in hospice service election, with fewer African American patients enrolling in hospice and having lower satisfaction with care compared to Non-Hispanic Whites. Hospice is interdisciplinary, with nursing care and “ancillary” services (social work, chaplain, nurses’ aide, volunteer). Little research exists about whether disparities exist in ancillary service election, and if patient demographics correlate with service utilization. We examined if ethnic or demographic differences exist among hospice beneficiaries in utilization of hospice services. Methods: Mixed-methods data collection took place from two community hospices. The quantitative arm involved retrospective chart review on new admissions from 2012 to 2016: acceptance of ancillary services and demographic data were collected as well as code status and outcome of hospice admission. The qualitative arm collected interview data from hospice personnel about thoughts on hospice care, which patients they think might decline ancillary services, and why. Results: Chart review was completed on 491 patient charts: interviews of hospice staff are ongoing. Sample was 55% female, 77% white, average age 77.8 years. Initial analysis on demographic data did not show statistical significance in utilization. Declination was lowest for social work (3.4% declined) and highest for hospice volunteer (88.9% declined). Initial interview themes involved need for patient education and role of health literacy. Discussion: Initial research does not show statistical ethnic or demographic differences in ancillary service utilization. However, broad utilization differences exist between services. Data can identify areas where hospices can improve care accessibility through patient education and personalization of services.
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Groninger, Hunter, Devin Gilhuly, and Kathryn A. Walker. "Getting to the Heart of the Matter: A Regional Survey of Current Hospice Practices Caring for Patients With Heart Failure Receiving Advanced Therapies." American Journal of Hospice and Palliative Medicine® 36, no. 1 (July 23, 2018): 55–59. http://dx.doi.org/10.1177/1049909118789338.
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Background: No guidelines exist regarding care for patients with advanced heart failure (HF) receiving hospice care while continuing advanced HF therapies such as left ventricular assist devices (LVADs) or continuous inotropes. Objective: We surveyed hospice providers in our tristate region to determine hospice demographics, current practices for care of patients with advanced HF, and perceived challenges of providing advanced HF therapies. Design: Cross-sectional survey of hospice clinical and administrative leaders. Results: Forty-six respondents representing 23 hospices completed the survey. Over half (27/46) held leadership administrative roles, and most (37/46) had more than 5 years of hospice experience. Although lack of experience and cost were cited as primary barriers to providing inotrope therapy in home hospice, about half of respondents (24/46) said they would manage inotropes. All participants said their respective hospices accept patients with implantable cardioverter-defibrillators; over half (28/46) said they accept patients with LVADs into hospice care. Lack of experience with LVADs was the most frequently cited barrier. Most participants were interested in training and support by an advanced HF program to facilitate hospice care of patients receiving these advanced therapies. General access to hospice services for patients with HF at their organization was considered adequate by 30 of 46 participants. Most (32/46) reported that referrals are made too late. Conclusions: Hospice specialists reported widely varied practice experiences caring for patients with HF receiving advanced therapies, noted specific challenges for care of these patients, and expressed a desire for targeted HF education.
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Jonasen, Aaron M., and Brenda Rust O’Beirne. "Death Anxiety in Hospice Employees." OMEGA - Journal of Death and Dying 72, no. 3 (March 5, 2015): 234–46. http://dx.doi.org/10.1177/0030222815575007.
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To measure hospice employees’ perceptions of their own death, the Revised Death Anxiety Scale (RDAS) was implemented among 128 employees at a Midwest hospice facility. Participants were asked to indicate their age, gender, position, and length of time employed in a hospice. Results indicated a negative correlation between RDAS scores and length of time employed in a hospice for “non-nurses” ( p = .011). Overall, RDAS scores were extremely low when compared with a recent study that implemented the RDAS in a group of hospice nurses ( Halliday & Boughton, 2008 ). Research of this nature should continue because a better understanding of how hospice employees experience their own mortality will allow hospices to better serve patients and patients’ friends and families.
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Klochko, A. R. "Trends in the Design of Hospices and Palliative Centers in the Russian Federation." IOP Conference Series: Earth and Environmental Science 988, no. 5 (February 1, 2022): 052068. http://dx.doi.org/10.1088/1755-1315/988/5/052068.
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Abstract This article examines a brief history of the spread of hospice care, studies the specifics of the architecture of palliative medicine centers and hospices. Attention is paid to the current state of hospices and palliative centers in the world and in Russia. The research results are presented in the form of basic recommendations on the hospice territories design and their improvement, architectural, planning, interior features of hospice design. The schemes of functional relationships in the hospice, variants of space-planning solutions and the design of 1 to 4 place hospital rooms are given. These results can be used in the architectural practice of designing palliative care centers and hospices, as well as in the educational process as methodological recommendations for the design of hospices and palliative care centers. The analysis of the problems of the architectural-planning and urban organization of hospices will allow to improve the structure of such architectural objects, to study their typology, for further development. The involvement of the public in the direction of the development of the current of palliative care, including from the point of view of their architectural and spatial organization, focuses people’s attention not only on the entertainment culture, which is now in absolute dominance, but also on human duty and dignity.
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Arter, Stephen G., and Arthur G. Lipman. "Hospice Care: A New Opportunity for Pharmacists." Journal of Pharmacy Practice 3, no. 1 (February 1990): 28–33. http://dx.doi.org/10.1177/089719009000300105.
