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Sample records for hospice center model

  1. The Hospice Concept of Care: A Family Centered Approach.

    ERIC Educational Resources Information Center

    Story, Marilyn

    This description of the Cedar Valley Hospice program emphasizes palliative and supportive care for terminally ill patients and their families. The history of the hospice movement is outlined along with a description of the Cedar Valley program and the results of a 1980 program evaluation. The appendices contain a statement of the hospice goals and…

  2. The Island Hospice model of palliative care.

    PubMed

    Khumalo, Thembelihle; Maasdorp, Valerie

    2016-01-01

    There has been a substantial increase in cancer detections in Africa over years, and it has also been noted that higher number of individuals are affected by the later stages of cancer that lead to death. When it comes to cancer care, Zimbabwe is no exception with its ongoing palliative care related research, though still in its infancy. The need for advanced and more accessible palliative care to assist the vulnerable has been intensified by this increase in cancer prevalence. Island Hospice, which is a centre of excellence in palliative care has varying elements of the models that it employs to engage those most in need of palliative assistance, especially children and financially-challenged individuals. PMID:27563349

  3. The Island Hospice model of palliative care

    PubMed Central

    Khumalo, Thembelihle; Maasdorp, Valerie

    2016-01-01

    There has been a substantial increase in cancer detections in Africa over years, and it has also been noted that higher number of individuals are affected by the later stages of cancer that lead to death. When it comes to cancer care, Zimbabwe is no exception with its ongoing palliative care related research, though still in its infancy. The need for advanced and more accessible palliative care to assist the vulnerable has been intensified by this increase in cancer prevalence. Island Hospice, which is a centre of excellence in palliative care has varying elements of the models that it employs to engage those most in need of palliative assistance, especially children and financially-challenged individuals. PMID:27563349

  4. African Americans and Hospice Care: A Culture-Centered Exploration of Enrollment Disparities.

    PubMed

    Dillon, Patrick J; Basu, Ambar

    2016-11-01

    Over the past decade, scholars and practitioners have called for efforts to reduce disparities in the cost and quality of end-of-life care; a key contributor to these disparities is the underuse of hospice care by African American patients. While previous studies have often relied on interviewing minority individuals who may or may not have been terminally ill and of whom few were using hospice care services, this essay draws upon the culture-centered approach to report the findings of a grounded theory analysis of 39 interviews with 26 African American hospice patients (n = 10) and lay caregivers (n = 16). Participants identified several barriers to hospice enrollment and reported how they were able to overcome these barriers by reframing/prioritizing cultural values and practices, creating alternative goals for hospice care, and relying on information obtained outside the formal health system. These findings have implications for understanding hospice experiences, promoting hospice access, and improving end-of-life care. PMID:27007165

  5. Documenting the impact of hospice.

    PubMed

    Merriman, M P

    1999-01-01

    Hospice care has had an impact at many levels--on individual patients and families, on the health care industry, and on society. However, no comprehensive body of evidence has been generated that documents the impact of hospice care in terms that are meaningful to competitors, referral sources, and consumers. In part, this is because of the many challenges for evaluating hospice care. This paper describes recent efforts in the documentation of the value of hospice which have focused on outcomes measurement by individual providers rather than on large scale studies. Several groups are working to develop reliable measurement tools, to support standardized measurement in large numbers of hospices, and to collect information for benchmarking and comparison. Measurement of the impact of hospice care will set standards for other providers of end-of-life care and will document the expertise and knowledge of hospice professionals. Once established as centers of excellence in care of the dying, hospices will be well positioned for whatever delivery models may evolve for end-of-life care. PMID:10839010

  6. Hospice Care

    MedlinePlus

    ... Page Resize Text Printer Friendly Online Chat Hospice Care What is Hospice Care? When is Hospice Care ... Family Counseling and Support Services What is Hospice Care? Hospice programs are available to help terminally ill ...

  7. Hospice care

    MedlinePlus

    Palliative care - hospice; End-of-life care - hospice; Dying - hospice; Cancer - hospice ... Hospice care helps people with illnesses that cannot be cured and who are nearing death. The goal is to ...

  8. Use of remote blood releasing system for red cell transfusion in hospice care center

    PubMed Central

    Chan, Kwok Ying; Leung, Rock Yuk Yan; Cheung, Ka Chi; Lam, Clarence; Koo, Eleanor; Ng, Sylvia

    2016-01-01

    Objectives: It is quite common to have advanced cancer or end-stage renal disease patients for regular or even frequent blood transfusion in palliative care. However, due to geographical reason in some hospice centers, blood transfusion is sometimes difficult if blood bank is closed during non-office hour or not available. Methods: Here, we reported a new blood releasing system, that is, remote blood releasing system, that could be used safely by nursing staff alone when the blood bank was closed during the night time and holiday. Results: On-call nursing staff could collect red cells successful in these two cases. Conclusion: The new blood releasing system seems useful. However, larger sample sizes and longer period of study are required to estimate its efficacy and safety. The provision of antibody-positive red cells and platelet remained a limitation of this system. PMID:27489720

  9. Hospice Care

    MedlinePlus

    ... term inpatient or respite care related to the terminal diagnosis. You can stop hospice at any time. ... http: / / www. hospicefoundation. org/ uploads/ hic_ fs_ hospice. pdf Additional Resource for Veterans: VA Guide to Long ...

  10. Hospice care

    MedlinePlus

    Hospice care helps people with illnesses that cannot be cured and who are nearing death. The goal ... give comfort and peace instead of a cure. Hospice care provides: Support for the patient and the ...

  11. Hospice Care

    MedlinePlus

    ... provide more information about hospice. National Hospice and Palliative Care Organization 1–800–658–8898 (helpline) 1–877– ... http://www.caringinfo.org The National Hospice and Palliative Care Organization’s Caring Connections website offers information and publications ...

  12. Selling hospice.

    PubMed

    Halabi, Sam

    2014-01-01

    Americans are increasingly turning to hospice services to provide them with medical care, pain management, and emotional support at the end of life. The increase in the rates of hospice utilization is explained by a number of factors including a "hospice movement" dating to the 1970s which emphasized hospice as a tool to promote dignity for the terminally ill; coverage of hospice services by Medicare beginning in 1983; and, the market for hospice services provision, sustained almost entirely by governmental reimbursement. On the one hand, the growing acceptance of hospice may be seen as a sign of trends giving substance to the death-with-dignity movement and the growing strength of end-of-life decision-makers and planners who integrate medical, community, family and spiritual networks. On the other hand, the precise relationship between the death-with-dignity and commercial processes driving hospice utilization rates are not well understood. On May 2, 2013, the U.S. Government intervened in a lawsuit brought by former hospice employees alleging that behind Vitas Innovative Hospice Care, the largest for-profit hospice service provider in the United States, lie an intricate web of incentives for patient intake nurses, physicians and marketers which not only drove hospice patients to use more expensive (and medically unnecessary) crisis care services, but influenced patient and family decisions as to whether or not to discontinue curative treatment. The corporate, investment, and regulatory history behind Vitas provides an important insight into the market realities behind Americans' embrace of hospice care and the risks to patient autonomy and health that accompany the commercialization of this ethically and morally complex health care service. PMID:25565612

  13. Hospice Care

    MedlinePlus

    ... support. The goal of the care is to help people who are dying have peace, comfort, and dignity. The caregivers try to control pain and other symptoms so a person can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's family. Usually, a hospice ...

