For example, future plans must be made and the family caregiver for someone who is dying is faced with "a series of difficult decisions." (Doka, 2005) Included in this series of decisions which are inherently difficult include decisions related to: (1) the living will; and (2) medical power of attorney
CHALLENGES FACED by HOSPICE CARE The need for hospice care in the United States has expanded rapidly and in a large-scale manner in the endeavor to provide and maintain care characterized by quality and all of this "under more regulation and financial pressure." (Vitez, 2006) Secondly, the president of the National Hospice and Palliative Care Organization, J
The gift of hospice is its capacity to help families see how much can be shared at the end of life through personal and spiritual connections often left behind. It is no wonder that many family members can look back upon their hospice experience with gratitude, and with the knowledge that everything possible was done towards a peaceful death (Naierman, 1997) V
What do we do when faced with a truly terminal disease? One answer was the creation of the St. Christopher's Hospice in England in the 1940's, (Harrison, 2007)
In a hospice, the terminally ill patient can be surrounded with friends and loved ones, and die in peace, rather than in an intensive care unit surrounded by strangers. Hospice care is often known as palliative care, as this author notes, "By contrast, the hospice offers palliative care, which focuses on maximizing comfort and controlling symptoms when health restoration is no longer possible" (Munley 20)
In some respects, hospice patients (and their families) report achieving a peace of mind greater than they experienced before they came to the realization that their medical conditions are terminal rather than curable (Humphry 1991). The acceptance stage of the psychological response to dying brings with it a renewed appreciation for life and a calmness that is not possible when the prognosis of a disease is still unknown, and where every laboratory result or blood test carries the potential for hope or despair (Abrams & Buckner 1989)
Hospice staff function as, and often consider themselves "specialists" whose specialty is the emotional well-being of their patients. Many hospice staff have considerable previous experience in traditional nursing; according to them, hospital settings provide even the most caring hospital nurse only comparatively brief opportunities to contribute to their patients' emotional state and their other non-medical comfort needs (Caplan, Engelhardt & McCartney 1981)
In many respects, it resembles a residential hospital or nursing home, because the facility includes a full medical staff. The essential difference between hospice and a hospital is that much of what hospitals do relates to treating illness whereas hospices focus on providing comfort only (Humphry 1991)
Although hospice care workers such as nurses, doctors and psychologist are the most prominent members of the interdisciplinary team, social workers also play an important role in hospice care as it relates to patients and their families. According to an article found in the journal Health and Social Work, social workers are often needed in a hospice care situation to assist families in dealing with ethical dilemmas related to patient care (Csikai, 2003)
Good communication allows the interdisciplinary team to come up with the best plan of action for the patient and to discuss the plan of action with the family. If proper communication does not take place the patient and the family may suffer (Egbert & Parrott, 2003)
Hospice Death and dying are concerns that every human being must deal with at some point in their lives (Jennings et al
1)It is reported that the OPCPs in terms of their "prevalence and sustainability…remains uncertain because these programs are, in general, not supported by health care insurance in the United States." (Levy, Bemski, and Kutner, 2008) Reported by Levy, Bemski, and Kutner (2008) is a survey that was comprised by an 18-question Web-based survey "created based on input from a team of palliative care/hospice clinical and researcher physicians and nurses affiliated with PoPCRN
(2010) entitled "Impact of Hospital Disenrollment on Healthcare Use and Medical Expenditures for Patients with Cancer" reports a study through use of "Surveillance, Epidemiology, and End-Results Medicare data for hospice users who died as a result of cancer between 1998 and 2002 to compare rates of hospitalization, emergency department, and intensive care unit admission and hospital death for hospital disenrollees and those who remained with hospice until death." (Carlson, et al
" Examples include that hospice patients receive medications related to their hospice diagnosis, durable medical equipment, home health aide services and care from an interdisciplinary team." (Casarett and Quill, 2010, p
" Examples include that hospice patients receive medications related to their hospice diagnosis, durable medical equipment, home health aide services and care from an interdisciplinary team." (Casarett and Quill, 2010, p
However, the magnitude of the differences between the three categories was modest, suggesting all three contribute significantly to hospice underutilization. This finding is consistent with the research literature (McGorty and Bornstein, 2003)
Of primary concern are the barriers associated with physicians and NPs because they act as gatekeepers to hospice care. Researchers have shown that only about 24% of physicians surveyed were familiar with hospice care, while the rest had limited understanding of the services hospice care provides and little familiarity with hospice referrals (McNeilly and Hillary, 1997)
¶ … Hospice Utilization: Survey Findings Survey Data Analysis Barriers to Hospice Care Utilization: Survey Findings Barriers to Hospice Care Utilization: Survey Findings Hospice care has been shown to improve patient quality of life, reduce depression, prolong life (reviewed by McGorty and Bornstein, 2003), and reduce the costs associated with end of life (EOL) care (Temel et al
Another concern is overoptimistic estimates of patient survival and Christakis and Lamont (2000) found that 63% (N = 468) of the physicians in their study fit within this category. One solution would be to extend the six-month limit on life expectancy required under the Medicare Hospice Benefit (Weckmann, 2008)
Among the studies conducted on the services provided by hospice centers it was noted that hospice centers that were larger had less restrictive admission policies for patients, (Lorenz, Asch, Rosenfeld, Liu, & Ettner, 2004) and were able to provide the full range of services including nursing care, physician care, medication management, psychosocial care, and caregiver support. (Carlson, Morrison, Holford, & Bradley, 2007) Other studies that have focused upon the impact of hospice care for patients Regulations Affecting Health Care in Hospice The regulations that affect hospice care are stated under the U