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Hospices are programs of care for patients who have advanced, irreversible diseases and life expectancies that are measurable in weeks and months as opposed to years. The first hospice in the United States was started in 1974 as a National Cancer Institute demonstration project. Since that time, approximately 1,700 programs have been started in this country. Most hospice care is provided in the patients' homes. The focus of care is the relief of pain and other symptoms. Hospice is interdisciplinary and medically directed. Pharmacists are important members of hospice teams. This article will describe the development of hospice programs in this country, how pharmacists might become involved in hospice care, and the roles that pharmacists play in hospice programs. A variety of pharmacist expertise, including clinical skills, drug information capabilities, management, and compounding, are needed by hospice programs. Hospice presents a challenging and professionally rewarding practice for many pharmacists today. Many more pharmacists are needed.
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Becker, Todd, and John Cagle. "Bereavement Support Services in a National Sample of Hospices: A Content Analysis." Innovation in Aging 5, Supplement_1 (December 1, 2021): 569. http://dx.doi.org/10.1093/geroni/igab046.2186.
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Abstract Although the Medicare Hospice Benefit mandates that hospices provide bereavement services to families for 1 year following death, it does not stipulate what services should be offered or how. Thus, this study aimed to explore the range of hospice bereavement services. This study stems from Cagle et al.’s (2020) prior study surveying 600 randomly selected agencies, stratified by state and profit status. Most participants (N = 76) worked as clinical supervisors or directors of patient services (41.6%) for medium-sized (53.2%), for-profit hospices (50.6%). Responses to “What types of bereavement support does your hospice provide to families?” were content analyzed. Analyst triangulation and peer debriefing enhanced trustworthiness. Four domains emerged: timing of support, providers of support, targets of support, and formats of support. Each domain reflected substantial variability. All hospices offered postdeath bereavement support. A minority described offering predeath support, often through bereavement risk assessment and supportive services targeting those at risk. Providers frequently included trained bereavement counselors, social workers, and chaplains. Less often, hospices leveraged familiar members of the decedents’ care team to encourage family participation. Although bereavement services predominantly targeted surviving adult family members of deceased hospice patients, services tailored to children and hospice-unaffiliated community members also emerged. The format of bereavement services demonstrated the widest variability. Commonly reported formats included written materials, support groups, and phone calls. Most hospices employed multiple formats. Although findings are consistent with prior research, the variability in each domain complicates rigorous investigation of which aspects offer the greatest benefit to bereaved family members.
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Klochko, Asmik, and Iuliya Yaseneckaya. "Modern trends in architectural design of hospices." Stroitel stvo nauka i obrazovanie [Construction Science and Education], no. 2 (June 30, 2020): 2. http://dx.doi.org/10.22227/2305-5502.2020.2.2.
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Introduction. This article reviews the brief history of palliative care spreading, it also studies specific characteristics of palliative care centers architecture. It also gives attention to the current condition of hospices in our country, and to the problems and opportunities that these hospices face. Materials and methods. Studies consider, firstly, methods of comparative analysis and synthesis of foreign and domestic scientific, literary and design materials; secondly, use of opinion poll findings; thirdly, use of interdisciplinary approach, which takes into account issues in the fields in medicine, sociology, legal regulations, that affect a set of requirements for hospice and palliative care centers design. Results. of the survey are presented as recommendations for the design of hospice territory, their landscaping, architectural planning and architectural-artistic characteristics of hospice design. These results can be used in architectural practice of hospice and palliative care centers design, as well as in the teaching and learning process as guidelines for hospice and palliative care centers design. Conclusions. Basic recommendations for hospice design are introduced. Problem analysis in the context of architectural planning and city planning organization of hospices will help to improve the structure of such architectural objects, and investigate their typology for future evolution. Public involvement in palliative care evolution, and in particular from the point of view of their architectural and spatial design, places an emphasis not only on currently dominating entertainment culture, but also on human duty and dignity.
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Lum, Hillary D., Carolyn Horney, David Koets, Jean S. Kutner, and Daniel D. Matlock. "Availability of Heart Failure Medications in Hospice Care." American Journal of Hospice and Palliative Medicine® 33, no. 10 (July 10, 2016): 924–28. http://dx.doi.org/10.1177/1049909115603689.
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Background: Availability of cardiac medications in hospice for acute symptom management of heart failure is unknown. This study explored hospice approaches to cardiac medications for patients with heart failure. Methods: Descriptive study using a quantitative survey of 46 US hospice agencies and clinician interviews. Results: Of 31 hospices that provided standard home medication kits for acute symptom management, only 1 provided medication with cardiac indications (oral furosemide). Only 22% of the hospice agencies had a specific cardiac medication kit. Just over half (57%) of the agencies could provide intravenous inotropic therapy, often in multiple hospice settings. Clinicians described an individualized approach to cardiac medications for patients with heart failure. Conclusion: This study highlights opportunities for practice guidelines that inform medical therapy for hospice patients with heart failure.
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Brock, Cara M., and Christopher M. Herndon. "A Survey of Hospice Volunteer Coordinators: Training Methods and Objectives of Current Hospice Volunteer Training Programs." American Journal of Hospice and Palliative Medicine® 34, no. 5 (January 12, 2016): 412–16. http://dx.doi.org/10.1177/1049909115625961.