  14. Hospice Care

    MedlinePlus

    ... nurses, social workers, spiritual counselors, home health aides, bereavement counselors and volunteers. The hospice team helps patients ... patient's family doctor Expert management of physical symptoms Bereavement and support groups for families What is bereavement ...

  15. Two Models of Caregiver Strain and Bereavement Adjustment: A Comparison of Husband and Daughter Caregivers of Breast Cancer Hospice Patients

    ERIC Educational Resources Information Center

    Bernard, Lori L.; Guarnaccia, Charles A.

    2003-01-01

    Purpose: Caregiver bereavement adjustment literature suggests opposite models of impact of role strain on bereavement adjustment after care-recipient death--a Complicated Grief Model and a Relief Model. This study tests these competing models for husband and adult-daughter caregivers of breast cancer hospice patients. Design and Methods: This…

  16. The Effect of Hospice on Hospitalizations of Nursing Home Residents

    PubMed Central

    Zheng, Nan Tracy; Mukamel, Dana B.; Friedman, Bruce; Caprio, Thomas V.; Temkin-Greener, Helena

    2014-01-01

    Objectives Hospice enrollment is known to reduce risk of hospitalizations for nursing home residents who use it. We examined whether residing in facilities with a higher hospice penetration: 1) reduces hospitalization risk for non-hospice residents; and 2) decreases hospice-enrolled residents’ hospitalization risk relative to hospice-enrolled residents in facilities with a lower hospice penetration. Method Medicare Beneficiary File, Inpatient and Hospice Claims, Minimum Data Set Version 2.0, Provider of Services File and Area Resource File. Retrospective analysis of long-stay nursing home residents who died during 2005-2007. Overall, 505,851 non-hospice (67.66%) and 241,790 hospice-enrolled (32.34%) residents in 14,030 facilities nationwide were included. We fit models predicting the probability of hospitalization conditional on hospice penetration and resident and facility characteristics. We used instrumental variable method to address the potential endogeneity between hospice penetration and hospitalization. Distance between each nursing home and the closest hospice was the instrumental variable. Main Findings In the last 30 days of life, 37.63% of non-hospice and 23.18% of hospice residents were hospitalized. Every 10% increase in hospice penetration leads to a reduction in hospitalization risk of 5.1% for non-hospice residents and 4.8% for hospice-enrolled residents. Principal Conclusions Higher facility-level hospice penetration reduces hospitalization risk for both non-hospice and hospice-enrolled residents. The findings shed light on nursing home end-of-life care delivery, collaboration among providers and cost benefit analysis of hospice care. PMID:25304181

  17. The Grief Group: A University and Hospice Collaboration

    ERIC Educational Resources Information Center

    O'Neill, Daniel; Fry, Michele

    2013-01-01

    This report describes a joint effort of a community hospice and a university counseling center to provide a campus grief group for university students led by a hospice counselor and a counseling center clinical psychologist. Hospice provided a curriculum outlining topics and activities for each of the group's six meetings. Notices announcing…

  18. Symposium: Hospices.

    ERIC Educational Resources Information Center

    Mental Retardation, 1984

    1984-01-01

    Concepts and practices associated with the hospice movement are described as a threat to persons with mental retardation. Three responses and a rejoinder discuss issues of equality of treatment, legal consent, definition of "quality of life," government legislation, public and private funding, and human service patterns. (JW)

  19. Hospice Enrollment, Local Hospice Utilization Patterns, and Rehospitalization in Medicare Patients

    PubMed Central

    Holden, Timothy R.; Smith, Maureen A.; Bartels, Christie M.; Campbell, Toby C.; Yu, Menggang

    2015-01-01

    Abstract Background: Rehospitalizations are prevalent and associated with decreased quality of life. Although hospice has been advocated to reduce rehospitalizations, it is not known how area-level hospice utilization patterns affect rehospitalization risk. Objectives: The study objective was to examine the association between hospice enrollment, local hospice utilization patterns, and 30-day rehospitalization in Medicare patients. Methods: With a retrospective cohort design, 1,997,506 hospitalizations were assessed between 2005 and 2009 from a 5% national sample of Medicare beneficiaries. Local hospice utilization was defined using tertiles representing the percentage of all deaths occurring in hospice within each Hospital Service Area (HSA). Cox proportional hazard models were used to assess the relationship between 30-day rehospitalization, hospice enrollment, and local hospice utilization, adjusting for patient sociodemographics, medical history, and hospital characteristics. Results: Rates of patients dying in hospice were 27% in the lowest hospice utilization tertile, 41% in the middle tertile, and 53% in the highest tertile. Patients enrolled in hospice had lower rates of 30-day rehospitalization than those not enrolled (2.2% versus 18.8%; adjusted hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.118–0.131). Patients residing in areas of low hospice utilization were at greater rehospitalization risk than those residing in areas of high utilization (19.1% versus 17.5%; HR, 1.05; 95% CI, 1.04–1.06), which persisted beyond that accounted for by individual hospice enrollment. Conclusions: Area-level hospice utilization is inversely proportional to rehospitalization rates. This relationship is not fully explained by direct hospice enrollment, and may reflect a spillover effect of the benefits of hospice extending to nonenrollees. PMID:25879990

  20. Medicare Hospice Benefits

    MedlinePlus

    ... Medic are covers You can get a one-time only hospice consultation with a hospice medical director or hospice doctor to discuss your care options and management of your pain and symptoms. You can get ...

  1. Home Economists and Hospice: A Needed Combination.

    ERIC Educational Resources Information Center

    Story, Marilyn D.

    1983-01-01

    Hospice is a family-centered concept of care which needs home economists from all subject-matter areas in volunteer or paid professional roles. In turn, home economists can grow personally as well as professionally through their involvement with hospice. (Author)

  2. 42 CFR 418.312 - Data submission requirements under the hospice quality reporting program.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... with CMS-approved vendors to collect the CAHPS® Hospice Survey data on their behalf and submit the data to the Hospice CAHPS® Data Center. (e) If the hospice's total, annual, unique, survey-eligible... exempt from the CAHPS® Hospice Survey reporting requirements in the current calendar year. In order...

  3. American Hospice Foundation

    MedlinePlus

    ... AHF worked to improve access to quality hospice care through public education, professional training, and consumer advocacy. Our vision was that hospice would be an integral part of our society, culture, and belief systems. ...

