Lessons from Rural Volunteer Hospices: Thinking Outside the Medicare Box (411-C)

Abstract

1.Discuss creative approaches to providing hospice and palliative care to under-served populations.2.Describe the volunteer hospice model.3.Discuss the current state of rural hospices in California. Background. Once the only form of hospice in the United States, volunteer hospices have, since the Medicare hospice benefits, become a small minority. Little is known about their current model of care. Research objectives. Describe the current structure and practice of volunteer hospices in California. Methods. Qualitative, semi-structured, key-informant interviews of four volunteer hospice programs in a rural county in California Results. Volunteer hospices have developed innovative ways to provide comprehensive end-of-life care without Medicare hospice benefits, involving community partnerships, efficient resource utilization, and funding support from their community. Since volunteer hospices in the study were prohibited from providing skilled nursing, they focused on care-coordination; education and training of caregivers, volunteers, and the community; and provision of spiritual and bereavement care. Their utilization of existing nursing and pharmacy resources and community support allowed them to successfully provide care to rural, under-served, and low-resource areas. However, volunteer hospices felt alienated from the larger hospice community. Conclusion. The volunteer hospice model, without a reliance on Medicare hospice benefits, offers creative approaches to providing hospice and palliative care to under-served populations, such as the under-insured and those in nursing homes and rural areas. More engagement of volunteer hospices is needed in research and in national organizations. Implications for research, policy, or practice. Medicare-certified hospices can use the same approaches currently used by volunteer hospices to provide care to under-served populations not covered by or inadequately covered by their insurances. Structure and Processes of Care