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Introduction: Currently more than 5800 hospice organizations operate in the United States.1 Hospice organizations are required by the Centers for Medicare and Medicaid Services (CMS) to use volunteers for services provided to patients.2 Although CMS regulates the amount of hours hospice volunteers should provide, there are currently no national requirements for objectives of training.3 The purpose of this study was to gather information from a sample of hospices regarding volunteer coordinator background, current training for volunteers, importance of training objectives, and any comments regarding additional objectives. Methods: Representative state hospice organizations were contacted by e-mail requesting their participation and distribution of the survey throughout their member hospices. The survey asked demographical questions, along with ratings of training components based on perceived level of importance and time spent on each objective. Results: A total of 90 surveys were received, and the response rate was undeterminable. Results showed the majority of hospices were nonprofit, had less than 100 currently trained volunteers, and maintained an average daily patient census of less than 50. Questions regarding training programs indicated that most use live lecture methods of approximately 19 hours or less in duration. Overall, responding hospice organizations agreed that all objectives surveyed were important in training volunteers. Conclusion: The small number of respondents to this survey makes generalization nationwide difficult, however it is a strong starting point for the development of further surveys on hospice volunteer training and achieving a standardized set of training objectives and delivery methods.
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Cardenas, Valeria, Anna N. Rahman, Mekiayla Singleton, YuJun Zhu, and Susan Enguidanos. "WHAT CONSUMERS SAY ABOUT HOSPICES IN ONLINE REVIEWS." Innovation in Aging 3, Supplement_1 (November 2019): S899—S900. http://dx.doi.org/10.1093/geroni/igz038.3287.
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Abstract Until recently, consumers have had limited resources to assess quality of hospices agencies, contributing to growing numbers of consumers turning to online review sites, such as Yelp. Yet little is known about the content of hospice Yelp reviews and how these relate to recently available Center for Medicare and Medicaid Services’ Hospice Compare site data. No study has examined Yelp hospice reviews and compared the themes identified in Yelp reviews to the topics addressed by CMS’s HC measures. To better understand how consumers perceive hospice care, we drew a purposeful sample of 67 hospices in California. Researchers used grounded theory to identify themes and categories within the hospice reviews. Each of two teams of two researchers independently coded the reviews and then met to compare coding and reconcile discrepancies until 100% consensus was reached. We coded a total of 692 consumer Yelp reviews, identifying 15 themes and grouping them under five overarching thematic categories: patient/caregiver-provider relationship; clinical care; agency competency; staff professionalism; and medical equipment and supplies. We found that overall Yelp comments were positive. The most frequently mentioned Yelp themes in hospice reviews were compassionate, caring staff; patient/family gratitude; and staff responsiveness. There was considerable overlap between the themes captured in HC caregivers survey items and Yelp. However, Yelp reviews cover a greater number and more diverse themes than those measures reported on the CMS Hospice Compare site. We recommend that consumers consider both HC and online review sites such as Yelp when evaluating a hospice.
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Kashiwagi, Tetsuo. "Palliative Care in Japan." Palliative Medicine 5, no. 2 (April 1991): 165–70. http://dx.doi.org/10.1177/026921639100500213.
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In 1990, palliative care services in Japan entered a new era when the national government authorized medical insurance cover for hospice care. Within the last decade, gradual yet remarkable progress has taken place in the perception of the need for palliative care services in Japan. The first Japanese hospice opened in 1981, followed by three other hospices over a nine-year period. These have been well received both by the public and medical professionals, although many difficulties have been encountered in establishing them. It is hoped that further development will include an increase in the number of hospices, a growing awareness within general hospitals of a hospice-style approach to care and an expansion in home care services.
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Russell, David, Elizabeth A. Luth, and Ruth Masterson Creber. "DIVERSITY IN HOSPICE AND END-OF-LIFE EXPERIENCES: THE INFLUENCE OF CHRONIC DISEASE AND SOCIOCULTURAL FACTORS." Innovation in Aging 3, Supplement_1 (November 2019): S790. http://dx.doi.org/10.1093/geroni/igz038.2909.
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Abstract Hospice provides supportive and palliative services to persons nearing the end-of-life. Use of the Medicare hospice benefit has grown to cover nearly half of all Medicare decedents. Even more notably, hospice agencies now serve patients with a diverse range of terminal conditions, including those not traditionally served by hospices, such as dementia and heart failure. In addition to expanded use of hospice care by patients with multiple types of chronic disease, demographic transitions in the United States over the last several decades have also led to increased use of hospice services among patients with diverse socio-cultural and linguistic backgrounds. Limited research has identified the unique experiences of patients enrolled in hospice who have diagnoses of dementia and heart failure, or explored how socio-cultural factors act to influence the course and outcomes of hospice care. This symposium features interdisciplinary collaborations between academic researchers and clinical practitioners at a large non-profit hospice agency in a multicultural urban environment. These collaborations, which draw on multiple theoretical perspectives and research methodologies, shed new light on patient experiences in hospice and identify opportunities for improving care and comfort at end-of-life. Presentations will include an exploration of the unique symptoms and experiences of hospice patients with heart failure, an evaluation of a clinical program for heart failure hospice patients, an exploration of collaborative goal setting between patients-providers, and an examination of cultural health capital as it relates to race/ethnic and socioeconomic disparities in hospitalization among hospice patients, and factors for disenrollment among hospice patients with dementia.
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Boucher, Nathan, and Kimberly S. Johnson. "CULTURAL COMPETENCE TRAINING FOR HOSPICE STAFF: FINDINGS FROM A NATIONAL HOSPICE SURVEY." Innovation in Aging 3, Supplement_1 (November 2019): S6. http://dx.doi.org/10.1093/geroni/igz038.019.