  4. Operational and financial performance of newly established hospices.

    PubMed

    McCue, Michael J; Thompson, Jon M

    2006-01-01

    The objective of the study was to examine the financial and operating performance of newly established, free- standing hospices relative to existing, freestanding hospices. A nonparametric median test was used to compare the median values of operating and financial performance measures between newly established hospices and existing hospices. Operating and financial data were measured for the 2 groups using cost report data from the Centers for Medicare and Medicaid Services. The authors sampled 44 new, freestanding hospices and selected 312 freestanding existing hospices and analyzed their data over 2 years from 2002 to 2003. The study found that 91% of these new hospices were owned by for-profit organizations and were located in the southern region of the United States. New hospices served fewer patients; however, they had a longer length of stay compared to existing hospices. They offered fewer imaging services and radiation therapy services. New hospices generated significantly higher revenue but incurred significantly higher expenses. The results suggest that longer lengths of stay allow these newer hospices to increase revenue and improve overall profitability. PMID:17060288

  5. Hospice: Morality and Economics.

    ERIC Educational Resources Information Center

    Gibson, Donald E.

    1984-01-01

    Examines hospice concepts and proposals to identify moral problems presented. Particular attention is given to the relationship between the hospice concept's alleged humanitarianism and emphasis on cost-efficiency. Suggests that cost emphasis raises serious questions about the meaning of hospice concepts. (JAC)

  6. The costs of a pediatric hospice program.

    PubMed Central

    Schweitzer, S O; Mitchell, B; Landsverk, J; Laparan, L

    1993-01-01

    The recent literature on economic issues of hospice care leaves several questions unanswered. The most important issue concerns how this type of care can be made financially attractive to patients and families for whom it is a medical option. A major study of a home-based pediatric hospice program permitted a more careful analysis than was previously feasible of the charges for hospice care and how those charges are paid. Data on provider utilization and duration in the program were obtained retrospectively on 177 patients. Costs of incidental expenditures and indirect costs were obtained prospectively from the families of 27 patients. A cost model was developed which is general enough to be used by other hospitals that might contemplate establishing a similar hospice program. Our findings are that insurance coverage, especially for publicly funded patients, is likely to be a major impediment for families deciding whether or not to use a hospice program at home. PMID:8434095

  7. Characteristics of Hospice Patients Utilizing Hospice Facilities

    PubMed Central

    Chung, Kyusuk; Burke, Sloane C.

    2014-01-01

    Given the increasing popularity of a hospice inpatient/residential facility (HIRF) among hospice patients and their family members, examining who uses HIRFs has been of increasing importance. Using the 2007 National Home and Hospice Care Survey (NHHCS), we found that about 14% of hospice patients received care in a HIRF in 2007. Characteristics of patients associated with HIRF use largely match the industry norm for a general inpatient level of care, and include: having no caregiver, or having an incapable caregiver; having imminent death; and being directly admitted to a hospice after discharge from a hospital. Given a recent stricter enforcement of reimbursement rules, however, we call for close monitoring of any change in the number of HIRF beds—particularly in rural and low-income urban areas. PMID:23264662

  8. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... hospice care to residents of a SNF/NF or ICF/IID. 418.112 Section 418.112 Public Health CENTERS FOR... participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID. In addition to meeting... residents of a SNF/NF or ICF/IID must abide by the following additional standards. (a) Standard:...

  9. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... hospice care to residents of a SNF/NF or ICF/IID. 418.112 Section 418.112 Public Health CENTERS FOR... participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID. In addition to meeting... residents of a SNF/NF or ICF/IID must abide by the following additional standards. (a) Standard:...

  10. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... hospice care to residents of a SNF/NF or ICF/MR. 418.112 Section 418.112 Public Health CENTERS FOR...: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR. In addition to meeting the... of a SNF/NF or ICF/MR must abide by the following additional standards. (a) Standard:...

  11. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... hospice care to residents of a SNF/NF or ICF/IID. 418.112 Section 418.112 Public Health CENTERS FOR... participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID. In addition to meeting... residents of a SNF/NF or ICF/IID must abide by the following additional standards. (a) Standard:...

  12. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR. 418.112 Section 418.112 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of...

  13. Essential Elements of an Effective Prison Hospice Program.

    PubMed

    Cloyes, Kristin G; Rosenkranz, Susan J; Berry, Patricia H; Supiano, Katherine P; Routt, Meghan; Shannon-Dorcy, Kathleen; Llanque, Sarah M

    2016-05-01

    As the number of prison inmates facing end-stage chronic illness grows, more prisons across the U.S. must address the need for end-of-life care. Many will likely need to develop a plan with potentially limited resources and external support. This case study presents one long-running model of care, the Louisiana State Penitentiary Prison Hospice Program. Based on field observations and in-depth interviews with hospice staff, inmate volunteers and corrections officers, we identify five essential elements that have contributed to the long-term operation of this program: patient-centered care, an inmate volunteer model, safety and security, shared values, and teamwork. We describe key characteristics of each of these elements, discuss how they align with earlier recommendations and research, and show how their integration supports a sustained model of prison end-of-life care. PMID:25735806

  14. Essential Elements of an Effective and Sustainable Prison Hospice Program

    PubMed Central

    Cloyes, Kristin G.; Rosenkranz, Susan J.; Berry, Patricia H.; Supiano, Katherine P.; Routt, Meghan; Shannon-Dorcy, Kathleen; Llanque, Sarah M.

    2015-01-01

    As the number of prison inmates facing end-stage chronic illness grows, more prisons across the U.S. must address the need for end-of-life care. Many will likely need to develop a plan with potentially limited resources and external support. This case study presents one long-running model of care, the Louisiana State Penitentiary Prison Hospice Program. Based on field observations and in-depth interviews with hospice staff, inmate volunteers and corrections officers, we identify five essential elements that have contributed to the long-term operation of this program: patient-centered care, an inmate volunteer model, safety and security, shared values, and teamwork. We describe key characteristics of each of these elements, discuss how they align with earlier recommendations and research, and show how their integration supports a sustained model of prison end-of-life care. PMID:25735806

  15. Hospice: Rehabilitation in Reverse

    PubMed Central

    Jeyaraman, Senthilkumar; Kathiresan, Ganesan; Gopalsamy, Kavitha

    2010-01-01

    Hospice care is about quality of life at a time when a person has an illness for which curative measures are no longer possible, and for which a physician has determined the patient has a life expectancy of about six months or less, a hospice program can support the process of death and dying in a compassionate way. A growing trend is to utilize physical therapy more frequently in hospice. Physical therapy has several vital roles in hospice care as follows: maximizing functional ability and comfort to enhance quality of life; assuring patient and care giver safety; helping people redesign their lives and life goals; providing support around physical, emotional and spiritual issues at the end of life. The purpose of this review is to provide 1) a description of hospice care, 2) an explanation of the roles of physical therapists in hospice care. PMID:21217999

  16. Spatial practices and the home as hospice.

    PubMed

    McGann, Sarah

    2011-01-01

    The modern hospice movement emerged in the late 1960s largely as a reaction to the way in which death and dying were dealt with in the hospital building. From the early development of the hospice movement, setting was considered to be very important. Hospice buildings were more residential and "homely" than their hospital counterparts. However, with the widespread development of "hospice home-care" programmes in the 1980s, this emphasis on place and setting changed, and along with it the meaning of the term "hospice" has changed. The current claim of the hospice movement is that "hospice" is a philosophy of care not a building or place.Home is now widely considered to be the best place to die, a place of familiar surroundings and the company of family and friends. The modern preference to die at home relies on traditional models of home, family and community. Dying at home was at one time commonplace and envisioned within the design of the home, and caring was a normal expectation of key family members. In modern society, however, dying is generally not a considered function within the design brief of the home and families may be unable, through economic, geographical or other reasons, to be carers. Thus, for some, home may not be the best place to die and family may not be the best carer. As a result, many people, despite their preference for home, still end up dying in the hospital building. This paper discusses the spatial issues surrounding the concept of home as hospice and questions the universal suitability of the contemporary home as a hospice. PMID:23393541

  17. 42 CFR 418.402 - Individual liability for services that are not considered hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... considered hospice care. 418.402 Section 418.402 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Coinsurance § 418.402 Individual liability for services that are not considered hospice care. Medicare payment to the...

