Hospice Care Providers Research Articles

Innovations in Dying in the Nursing Home: The Impact of Market Characteristics

During the 1980s nursing homes emerged as a dominant site of death for the elderly. This may precipitate more innovative approaches to death and dying in the nursing home and may account for the recent emergence of hospice care and pain management programs in nursing homes. However, the provision of hospice care and pain management in nursing homes are trends about which we have virtually no information. As a first step in examining these phenomena we provide a descriptive analysis of nursing homes that provide hospice care or pain management programs and an analysis of the impact of market characteristics as determinants of nursing homes providing them. Our findings suggest that the provision of pain management programs and hospice care are becoming prevalent in nursing home settings and that nursing homes are quite sensitive to their market environment indicating that policy changes could encourage further increases in these service innovations in death and dying.

Identifying and Meeting Needs of Ethnic Minority Patients

SUMMARYIn an effort to meet the unique needs of terminally ill patients and their loved ones within underserved minority populations, hospices are attempting to learn more about the diverse cultures represented in their communities. This paper will discuss one hospice’s experience and perceptions of barriers to providing hospice care to individuals of diverse cultural backgrounds and the steps taken to more effectively serve them. [Single or multiple copies of this article are available from The Haworth Document Delivery Service: 1-800-342-9678, 9:00 a.m. - 5:00 p.m. (EST).]

Identifying and meeting needs of ethnic minority patients.

In an effort to meet the unique needs of terminally ill patients and their loved ones within underserved minority populations, hospices are attempting to learn more about the diverse cultures represented in their communities. This paper will discuss one hospice's experience and perceptions of barriers to providing hospice care to individuals of diverse cultural backgrounds and the steps taken to more effectively serve them.

Access to Hospice Programs in End‐Stage Dementia: A National Survey of Hospice Programs

Because care of end-stage dementia is a significant clinical problem for which alternative modes of care are needed, this study examined the extent to which hospice programs served dementia patients. A survey of 1694 hospices with 1184 respondents (70%). Identified patients had end-stage dementia, with no concurrent terminal illness. The proportion of end-stage dementia patients in hospice was measured. Fewer than 1% of hospice patients had a primary diagnosis of end-stage dementia, and only 21% of the hospices served such patients. However, 7% of hospice patients had a dementia secondary to another terminal illness, and 56% of the hospices served such patients. For 80% of the hospices, the major problem in serving dementia patients was the difficulty in predicting their survival time. A higher proportion of for-profit hospices served dementia patients (42%) compared with non-profit programs (22%) or public programs (15%), P < .001. A national survey of hospices revealed that few patients with primary dementia are currently treated by these programs, unless they have other terminal illnesses. An inability to predict survival was the major reason offered to explain this phenomenon. The higher percentage of patients with secondary dementia in hospice suggests that dementia per se does not make hospices care unfeasible. Similarly, the high proportion of for-profit hospices that enrolled patients whose dementia was primary implies the fiscal feasibility of providing hospice care for these patients. Further study is needed concerning the determinants of survival time in end-stage dementia.

Hospice care for children: past, present, and future.

Of the 100,000 children who die each year in the United States, close to 15,000 children could benefit from hospice/home care services. This article describes the concept of pediatric hospice care, reviews the Martinson study that was conducted in the 1970s, gives a chronological report on some institutions that provide hospice care for children in the United States and other parts of the world, and discusses the future of pediatric hospice care.

Hospice values, access to services, and the Medicare hospice benefit.

The Medicare benefit has been an important force in shaping the American hospice movement during the 1980's. Hospice reimbursement under Medicare added legitimacy to the movement, increased access to hospice care for some Medicare beneficiaries, and provided financial support to Medicare certified hospice programs. But the increased access for some may come at the cost of decreased access for others, and the price of reimbursement may be the erosion of hospice as a unique form of terminal care in this country. It is up to hospice professionals to balance the fiscal realities of providing hospice care without losing sight of the values and philosophies that have made hospice a "special kind of care."

Hospice care as an alternative to euthanasia.