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Abstract Compared to whites, racial/ethnic minorities are less likely to enroll in hospice and if they enroll, more likely to experience poor quality care. Building cultural competence (CC) among hospice staff is a strategy that may reduce these disparities. We conducted a national survey of hospices’ practices to promote CC. A total of 197 hospices participated; most were not-for-profit (80%) with an average daily census over 100 (53%); 73% offered staff cultural competence training (CCT). There were no differences in characteristics of hospices who offered CCT and those that did not. Of hospices offering CCT, 54% held it annually. Most trainings were one hour (60%); content was delivered via web (58%) and/or lecture (57%). While over 90% of staff (i.e., nurses, social workers, and chaplains) completed CCT, a smaller proportion of medical directors (63%), senior leaders (70%) and board members (23%) did so. Most common (>70%) topics were: cross-cultural communication, death and illness beliefs, and spirituality’s role, and healthcare disparities. The majority focused on African-Americans (83%), Hispanics (76%), and Asians (61%)—the most common U.S. minority groups. Almost 30% reported no assessment of effectiveness of CCT while 45% reported a quiz at the end. In this study, most hospices offered some CCT. CCT has been shown to improve healthcare providers’ knowledge and skills in caring for diverse patients and is associated with increased patient satisfaction. Future research should evaluate effectiveness of CCT in improving the ability of hospices to deliver high quality end-of-life care to diverse groups of older adults.
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Simon, Natalia, Thomas Pence Boike, Kiran Devisetty, Sam Beusterien, Kelly DeVries, and Jennifer J. Griggs. "Palliative radiation therapy pathway for patients on hospice in a statewide quality improvement collaborative." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 201. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.201.
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201 Background: Patients on hospice receive care directed at alleviating symptoms with the goal of reducing burdensome and unnecessary healthcare. Single-fraction radiation therapy is an effective palliative treatment for cancer‐related bleeding. Hospice physicians and radiation oncologists are driven by the same goals of relieving symptoms and decreasing the burden of treatment. In general, hospices are not able to support the costs of providing palliative radiation in eligible patients. The inability to receive radiation therapy may pose a barrier to hospice enrollment. Methods: The Michigan Oncology Quality Consortium (MOQC), a collaborative of nearly 90% of oncologists in Michigan, partnered with radiation oncologists, hospice directors, and patients and caregivers to create a pathway for the referral and treatment of patients with cancer-related bleeding. Through regular meetings, the collaboration created a pathway for patients on hospice or eligible for hospice who were candidates for palliative radiation therapy for bleeding. In patients with cancer-related bleeding, the hospice clinician collaborates with a participating radiation oncologist to confirm eligibility. This decreases the hospice costs of treatment, increases access to palliative radiation, and alleviates the financial and emotional burdens on the patient and family. Results: In Michigan radiation oncology practices and hospices with statewide representation approved the pathway. Radiation oncologists in 19 practices across the state agreed to high value radiation treatment (focused level 3 consultation, complex isodose planning, single fraction treatment). Eligible patients may be seen via virtual consultation and then treated within 1 to 2 days with a single fraction of 8 Gy. A second fraction can be given in patients who continue to have bleeding. MOQC established direct connection to members of the collaborative whose contact information is available on MOQC website. In addition to this treatment pathway, the previously adopted palliative radiation pathway for oncology patients with bone metastases may be found on MOQC website. Conclusions: The radiation therapy pathway for patients with bleeding ensures a unified approach to providing a patient-focused care in patients with limited life expectancy. Challenges to the implementation of the pathway include dissemination of the document across over 100 Michigan hospices and the upfront effort required to screen patients.[Table: see text]
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Broom, Alex. "On Euthanasia, Resistance, and Redemption." Qualitative Health Research 22, no. 2 (September 9, 2011): 226–37. http://dx.doi.org/10.1177/1049732311421181.
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Euthanasia/assisted dying, the desire to hasten death, and religious supportive care at the end of life are controversial issues that have been heavily debated within the academic and medical communities. Little research has been done on hospice patients’ views, despite hospices being political spaces, espousing a range of perspectives on assisted dying, religiosity, and “good deaths.” In this article I document the presence, articulation, and significance of these issues as perceived and experienced by 20 hospice inpatients in the last 4 weeks of their lives. Key themes to emerge included polarization in desire for hastened death and assisted dying in the hospice; the hospice as a morally bound space situated within particular notions of “dying well”; and the divisive character of religion as part of formalized hospice care. Theoretically, the participants’ perspectives on euthanasia/assisted dying and religiosity in the hospice provide a means of unpacking and revealing the moral economy of modern dying practices and the institutional governance and production of “timely deaths.”
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Rantanen, Petra A. "A Macroergonomic Study of Hospice and Life-Prolonging Treatment in the UK." Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 9, no. 1 (September 2020): 100–106. http://dx.doi.org/10.1177/2327857920091040.
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This research explored how people attribute meanings to care in a hospice and life-prolonging treatment and in what ways these two types of care can coexist in the British hospice model. The objectives of this research were to understand the commonality of life-prolonging treatment in conjunction with care in a hospice in the UK and patient awareness of this possibility; to understand patient decisions to receive or not receive care in a hospice and to receive or not receive life-prolonging treatment; and to understand physician decision-making when recommending a hospice and/or life-prolonging treatment to a patient. In-depth semi-structured interviews were conducted with seventeen palliative care physicians working in hospices or hospitals and oncologists in the London area. The results indicate that negative meanings attached to hospice by patients, the general public, and physicians are prevalent; that improved communication between hospice physicians, palliative care physicians, and treating physicians is necessary to decrease these meanings; that patient attitudes often shift positively once a patient is receiving care in a hospice; that patients may choose to opt out of life-prolonging treatment once they are in hospice for a variety of reasons; and that opting out may lead to further shifts in attitude. This research has implications for policies surrounding hospice care in both the UK and the United States.