  18. 42 CFR 418.400 - Individual liability for coinsurance for hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... care. 418.400 Section 418.400 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Coinsurance § 418.400 Individual liability for coinsurance for hospice care. An individual who has filed an election for hospice care...

  19. 42 CFR 418.400 - Individual liability for coinsurance for hospice care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... care. 418.400 Section 418.400 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Coinsurance § 418.400 Individual liability for coinsurance for hospice care. An individual who has filed an election for hospice care...

  20. Psychological contracts of hospice nurses.

    PubMed

    Jones, Audrey Elizabeth; Sambrook, Sally

    2010-12-01

    Psychological contracts have been described as individuals' beliefs regarding the obligations, expectations, and contributions that exist between them and their employer. They can be influenced by the organization's culture and philosophy, through human resources policies, and through the employee's personality and characteristics. Owing to the recent economic crisis, hospices in the UK are currently in a transitional phase and are being expected to demonstrate efficiencies that might be more in line with a business model than a health-care environment. This may conflict with the philosophical views of hospice nurses. To support nurses through this transition, it might be helpful to understand the antecedents of hospice nurses' behaviour and how they construct their psychological contracts. Failure to offer adequate support might lead to negative outcomes such as a desire to leave the organisation, poorer quality work, or disruptive behaviour. This study used a modified grounded theory approach involving in-depth interviews to explore the context and content of the psychological contracts of hospice nurses in the UK. Four main themes emerged: the types of psychological contracts formed, how the contracts are formed, their contents, and the breaches and potential violations the nurses perceive. PMID:21240104

  1. Hospice Care in the United States: The Process Begins.

    ERIC Educational Resources Information Center

    Buckingham, Robert W.

    1982-01-01

    The hospice concept represents a return to humanistic medicine, to care within the patient's community, for family-centered care, and the view of the patient as a person. Medical, governmental, and educational institutions have recognized the profound urgency for the advocacy of the hospice concept. (Author)

  2. Estimating goodwill: an application of Pine's procedures for hospices.

    PubMed

    Doka, Kenneth J; Pine, Vanderlynn

    2004-01-01

    Hospice care is a philosophy as well as a business. As a business, especially in the current healthcare environment, it is subject to many of the same forces that affect other businesses, such as acquisitions, sales, and mergers. Yet, estimating the value of a hospice is problematic, since its most valued asset (the reputation and goodwill that it has generated within the communities it serves) is intangible. This article explores the problem of assessing the value of a hospice, applying Pine's model for estimating goodwill in funeral service as a useful approach for hospices. The article offers assumptions for assessment and examples of suggested approaches. PMID:15315192

  3. Hospice care in Calgary

    PubMed Central

    Spice, Ronald; Lau, Monica; Perez, Grace; Turley, Nathan; Turin, Tanvir Chowdhury

    2016-01-01

    Abstract Objective To explore Calgary family physicians’ knowledge about hospices, their attitudes toward the referral process, and their understanding of barriers to referral for hospice care. Design Surveys were mailed to 400 randomly selected participants. The survey contained 18 questions related to hospice care, physician experience, attitudes, and perceived barriers to making a hospice referral. Setting Calgary, Alta. Participants Family physicians. Main outcome measures Survey responses were analyzed quantitatively using the 2 goodness-of-fit test, Kruskal-Wallis tests, and logistic regression analyses to examine univariate associations. Qualitative analysis of open-ended questions was done by content analysis and thematic coding. Results In total, 104 surveys were mailed back. Family physicians agreed that palliative care in a hospice setting can greatly improve quality of life for patients, but only 2 of 6 knowledge questions about hospice care were answered correctly by most. Family physicians with special areas of interest or subspecialties were more likely to feel well-informed about hospice referrals (P = .017), indicated a higher comfort level discussing hospice and palliative care (P = .030), and were less likely to defer discussing it with patients (P = .023). Physicians with a special interest in palliative medicine were more likely to correctly answer the knowledge questions (P < .034) and to be familiar with the referral process (P < .001), patient eligibility (P < .001), and the palliative home care program (P = .003). Qualitative analysis revealed support for palliative home care and consultation services but concerns about caregiver coping and family issues. Concerns about disengagement of family physicians and uncertainty about the referral process are obstacles to referral. Conclusion While Calgary family physicians are appreciative of hospice care, there are knowledge gaps. It is important to engage family physicians in the referral

  4. The Rural Hospice: Integrating Formal and Informal Helping Systems.

    ERIC Educational Resources Information Center

    Jenkins, Lowell; Cook, Alicia S.

    1981-01-01

    Describes the implementation of the hospice philosophy in rural areas and provides a model of how formal helping systems and natural helping networks can work together effectively. Suggests the emergence of the hospice can reorient social workers to the basic concepts of helping. (Author/JAC)

  5. Findings from a nursing scholarship study tour to inform a proposal for a day hospice model in South Australia.

    PubMed

    Swetenham, Kate

    2014-02-01

    South Australia releases national and international travel scholarships every year to the nursing and midwifery workforce to enable them to undertake observational site visits to inform the development of service models that can be introduced into care practices back in South Australia. Ten sites across New Zealand, Canada, and the UK agreed to host a site visit as part of a scholarship to look at day hospice (DH) programmes. The author undertook an observational study that included participation in DH programmes and discussions with staff and patients. There were many similarities across the three countries, in particular in the structure of the programmes, the staff makeup, and the support of the volunteer workforce. Two distinct models were observed: social and medical. Each has its value and both need to be incorporated to ensure services and participants have their needs met. Based on the site visits and other research, the author devised a proposal for South Australia to commence with a time-limited sessional group DH programme with a focus on maintenance of function for participants coupled with caregiver education and information provision. PMID:24577215

  6. Making the Transition to Hospice: Exploring Hospice Professionals' Perspectives

    ERIC Educational Resources Information Center

    Waldrop, Deborah P.; Rinfrette, Elaine S.