The same concerns that have led society to consider euthanasia as an option for relieving the suffering of the dying led to the development of the hospice movement. How effectively has hospice care met these needs, and is there still a need for euthanasia? Is the hospice approach to death an alternative to euthanasia, compatible with euthanasia, or euthanasia in another form? Do those health care workers who are drawn to providing hospice care favor or oppose euthanasia?Hospice care developed out of a sense of frustration with the treatment of the dying, and as a reaction against the abuses of an impersonal high-technology approach to patients. There was institutional denial of death which made it impossible to integrate death into the lives of people. Due to neglect, many patients were under-treated with little attention paid to relieving pain or dealing with their or their families’ psychosocial needs.

The dental hygienist as a hospice care provider

The hospice concept focuses on the interdisciplinary team approach to providing palliative care for the terminally ill patient. Although oral conditions resulting from the patient's disease and treatment are frequently encountered in hospice patients, dental personnel have not traditionally been recognized as members of the interdisciplinary hospice team. This paper presents a model which incorporates a dental hygienist into the hospice team. We suggest that the roles of the dental hygienist are educator, dental consultant, and primary care provider.

Hospice and home care for persons with AIDS/ARC: meeting the challenges and ensuring quality.

Every community is or will be faced with the challenge of caring for individuals with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC). In most communities in the United States, home health care is an existing alternative to hospitalization. Although there are many potential barriers to home health and hospice care provision, these barriers are not insurmountable. As demonstrated by the community's response in San Francisco, careful planning, cooperation, and education reduce the barriers to allow persons with AIDS/ARC to receive care at home or to identify alternatives when home care is no longer an option. The AIDS Home Care and Hospice Program of the Visiting Nurses and Hospice of San Francisco is used as the model for the article. This program was the first of its kind in the world. It has developed an innovative approach to home and hospice care for persons with AIDS/ARC. Its sensitive and humane approach, offers support from early in the disease process (to assist patients as they struggle with difficult treatment decisions) until long after death occurs (to enable friends and family members to cope with the loss of a loved one). This article identifies the challenges that administrators and staff face in keeping the terminally ill individual with AIDS/ARC at home, offers suggestions to best meet the needs of the person with AIDS/ARC living at home, and suggests alternatives when home care is no longer an option.

Christian care for aids victims.

A North London charitable Christian hospital has become the first such institution to provide hospice care for people with AIDS.

The needs of hospice patients and primary caregivers.

It would appear that hospice care providers in the program investigated here are highly accurate in their perceptions of their clients' needs. The program therefore is in an excellent position to accomplish its goals. However, findings also suggest that nurses are most accurate in their perceptions of social, emotional, and physical needs. They don't do as well in estimating the importance of material needs, such as financial and legal concerns. Nurses are also more likely to misperceive the importance of religious and spiritual needs. Hospice programs might consider implementing a structural mechanism to assist nurses in the task of understanding these patient and family concerns. Encouraging nurses to routinely inquire about the need for assistance with these issues is one potential remedy. Specific in-service training to teach nurses how to cue in on material and religious needs may also be beneficial. Another approach would be to further integrate staff persons who have specific training in understanding these types of needs into hospice programs. Attorneys, financial consultants, and clergy may need direct contact with patients and families rather than being called into a specific case only after nurses identify the need. Another implication of these results stems from the finding that nurses' perceptions become more similar to caregivers over time. This is particularly true for the assessment of patients' needs. Previous research shows that a substantial proportion of patients do not enter hospice until a few days prior to their deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Home care for the dying: homemakers' perspectives.

Homemakers are important members of the health care team providing hospice care at home, yet there is little information about their views and experiences. This paper summarizes findings of a survey of homemakers working with a newly-developed program for providing home care for dying patients and their families. Results indicate that homemakers perform multiple roles, which they report tend to be more demanding physically and psychosocially than other kinds of homemaking. Being able to provide comfort in a time of extreme need is satisfying to homemakers, although frustrations exist as well. Implications for program planning and future research are discussed.

ADA statement on legislation to provide hospice care under Medicare

ADA statement on legislation to provide hospice care under Medicare