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Wladkowski, Stephanie P., Cara L. Wallace, and Karla Washington. "LIVE DISCHARGE FROM HOSPICE WITH DEMENTIA: CHALLENGES TO SUPPORTING THE PATIENT-CAREGIVER DYAD." Innovation in Aging 6, Supplement_1 (November 1, 2022): 685. http://dx.doi.org/10.1093/geroni/igac059.2514.
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Abstract A live discharge from hospice disrupts care continuity and results in burdensome transitions for individuals with a life-limiting illness and their caregivers. In 2019, hospices served more than 1.6 million people across the United States, with nearly 63% of Medicare decedents age 85 or older. Of these patients, nearly 350,000 (20.9%) had a principal diagnosis of Alzheimer’s Disease/Dementia/Parkinson’s Disease. Research demonstrates that hospice care improves end-of-life outcomes for adults with Alzheimer’s Disease and related dementias (ADRD), yet with eligibility limited to a six-month prognosis, hospice is not structured to meet longer-term needs. The result is a live discharge from hospice. In 2019, 17.4% of hospice patients were discharged alive from hospice, with 6.5% discharged due to being ‘no longer terminally ill.’ The majority of live discharges are either hospice-initiated due to patient stabilization (extended prognosis resulting in a situation in which a patient no longer meets the life expectancy hospice eligibility criteria) or are patient-initiated (revocation) where a patient or proxy chooses to leave hospice care, typically to access disease-directed therapies or inpatient hospitalization. Both present unique challenges and opportunities for hospice providers. Informed by over 10 years of practice experience and research, this presentation will discuss the impact of live discharge from hospice and the unique impact for patients and primary caregivers of individuals with ADRD, the service gaps that exist for this population, and our recommendations for policy reform.
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Floriani, Ciro Augusto, and Fermin Roland Schramm. "Casas para os que morrem: a história do desenvolvimento dos hospices modernos." História, Ciências, Saúde-Manguinhos 17, suppl 1 (July 2010): 165–80. http://dx.doi.org/10.1590/s0104-59702010000500010.
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Retrata os primeiros hospices modernos, no Reino Unido vitoriano tardio, descrevendo a filosofia reinante e as dificuldades dessas instituições. Aborda, também, a fundação do St. Christopher's Hospice, considerado o marco do nascimento do moderno movimento hospice, bem como o desenvolvimento desse movimento até os dias atuais. Seu surgimento ocorre em cenário de crescente valorização tecnológica e à margem das prioridades do sistema de saúde britânico, em período de intensas transformações nas sociedades ocidentais. No Brasil, descreve como surgiu o primeiro hospice, na cidade do Rio de Janeiro, em 1944. Finaliza com um panorama atual do moderno movimento hospice no Brasil, além de considerações acerca das dificuldades para sua inserção no sistema de saúde.
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Seredyńska, Anna. "Motivation of hospice volunteers in the past and today." Forum Pedagogiczne 8, no. 1 (April 6, 2018): 297–308. http://dx.doi.org/10.21697/fp.2018.1.20.
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The first hospices in Poland were opened in 1970s, however, the reasons why people decided to volunteer in such places in the past and why they do it today differ. The article presents the ideas governing hospice volunteering over forty years ago on the basis of an interview with Ewa Bodek, an ex-coordinator of voluntary service in St. Lazarus Hospice in Cracow. This interview is now being prepared for publication. Present volunteers' motivation is analysed on the basis of interviews with candidates for voluntary service in St. Lazarus Hospice in Cracow conducted during the last four recruitment processes. The novelty of the article lies in juxtaposition of qualitative research on motivation of the first hospice volunteers in Poland and the results of the analysis of the motivation of contemporary candidates for voluntary service in St. Lazarus Hospice in Cracow.
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TANG, SIEW TZUH, RUTH MCCORKLE, and ELIZABETH H. BRADLEY ph.d. "Determinants of death in an inpatient hospice for terminally ill cancer patients." Palliative and Supportive Care 2, no. 4 (December 2004): 361–70. http://dx.doi.org/10.1017/s1478951504040489.
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Objective:Despite the strong emphasis on home-based end-of-life care in the United States and the recognition of dying at home as a gold standard of quality of care, hospice home care is not a panacea and death at home may not be feasible for every terminally ill cancer patient. Admission to an inpatient hospice and dying there may become a necessary and appropriate solution to distressing patients or exhausted families. However, the factors associated with death in an inpatient hospice have not been examined in previous studies.Methods:A prospective cohort study was conducted to investigate the determinants of death in an inpatient hospice for terminally ill cancer patients. Approximately two-fifths (40.8%) of the 180 terminally ill cancer patients in this study died in inpatient hospices over the 3-year study period.Results:Results from Cox proportional hazards model with adjustment for covariates revealed several factors that were significantly associated with dying in inpatient hospice, as opposed to home, in a nursing home, or in the hospital. Patients were more likely to die in an inpatient hospice if they received hospice care before death (hazard ratio [HR] = 7.32, 95% confidence interval [CI]: 3.21–16.67), if they had a prestated preference to die in an inpatient hospice (HR = 4.86, 95% CI: 2.24–10.51), if they resided in New Haven County (HR = 1.70, 95% CI: 1.00–2.93), or if they experienced higher levels of functional dependency (HR = 1.05, 95% CI: 1.02–1.08).Significance of results:The high prevalence of inpatient hospice deaths for terminally ill cancer patients in this study was related to the local health care system characteristics, health care needs at the end of life, and personal preference of place of death. Findings from this study may shed light on future directions for developing end-of-life care tailored to the needs of cancer patients who are admitted to hospices and eventually die there.