    2009-01-01

    Hospice care is available for 6 months before death but the length of use varies widely, suggesting that there are different perspectives on the appropriate timing for this transition. This qualitative study explored hospice professionals' views on the appropriate timing for and communication about hospice. Ethnography of team meetings informed…

  7. The Developmental Transition From Living With to Dying From Cancer: Hospice Decision Making.

    PubMed

    Waldrop, Deborah; Meeker, Mary Ann; Kutner, Jean S

    2015-01-01

    Despite increasing utilization of hospice care, older adults with cancer enroll in hospice for shorter periods of time than those with other life-limiting illnesses. How older adults with cancer and their family members consider hospice is unknown. The purpose of this study was to compare decision making in late-stage cancer in people who enrolled in hospice with those who declined. Concepts from the Carroll and Johnson (1990) decision-making framework guided the development of a hospice decision-making model. The study design was exploratory-descriptive, cross-sectional, and used a two-group comparison. Qualitative and quantitative data were collected in the same interview. Open-ended questions were used to explore the illness trajectory and decision-making process. The interrelationships between functional ability, quality of life, and social support with hospice decision making were assessed using the Katz, QLQ-30, and Lubben Social Network Scales. Study participants included 42 older adults with cancer who had been offered hospice enrollment (24 non-hospice and 18 hospice) and 38 caregivers (15 non-hospice and 23 hospice); N = 80. The decisional model illustrates that the recognition of advanced cancer and information and communication needs were experienced similarly by both groups. There was interaction between the decisional stages: formulation of awareness and generation of alternatives that informed the evaluation of hospice but these stages were different in the hospice and non-hospice groups. The hospice enrollment decision represents a critical developmental juncture, which is accompanied by a transformed identity and substantive cognitive shift. Increased attention to the psychosocial and emotional issues that accompany this transition are important for quality end-of-life care. PMID:26176303

  8. The Developmental Transition from Living with to Dying From Cancer: Hospice Decision-making

    PubMed Central

    Waldrop, Deborah; Meeker, Mary Ann; Kutner, Jean S.

    2016-01-01

    Despite increasing utilization of hospice care, older adults with cancer enroll in hospice for shorter periods of time than those with other life-limiting illnesses. How older adults with cancer and their family members consider hospice is unknown. The purpose of this study was to compare decision-making in late-stage cancer in people who enrolled in hospice with those who declined. Concepts from the Carroll and Johnson (1990) decision-making framework guided the development of a hospice decision-making model. The study design was exploratory-descriptive, cross-sectional and used a 2-group comparison. Qualitative and quantitative data were collected in the same interview. Open-ended questions were used to explore the illness trajectory and decision-making process. The interrelationships between functional ability, quality of life and social support with hospice decision-making were assessed using the Katz, QLQ-30 and Lubben Social Network Scales. Study participants included 42 older adults with cancer who had been offered hospice enrollment (24 non-hospice and 18 hospice) and 38 caregivers (15 non-hospice and 23 hospice); N=80. The decisional model illustrates that the Recognition of Advanced Cancer and Information and Communication Needs were experienced similarly by both groups. There was interaction between the decisional stages: Formulation of Awareness and Generation of Alternatives that informed the Evaluation of Hospice but these stages were different in the hospice and non-hospice groups. The hospice enrollment decision represents a critical developmental juncture which is accompanied by a transformed identity and substantive cognitive shift. Increased attention to the psychosocial and emotional issues that accompany this transition are important for quality end-of-life care. PMID:26176303

  9. Hospice Care in America

    MedlinePlus

    ... iii 4. Survey of Team Attitudes and Relationships (STAR)  iv ( www. nhpco. org/ star) • Job satisfaction (hospice-specific) • Salary ranges • Provider-level ... to national estimates and peer groups. iv The STAR national summary report is available for purchase by ...

  10. The U.S. hospice movement: issues in development.

    PubMed Central

    Osterweis, M; Champagne, D S

    1979-01-01

    A grass-roots hospice care movement is underway in the United States modeled after recently popularized British hospice programs. Hospice care is intended to help the terminally ill maintain a personally acceptable quality of life until death. Attention should be given to ensuring the future viability of this service option by allowing for experimentation with and adaptation of existing models, and by integrating it with the overall health care system. Issues to be considered in integrating hospice care include utilization of existing resources, regional planning, standards and licensure, and reimbursement opportunities. Although hospice care may not have an immediate cost savings impact on the health care system, it could develop this capacity in the future. Such impact would not only assure a stable financial base for hospice care but would also affect bed use generally. Continuing dialogue among providers, consumers, and policy makers of various backgrounds is necessary to the effective and appropriate development of hospice care in the U.S. PMID:434281

  11. Hospice care in the nursing home setting: a review of the literature.

    PubMed

    Stevenson, David G; Bramson, Jeffrey S

    2009-09-01

    The U.S. Medicare hospice benefit has expanded considerably into the nursing home (NH) setting in recent years. This literature review focuses on the provision of NH hospice, exploring its growth and the impact of such care on NH residents, cost and efficiency implications for NHs and government, and policy challenges and important areas for future research. Although hospice utilization is relatively modest among NH residents, its increased availability holds great promise. As an alternative to traditional NH care, hospice has been shown to provide high-quality end-of-life care and offer benefits, such as reduced hospitalizations and improved pain management. The provision of NH hospice also has been shown to have positive effects on nonhospice residents, suggesting indirect benefits on NH clinical practices. Importantly, the expansion of hospice in NHs brings challenges, on both clinical and policy dimensions. Research has shown that NH-hospice collaborations require effective communication around residents' changing care needs and that a range of barriers can impede the integration of hospice and NH care. Moreover, the changing case mix of hospice patients, including increased hospice use by individuals with conditions such as dementia, presents challenges to Medicare's hospice payment and eligibility policies. To date, there has been little research comparing hospice costs, service intensity, and quality of care across settings, reflecting the fact that few comparative data have been available to researchers. The Centers for Medicare & Medicaid Services have taken steps toward collecting these data, and further research is needed to shed light on what refinements, if any, are necessary for the Medicare hospice program. PMID:19735904

  12. Hospice Core Professions' Views on Interdisciplinary Teams: A Qualitative Investigation.

    PubMed

    Kobayashi, Rie; McAllister, Carolyn A

    2016-01-01

    The hospice interdisciplinary team (IDT) has been recognized as an ideal model for interprofessional collaboration. To address the manner in which interdisciplinary practices are perceived by team members, this study explored profession-based similarities and differences in perceptions among the four core hospice IDT members (physicians, nurses, social workers, and spiritual care providers) as well as experiences on the IDT. Semistructured interviews with 20 hospice professionals, 5 from each profession, were completed. Findings suggested that while hospice professions share some perceptions and experiences about hospice team membership, strengths of and barriers to teamwork, and individual members' contribution to the team, significant profession-based differences exist largely in the area of hospice team membership beyond the core members, type of language and descriptions used, perceptions of causes and effects of barriers to teamwork, and understandings of how team effectiveness is evaluated. Changes at the team-based, organizational, policy, and educational levels are needed to further maximize strengths of individual hospice IDT member and team qualities. PMID:27462950