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Becker, Todd, and John Cagle. "Unmet Family Needs in Hospice and Research Priorities: Perspectives From a National Sample of Hospice Agencies." Innovation in Aging 5, Supplement_1 (December 1, 2021): 355–56. http://dx.doi.org/10.1093/geroni/igab046.1380.
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Abstract Although hospice cares for nearly 1.5 million patients and families annually, little is known about practitioners’ opinions of current gaps in care and research. To this end, we posed two open-ended questions to hospice representatives to identify practice-relevant research priorities. Data stem from two optional questions (Q1: N = 72; Q2: N = 73) appended to Cagle et al.’s (2020) national survey of 600 randomly selected hospices, stratified by state and profit status. Most participants provided the majority of care in-home (84.7%; 79.5%) and worked at a medium-sized hospice (50.0%; 49.3%). Responses to Q1 (“What is the biggest unmet need for hospice patients and families?”) and Q2 (“In your opinion, what is the most pressing topic that hospice researchers need to study?”) were analyzed for content and then synthesized. Analyst triangulation and peer debriefing improved trustworthiness. Emerging domains included: access to hospice, hospice services and workforce issues, and education. The access to hospice domain contained a subtheme regarding the need for earlier referrals. Participants noted that short lengths of stay undermine the clinical benefits to patients and families, and that hospice enrollment criteria may contribute to inadequate lengths of stay. The hospice services and workforce issues domain largely focused on burnout prevention. Participants acknowledged that provider self-care was linked to the quality of patient care. The education domain contained subthemes related to improving physician knowledge regarding prognostication and referral, and to patients and families regarding misconceptions about hospice care. Findings highlight critical needs for future hospice research and policy change.
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Hillier, Richard. "Hospice U.K. – 2000 AD." Journal of Palliative Care 1, no. 1 (March 1985): 9–15. http://dx.doi.org/10.1177/082585978500100103.
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This paper examines the possible shape of the hospice movement in the year 2000 AD. The number of patients dying from cancer will be similar to today, and cancer will remain the most common disease referred to hospices. After reviewing the key developments during the past fifteen years, the effects of national policy and financial constraint on future developments are examined. Most advances will stem from better organization and more realistically staffed hospices and hospice care teams. This will encourage greater flexibility and imaginative development. Advances will be made in rehabilitation, halfway houses for the elderly frail, and greater involvement with mainstream medical services. The role of home care teams, hospital support teams and day care, coupled with the better use of volunteers will maintain more patients at home and reduce the bed norms to 25 per million. A statement on education and training is made.
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Abel, Emily K. "The Hospice Movement: Institutionalizing Innovation." International Journal of Health Services 16, no. 1 (January 1986): 71–85. http://dx.doi.org/10.2190/rqbv-j2pg-vfnm-1h97.
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The early leaders of the hospice movement shared a number of attitudes with the founders of the alternative institutions of the 1960s and early 1970s: nostalgia for simple, old fashioned ways, dissatisfaction with bureaucratic and authoritarian institutions, faith in the power of nature, a determination to avoid domination by experts, and a desire to improve the quality of personal relationships. However, as hospices have become better established, they gradually have been incorporated into the dominant health care system and have lost their uniqueness. Some have affiliated with hospitals or home health agencies. Even autonomous organizations are subject to pressures for accommodation because they rely on the established order for resources, personnel, and political acceptance. Organizations receiving payment under the new Medicare benefit must adhere to a set of regulations that may distort the movement. Though creation of this benefit may have been facilitated by increased support for hospice ideals, the government views hospices primarily as a way to save money. Paradoxically, as hospices have grown in popularity, the critical force of the movement has been blunted.
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Lutz, Stephen, Carol Spence, Edward Chow, Nora Janjan, and Stephen Connor. "Survey on Use of Palliative Radiotherapy in Hospice Care." Journal of Clinical Oncology 22, no. 17 (September 1, 2004): 3581–86. http://dx.doi.org/10.1200/jco.2004.11.151.
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Purpose Radiation oncologists and hospice professionals both provide end-of-life care for oncology patients, and little has been written about the interface between these two groups of specialists. Hospice professionals were surveyed to assess the perceived need for palliative radiotherapy in the hospice setting, to investigate factors that limit the access of hospice patients to radiotherapy, and to suggest areas of future collaboration on education, research, and patient advocacy. Patients and Methods Members of the National Hospice and Palliative Care Organization (NHPCO) and American Society for Therapeutic Radiology and Oncology jointly authored a questionnaire to investigate the beliefs of hospice professionals toward the use of radiotherapy for oncology patients in hospice. The questionnaire was distributed to all NHPCO member institutions, and the results were compiled and statistically analyzed. Results Four hundred eighty of more than 1,800 surveyed facilities responded to the questionnaire. The findings suggest that the majority of hospice professionals feel that radiotherapy is important in palliative oncology and that radiotherapy is widely available in the United States. Yet less than 3% on average of hospice patients served by hospices responding to the survey actually received radiotherapy in 2002. The most common barriers to radiotherapy in hospice care include radiotherapy expense, transportation difficulties, short life expectancy, and educational deficiencies between the specialties. Conclusion Multiple barriers act to limit the use of palliative radiotherapy in hospice care. Finding ways to surmount these obstacles will provide opportunity for improvement in the end-of-life care of cancer patients.
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Csikai, Ellen L. "The State of Hospice Ethics Committees and the Social Work Role." OMEGA - Journal of Death and Dying 45, no. 3 (November 2002): 261–75. http://dx.doi.org/10.2190/nwx5-bl1c-kurq-xc4n.
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This study found that in six states, most hospices (73 percent) had access to some type of ethics committee; however, less than 1/3 maintain a hospice-specific ethics committee. Social workers, although integral to the hospice team, were only members of about one-half of the hospice committees. Further, the study examined social workers' current participation and role expectations of social workers and committee chairs for social work participation. Both groups viewed that social workers were important contributors and expected higher participation in all the three main activity areas—case consultation, policy, and education—than currently took place. As the particular skills and values of social work parallel both the purpose of ethics committees and hospice philosophy, and as these data suggest, opportunity exists for social workers to take on a greater role on hospice ethics committee and may be an important resource in the formation of such committees.
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West, Emily, Bregje Onwuteaka-Philipsen, Hans Philipsen, Irene J. Higginson, and H. R. W. Pasman. "“Keep All Thee ‘Til the End”: Reclaiming the Lifeworld for Patients in the Hospice Setting." OMEGA - Journal of Death and Dying 78, no. 4 (March 6, 2017): 390–403. http://dx.doi.org/10.1177/0030222817697040.
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St Christopher’s Hospice, London, was founded to provide specialist care to the incurably ill. We studied the dimensions of difference that set St Christopher’s Hospice apart from hospital care of the dying, focusing on physical space and social organization. Material from 1953 to 1980 from the Cicely Saunders Archive was analyzed qualitatively. Through thematic analysis, quotes were found and analyzed using open coding. Five themes were developed. Themes identified were home/homelike, community, consideration of others, link with outside world, and privacy. The hospice philosophy functioned as the catalyst for the development of the physical environment of St Christopher’s Hospice. Taking Habermas’ concept of lifeworld, it seems that, in contrast to acute care, the need for hospice to formulate their own lifeworld to support and fully engage patients was central. As lifeworlds are culture sensitive, this underlines the need for variation in design and organization of hospices around the world.
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Manca, Sara, Marino Bonaiuto, and Ferdinando Fornara. "Perceived Hospital Environment Quality Indicators: The Case of Healthcare Places for Terminal Patients." Buildings 13, no. 1 (December 27, 2022): 57. http://dx.doi.org/10.3390/buildings13010057.
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The “user-centered” design perspective (Gifford, 2002) suggests that healthcare places should improve their environmental quality in order to both meet the users’ needs and become “more humane” care environments, facilitating a higher level of patients’ satisfaction, wellbeing, and quality of life. The hospice is a specific category of healthcare, given the specificity of its target population, i.e., the terminal patients. This research aimed (i) to verify the factorial structure of an adapted version of the Perceived Hospital Environment Quality Indicators (PHEQIs, Fornara et al., 2006) for the hospice environment; (ii) to test the reliability of such indicators; and (iii) to detect the association between each indicator and the global satisfaction toward the hospice. Participants (N = 135) were patients, their relatives, and staff of eleven Italian hospices. They had to fill in a questionnaire including items tapping three diverse hospice settings (i.e., external spaces, interior common spaces, and interior private spaces). The confirmatory factor analysis run for each scale produced six reliable Hospice PHEQIs. As expected, significant relationships between most of them and the overall users’ satisfaction toward the hospice environment emerged.
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Koorn, Remco M., Merel van Klinken, Everlien de Graaf, Rick E. G. W. Bressers, Adri P. Jobse, Frederieke van der Baan, and Saskia C. C. M. Teunissen. "Who Are Hospice Patients and What Care Is Provided in Hospices? A Pilot Study." American Journal of Hospice and Palliative Medicine® 37, no. 6 (December 13, 2019): 448–54. http://dx.doi.org/10.1177/1049909119889004.
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Background: Hospices provide multidimensional care. In the Netherlands, patients with <3 months estimated life expectancy have access to hospice care. Insight into patients admitted to hospices and the care provided is lacking. In preparation for a national multicenter study, a pilot study was performed. Objective: The primary objective was to test the appropriateness of the study procedures and the availability of hospice patient records (HPRs), and patient and care characteristics. Method: A cross-sectional pilot study was performed using a descriptive exploratory design. Sixteen hospices were invited to participate, and HPRs from 8 deceased patients per hospice were selected. Data were collected using self-developed electronic case report forms. Outcomes: (1). Appropriateness of procedures: availability of HPRs and identified barriers and strategies. (2) Availability of patient and care characteristics in HPRs. Results: In total, 104 HPRs of patients from 13 hospices were enrolled. Various types of HPRs were found with different availabilities: nurses’ records were most available (98%) compared to volunteers’ records (62%). Overarching barriers were as follows: ethical issues, lack of knowledge, and lack of communication. Information about the illness was most available (97%), whereas descriptions of experienced symptoms were least available (10%). Conclusion: Collecting HPRs is difficult and time-consuming. Specifically, data from separate records of home care nurses and general practitioners were difficult to come by. Patient and care characteristics were alternately present, which led to an extension of data collection in HPRs to 3 time periods. Piloting is essential to adjust study procedures and outcome measures to ensure a feasible national multicenter hospice study.