  13. Same Agency, Different Teams: Perspectives From Home and Inpatient Hospice Care

    PubMed Central

    Hurley, Susan Lysaght; Barg, Frances K.; Strumpf, Neville; Ersek, Mary

    2015-01-01

    Tremendous growth in hospice over the past 30 years in the United States has increased the number of terminally ill patients dying at home. Recently, however, more hospice patients are dying at inpatient facilities. To understand the varying perceptions about care in the home and inpatient hospice, we conducted semistructured interviews with 24 interdisciplinary team (IDT) members and analyzed the data using the constant comparative method. Core interdisciplinary tasks, including identifying the focus of energy, tailoring family caregiver involvement, acknowledging who is in charge, and knowing both sides differed in the home and inpatient settings. Despite the overarching umbrella of hospice care, home and inpatient hospice settings create different foci for IDT members, burdens and privileges for family caregivers, and control of the care plan. Key differences between home and inpatient hospice processes of care highlight the complexity of patient-centered end-of-life care in the United States. PMID:25294344

  14. Hospice Eligibility and Election: Does Policy Prepare Us to Meet the Need?

    PubMed

    Wallace, Cara L

    2015-01-01

    A 7-point policy model is used to examine policy on hospice eligibility and election in the United States. Despite the growth of hospice, many eligible patients continue to lack access due to difficulties experienced by providers in discerning 6-month prognoses among chronically ill patients, the inability of patients to elect hospice alongside curative care, and limited reimbursement for hospice providers. Though the landscape of dying has evolved, with more deaths occurring later in life from chronic illness, Medicare hospice eligibility requirements have historically remained the same. Utilization would increase if hospice agencies were able to provide fewer restrictions by including ongoing treatments such as transfusions, intravenous nutrition, or palliative radiation. Hospices would be more likely to enroll critically ill patients who require some ongoing curative measures if Medicare reimbursement rates were higher, and patients would be more likely to seek hospice earlier if Medicare election policies were altered to allow concurrent care. Participation would also be increased by extending hospice eligibility past the traditional prognosis of 6 months. Though expansion in public spending of hospice care has been met with some opposition, current research suggests that potential savings due to decreased costs in acute care is promising. PMID:26161945

  15. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... inpatient care directly. 418.110 Section 418.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of... management. (i) The hospice must address real or potential threats to the health and safety of the...

  16. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... inpatient care directly. 418.110 Section 418.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of... management. (i) The hospice must address real or potential threats to the health and safety of the...

  17. Characteristics of hospice patients utilizing hospice inpatient/residential facilities.

    PubMed

    Chung, Kyusuk; Burke, Sloane C

    2013-11-01

    Given the increasing popularity of a hospice inpatient/residential facility (HIRF) among hospice patients and their family members, examining who uses HIRFs has been of increasing importance. Using the 2007 National Home and Hospice Care Survey (NHHCS), we found that about 14% of the hospice patients received care in an HIRF in 2007. Characteristics of patients associated with HIRF use largely match the industry norm for a general inpatient level of care and include having no caregiver or having an incapable caregiver; having imminent death; and being directly admitted to a hospice after discharge from a hospital. Given a recent stricter enforcement of reimbursement rules, however, we call for close monitoring of any change in the number of HIRF beds--particularly in rural and low-income urban areas. PMID:23264662

  18. Straddling the fence: ICU nurses advocating for hospice care.

    PubMed

    Borowske, Deborah

    2012-03-01

    A key factor in nurses' experiencing moral distress is their feeling of powerlessness to initiate discussions about code status, EOL issues, or patients' preferences. Moreover, nurses encounter physicians who give patients and their families a false picture of recovery or, worse, block EOL discussions from occurring. Since its release in 1995, the landmark study of almost 10,000 patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) reported a widespread gap with physicians' discussions in honest prognosis and EOL issues. Since the SUPPORT report, other studies have validated patients' and their families' preference for realistic discussions of disease trajectory and life expectancy. Unfortunately, the phenomenon of physicians failing to discuss bad news or terminal disease trajectory persists. Moreover, with a burgeoning geriatric population, coupled with advances in medical treatments, a growing segment of chronically ill patients are admitted to the ICU. With these communication shortcomings, it becomes an essential element of practice for the ICU nurse to initiate discussions about healthcare goals, preferences, and choices. The ICU nurse must be integral in fostering those discussions, particularly in cases where the family asks if hospice should be considered. Nurses have a long history of patient advocacy, with both the American Nurses Association and the American Association of Critical-Care Nurses stating that nurses have a duty to educate and promote dialogue about patients' preferences, goals, and EOL issues. With these tenets in the forefront, the ICU nurse is an integral member of the healthcare team, working with patients and their families to distinguish between what can be done and what should be done. Too often, hospice is thought of as a last resort. Rather, it is a model of care that centers on the belief that each of us has the right to die pain free and with dignity, and that our families

  19. The association between hospice use and depressive symptoms in surviving spouses

    PubMed Central

    Ornstein, Katherine A.; Aldridge, Melissa D.; Garrido, Melissa M.; Gorges, Rebecca; Meier, Diane E.; Kelley, Amy S.

    2015-01-01

    Importance Family caregivers of individuals with serious illness are at risk for depressive symptoms and depression. Hospice includes the provision of support services for family caregivers, yet evidence is limited regarding the impact of hospice use on depressive symptoms among surviving caregivers. Objective To determine the association between hospice use and depressive symptoms in surviving spouses. Design We linked data from the Health and Retirement Study (HRS), a nationally representative longitudinal survey of community dwelling U.S. adults 50 years of age and older to Medicare claims. With propensity score matching on both decedent and spousal characteristics, we compared the spouses of individuals enrolled in hospice prior to death to the spouses of individuals who did not use hospice. Setting National study of decedents and surviving spouses. Participants Propensity score matched sample of 1016 HRS decedents with at least one serious illness and their surviving spouses interviewed 2002–2010. Exposure(s) for observational studies Hospice enrollment for at least 3 days in the year prior to death. Main Outcome(s) and Measure(s) Spousal depressive symptom scores measured 0–2 years post-death with the Center for Epidemiologic Studies Depression Scale (CES-D), which is scored 0 (no symptoms) to 8 (severe symptoms). Results Of the decedents in the matched sample, 305 (30.0%) used hospice services for >= 3 days in the year prior to death. Of the spouses, 52% had more depressive symptoms over time (mean change = 2.56; S.D = 1.65), with no difference related to hospice use. A minority, (28.2%) of spouses of hospice users had improved CES-D scores, compared to 21.7% of spouses of decedents who did not use hospice (p=0.06). Among the spouses who were the primary caregivers (n-662), 27.3% of spouses of hospice users had improved CES-D scores, compared to 20.7% of spouses of decedents who did not use hospice (p=0.10); in multivariate analysis, the odds ratio for

  20. The impact of prison hospice: collaboration among social workers and other professionals in a criminal justice setting that promotes care for the dying.

    PubMed

    Bronstein, Laura R; Wright, Kevin

    2006-01-01

    This study reports on a qualitative national telephone survey with coordinators of 14 prison hospice programs in 11 states. The rationale behind the survey was to learn about interdisciplinary collaboration between social work and criminal justice, using prison hospice as an exemplar of this collaboration. In addition to learning that all prison hospices in the study operate using an interdisciplinary team model and that most report high quality collaboration on the hospice team, the following additional five themes emerged: administrators and wardens are very supportive while correctional staff provides mixed support to team and program; greater collaboration with those outside prison hospice is critical; collaboration through prison hospice has a positive impact on dying prisoners; collaboration through prison hospice has a positive impact on prisoner volunteers; and, collaboration through prison hospice has a positive impact on the entire culture of the prison. PMID:17387096

  1. 42 CFR 418.309 - Hospice cap amount.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Hospice cap amount. 418.309 Section 418.309 Public...) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.309 Hospice cap amount. The hospice cap amount... until October 31 of the following year. (b) Each hospice's cap amount is calculated by the...