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Rinaldi, Anoel, and Michael C. Kearl. "The Hospice Farewell: Ideological Perspectives of its Professional Practitioners." OMEGA - Journal of Death and Dying 21, no. 4 (December 1990): 283–300. http://dx.doi.org/10.2190/63tk-bmhx-lmur-1e1m.
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This research examines a social service devoted to “good deaths” in our country: hospice. Using a modified Delphi technique, a national sample of hospice experts ( n = 48) was questioned in order to elicit group judgments about hospice ideology, the issue of control over one's own death trajectory, and hospice's relevance for older individuals. The respondents generally concurred that hospice, influenced by the work of Kübler-Ross, represents a radical departure in how we die, a reaction to the quality of death within a cultural climate of death denial, and, in some sense, a demodernization movement. While a high rate of consensus was obtained on many of the issues that evolved, little evidence of a coherent ideology could be detected linking notions of hospice origins, issues of patient control, and suitability of hospice care for older individuals.
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Hall, Hadley Dale. "Hospice-to-Hospice." American Journal of Hospice Care 3, no. 6 (November 1986): 13–14. http://dx.doi.org/10.1177/104990918600300608.
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Bogusz, Halina, Katarzyna Pękacka-Falkowska, and Anita Magowska. "Under the British Roof." Journal of Palliative Care 33, no. 2 (February 20, 2018): 115–19. http://dx.doi.org/10.1177/0825859718757083.
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The article focuses on British contribution to the development of palliative and hospice care in Poland in the 1980s and beyond. It is based on archival research in the hospices in Cracow and Poznan and broad-scoped Polish journals’ review. The social background of the hospice movement in Poland is described. We explore the role of inspiration and help of Dame Cicely Saunders and other British leaders in the transfer of British hospice philosophy and practice of palliative care to the medical community in Poland. This study demonstrates the importance of institutions for the formal exchange of medical information.
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Lavenburg, Philip, and Frank M. Bernt. "Training and Supporting Hospice Volunteers." American Journal of Hospice and Palliative Medicine® 29, no. 5 (October 13, 2011): 355–61. http://dx.doi.org/10.1177/1049909111423527.
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We surveyed volunteers from 8 hospices in the Delaware Valley regarding training, perceived needs, and role satisfaction. Results were consistent with previous studies: satisfaction with preservice training and with volunteering was very high; respondents reported feeling very prepared and confident about doing hospice work as a result of their volunteer training. In addition, longer volunteer preservice training was associated with higher levels of overall satisfaction with training; levels of volunteer satisfaction and fulfillment tended to be lower during the first year of volunteering; and participation in volunteer support teams was associated with finding volunteer work rewarding and with feeling a part of the hospice team. Implications for preservice training and ongoing support and education of hospice volunteers are discussed.
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Lassell, Rebecca, Aditi Durga, Shih-Yin Lin, Tessa Jones, Ariel Ford, and Abraham Brody. "INTERDISCIPLINARY DEMENTIA CARE WORKFORCE TRAINING DURING COVID-19 AND TWO HOSPICE CASE STUDIES." Innovation in Aging 6, Supplement_1 (November 1, 2022): 85. http://dx.doi.org/10.1093/geroni/igac059.338.
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Abstract Hospice is a care model characterized by interdisciplinary team-based, person and family-centered care. To optimize agency-wide interdisciplinary team-based hospice dementia care, at least two levels of tailoring of the dementia care workforce training are imperative, first, by discipline, and second, by hospices’ local culture and needs. As of February 2022, a thousand and one skilled hospice interdisciplinary team members (not counting champions) across 18 hospice agencies have completed their discipline-specific Aliviado dementia care training, including 56 providers, 763 nurses, 129 social workers, and 53 chaplains. In this presentation, we describe how we tailored dementia workforce training for skilled interdisciplinary team members (first level tailoring), as well as provide two case studies elucidating how we performed further tailoring of the program for two large hospice agencies (average daily census: 354 and 868, respectively) in two different states to meet their local needs (second level tailoring), and lessons learned.
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Taylor, Andrea, Tara French, and Sneha Raman. "Developing design principles for a Virtual Hospice: improving access to care." BMJ Supportive & Palliative Care 8, no. 1 (August 23, 2017): 53–57. http://dx.doi.org/10.1136/bmjspcare-2016-001254.
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ObjectivesProviding access to hospice services will become increasingly difficult due to the pressures of an ageing population and limited resources. To help address this challenge, a small number of services called Virtual Hospice have been established. This paper presents early-stage design work on a Virtual Hospice to improve access to services provided by a hospice (Highland Hospice) serving a largely remote and rural population in Scotland, UK.MethodsThe study was structured as a series of Experience Labs with Highland Hospice staff, healthcare professionals and patients. Experience Labs employ a participatory design approach where participants are placed at the centre of the design process, helping to ensure that the resultant service meets their needs. Data from the Experience Labs were analysed using qualitative thematic analysis and design analysis.ResultsA number of themes and barriers to accessing Highland Hospice services were identified. In response, an initial set of seven design principles was developed. Design principles are high-level guidelines that are used to improve prioritisation and decision making during the design process by ensuring alignment with research insights. The design principles were piloted with a group of stakeholders and gained positive feedback.ConclusionsThe design principles are intended to guide the ongoing development of the Highland Hospice Virtual Hospice. However, the challenges faced by Highland Hospice in delivering services in a largely remote and rural setting are not unique. The design principles, encompassing digital and non-digital guidelines, or the design approach could be applied by other hospices in the UK or overseas.