  2. Continuum of care comes full circle. Adding hospice care allows a Denver system to better meet patient needs.

    PubMed

    Rockers, T H; Hoagland, B

    1994-09-01

    In November 1993 Hospice of Peace, a home hospice program in Denver, was reorganized under a new joint sponsorship of Provenant Health Partners and Catholic Charities and Community Services. Home hospice completes Provenant's continuum of healthcare. Based on the campus of Provenant Senior Life Center, Hospice of Peace employs multidisciplinary professionals who care for patients and their family care givers in their homes. Each hospice team works with a patient's physician and comes from a pool of primary care nurses, certified nurse assistants, social workers, counselors, pastoral care counselors, and specially trained volunteers and bereavement counselors. Respect for human life at all stages is the ethic behind the organizations' hospice efforts. Even at life's end, when aggressive medical treatment is no longer appropriate, healthcare professionals can enhance patients' quality of life and provide bereavement support to their loved ones. Just as Catholic healthcare addresses the spiritual component of healing, so it addresses the spiritual component of dying. PMID:10136079

  3. 42 CFR 418.26 - Discharge from hospice care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Discharge from hospice care. 418.26 Section 418.26 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or...

  4. 42 CFR 422.320 - Special rules for hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules for hospice care. 422.320 Section 422.320 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations §...

  5. Rehospitalization of Older Adults Discharged to Home Hospice Care

    PubMed Central

    Goldenheim, Anna; Oates, Daniel; Parker, Victoria; Russell, Matthew; Winter, Michael

    2014-01-01

    Abstract Background: Acute hospital readmission of older adults receiving hospice care is not aligned with hospice goals. Objective: To identify factors associated with 30-day readmission among older adults newly discharged to hospice. Design/Subjects: Medical record review of 59 patients, 19 readmitted within 30 days and 40 randomly selected controls not readmitted, from 206 patients newly discharged to home hospice care between February 1, 2005 and January 31, 2010. Measures/Analysis: Information was collected about hospital course, end-of-life planning, and posthospitalization follow-up. We calculated bivariate associations and developed a Cox Proportional Hazards model examining the relation between index admission characteristics and readmission. Results: Patients' mean age was 79.7±8.4; 74.6% were female; 52.5% were black. Among those readmitted, 25% had received a palliative care consultation, compared to 47.1% of those not readmitted (p=0.06). Patients without a participating decision-maker involved in their hospice decision had 3.5 times the risk of readmission within 30 days, compared to those with (hazard ratio [HR] 3.53, confidence interval [CI] 0.97, 12.82). Patients who had one or more telephone contacts with their primary care physician (PCP) during week 1 after discharge had 2.4 times the readmission risk within 30 days, compared to patients with no such contacts during this period (HR 2.35, CI 0.9, 6.1). Conclusions: Readmission within 30 days of initial discharge to hospice is associated with several measures of care and care planning. Further study of these measures may identify opportunities for interventions to improve the hospital-to-hospice transition and to decrease hospital readmissions. PMID:24708490

  6. Relationships between Social Work Involvement and Hospice Outcomes: Results of the National Hospice Social Work Survey

    ERIC Educational Resources Information Center

    Reese, Dona J.; Raymer, Mary

    2004-01-01

    In a struggle to balance fiscal realities with hospice philosophy, some hospices have attempted to cut costs by reducing social work involvement. This cross-sectional survey of 66 hospices found, however, increased social work involvement was significantly associated with lower hospice costs. Additional benefits included better team functioning,…

  7. Discussions with Physicians about Hospice among Patients with Metastatic Lung Cancer

    PubMed Central

    Huskamp, Haiden A.; Keating, Nancy L.; Malin, Jennifer L.; Zaslavsky, Alan M.; Weeks, Jane C.; Earle, Craig C.; Teno, Joan M.; Virnig, Beth A.; Kahn, Katherine L.; He, Yulei; Ayanian, John Z.

    2009-01-01

    Context Many terminally-ill patients enroll in hospice only in the final days before death or not at all. Discussing hospice with a provider could increase awareness of hospice and possibly result in earlier use. Methods We used data on 1517 patients diagnosed with stage IV lung cancer from a multi-regional study. We estimated logistic regression models for the probability that a patient discussed hospice with a physician or other health-care provider before an interview 4−7 months after diagnosis as reported by either the patient or surrogate or documented in the medical record. Results Half (53%) of patients had discussed hospice with a provider. Patients who were black, Hispanic, non-English speaking, married or living with a partner, Medicaid beneficiaries, or had received chemotherapy were less likely to have discussed hospice. Only 53% of individuals who died within two months after the interview had discussed hospice, and rates were lower among those who lived longer. Patients who reported that they expected to live less than two years had much higher rates of discussion than those expecting to live longer. Patients reporting the most severe pain or dyspnea were no more likely to have discussed hospice than those reporting less severe or no symptoms. A third of patients who reported discussing do-not-resuscitate (DNR) preferences with a doctor had also discussed hospice. Conclusions Many patients diagnosed with metastatic lung cancer had not discussed hospice with a provider within 4−7 months of diagnosis. Increased communication with physicians could address patients’ lack of awareness about hospice and misunderstandings about prognosis. PMID:19468089

  8. National Hospice and Palliative Care Organization

    MedlinePlus

    ... Strategic Planning for Hospice Hospice Policy and Advocacy Healthcare Reform and Innovation Inspirational Address Booking Policies Contact NHPCO ... Webinar Registration MP4 Recordings Pay for CE/CME Online Learning E-OL Courses Interdisciplinary Team Palliative Care ...

  9. The Need for Quality Hospice Care.

    ERIC Educational Resources Information Center

    Butler, Robert N.

    1979-01-01

    There has been little comment in the hospice literature about the special problems of the elderly. Promotes the continued refinement of hospice concepts and practices in relation to both disease and age. (Author/CMG)

  10. Psychological Consultation in an HMO Hospice.

    ERIC Educational Resources Information Center

    Gould, Warren

    Hospice care differs from traditional medical care in that it aims to optimize the quality of the patient's remaining life rather than to maximize its duration. The Hayward Hospice project, begun in November of 1977 as a pilot project to evaluate whether hospice quality care could be provided within manageable costs and thus be included as a…

  11. Profile of an Effective Hospice Team Member.

    ERIC Educational Resources Information Center

    Basile, Joseph L.; Stone, Donald B.

    1987-01-01

    Examined competencies that hospice practitioners and experts in the field would agree upon as necessary attributes to being an effective hospice team member. Results indicated strong positive agreement between the rankings of the practitioners on emotional and interpersonal characteristics needed by hospice personnel to effectively function with…

  12. NATIONAL HOME AND HOSPICE CARE SURVEY (NHHCS)

    EPA Science Inventory

    The National Home and Hospice Care Survey is a continuing series of surveys of home and hospice care agencies in the United States. Information was collected about agencies that provide home and hospice care and about their current patients and discharges. The NHHCS is based on a...

  13. Evaluating transformational leadership skills of hospice executives.

    PubMed

    Longenecker, Paul D

    2006-01-01

    Health care is a rapidly changing environment requiring a high level of leadership skills by executive level personnel. The hospice industry is experiencing the same rapid changes; however, the changes have been experienced over the brief span of 25 years. Highly skilled hospice executives are a necessity for the growth and long-term survival of hospice care. This descriptive study was conducted to evaluate the leadership skills of hospice executives. The study population consisted of hospice executives who were members of the state hospice organization in Ohio and/or licensed by the state (88 hospice providers). Three questionnaires were utilized for collecting data. These questionnaires collected data on transformational leadership skills of participants, participants' personal demographics, and their employer's organizational demographics. Forty-seven hospice executives responded (53%). Key findings reported were high levels of transformational leadership skills (mean, 3.39), increased use of laissez-faire skills with years of hospice experience (P = .57), and positive reward being a frequent leadership technique utilized (mean, 3.29). In addition, this was the first study of leadership skills of hospice executives and the first formal collection of personal demographic data about hospice executives. PMID:17060280

  14. Conflicts and conflict regulation in hospices: nurses' perspectives. Results of a qualitative study in three German hospices.

    PubMed

    Walker, Andreas; Breitsameter, Christof

    2013-11-01

    The present article considers conflicts and conflict regulation in hospices. The authors carried out a qualitative study in three hospices in North Rhine-Westphalia, Germany, to explore how conflicts arise and how conflict regulation proceeds. Hospice nurses should act according to a set of ethical codes, to mission statements of the institution and to professional standards of care. In practice the subjective interpretations of codes and/or models concerning questions of care are causes of conflicts among nurses, with doctors, patients and family members. The management has two choices to react to these conflicts. It can either tolerate the conflicts, as long as they do not disturb the daily routine. Or it can increase the degree of organisation by integrating the different viewpoints into its own program and/or by restructuring its organisational units. PMID:23264046

  15. The Hospice: An Integrated Bibliography.

    ERIC Educational Resources Information Center

    Bodine, George E.; Sobotor, William

    This extensive bibliography of books and articles provides an interdisciplinary overview of present day terminal care and the hospice alternative. Designed to aid in the development and implementation of terminal care programs stressing palliative and supportive services for both patients and their families, the bibliography includes abstracts of…

  16. Communication Aspects of Hospice Care.

    ERIC Educational Resources Information Center

    Jensen, Marvin D.

    No theories of communication can minimize the crisis of dying. But those who study commmunication can suggest ways of offering comfort and dignity to the dying person. Many of these ways go beyond words, for death cannot be addressed with verbal cliches. The theoretical work from which a communication scholar draws can help hospice volunteers and…

  17. Nonverbal Communication in Hospice Care.

    ERIC Educational Resources Information Center

    Jensen, Marvin D.

    Hospice care (health care for the terminally ill that emphasizes emotional support for the patient and family) is essential to ease emotional, psychological, and social pain, and can be a factor in addressing spiritual and physical pain. Yet to ease the pain of final illness, therapeutic communication must extend beyond words. Physical contact--in…

  18. Motivations of German Hospice Volunteers: How Do They Compare to Nonhospice Volunteers and US Hospice Volunteers?

    PubMed

    Stelzer, Eva-Maria; Lang, Frieder R

    2016-03-01

    We examined reasons of volunteering for hospice and nonhospice organizations in a study with 125 volunteers (22-93 years) from the United States and Germany. Motives of US and German hospice volunteers revealed similarities and few differences. Hospice volunteers are involved because they seek to help others, seek new learning experiences, seek social contacts, or seek personal growth. The US hospice volunteers reported motives related to altruistic concerns, enhancement, and social influence as more influential, while German hospice volunteers rated career expectations as being more important. Comparison of German hospice with nonhospice volunteers revealed stronger differences: German hospice volunteers scored higher on altruistic motives, while German nonhospice volunteers yielded higher scores on self-serving motives. Findings contribute to improved understanding of volunteering motivation and of activating or retaining hospice volunteers. PMID:25422517

  19. The need for increased access to pediatric hospice and palliative care.

    PubMed

    Jones, Brian W

    2011-01-01

    Pediatric hospice and palliative care continue to be an underutilized model of care. There is much confusion over the differences between hospice and palliative care. Nurses and physicians continue to need specialized training regarding end-of-life care and the pediatric population. Children and their families may needlessly be suffering during the dying process. Many barriers exist that prevent its use among medical professionals. This article discusses some of these barriers and strategies to reduce them. Recent changes in health care law will allow both curative and hospice care to be provided at the same time. PMID:21841410

  20. The two-faced angel: do phase I clinical trials have a place in modern hospice?

    PubMed

    Ross, Daniel S

    2006-01-01

    Increasingly, bioethicists have been exploring the possibility of making phase I clinical trials available to hospice patients. Phase I clinical trials are designed to test a drug's safety and dosage, not its effectiveness. Participants in these studies generally do not understand that the purpose of the investigation is not to benefit them, thus challenging the notion of informed consent. But furthermore, the idea that patients believe experimental drugs will help them is contrary to the principles of hospice. Also, the very nature of the research in phase I conflicts with hospice's methods. For these reasons, this paper finds that the two models must remain distinct. PMID:17146915

  1. Improving Diabetes Care for Hospice Patients.

    PubMed

    Lee, Sei J; Jacobson, Margaret A; Johnston, C Bree

    2016-07-01

    Although type 2 diabetes guidelines recommend less aggressive glycemic control for patients with limited life expectancy, many hospice patients continue their glucose-lowering medications, resulting in an increased risk of hypoglycemia. Three common reasons for overly tight glycemic control in hospice patients include (1) discussions about reducing or stopping chronic medications are uncomfortable; (2) many patients and families believe that mild hyperglycemia can cause symptoms; and (3) until 2014, Healthcare Information and Data Information Set (HEDIS) quality indicators for glycemic control included hospice patients. To address these issues, we recommend (1) providers discuss with patients and families upon hospice enrollment that diabetes medications can be reduced or discontinued as their life-limiting disease progresses; (2) keeping blood glucose levels between 200 and 300 mg/dL; and (3) educate providers that HEDIS measures now exclude hospice patients. Implementing these recommendations should decrease the risk of hypoglycemia in hospice patients and improve their quality of life. PMID:25852204

  2. The routinization of hospice: charisma and bureaucratization.

    PubMed

    James, N; Field, D

    1992-06-01

    In 25 years the number of hospices in Britain has multiplied from under 15 in 1965 to over 430 in 1991. During this period, often working out with the mainstream health system, the hospices actively sought to transform terminal care. More recently a process of diversification and legitimation has meant that hospices have become increasingly subject to mainstream influence. Using Weber's concept of charisma we examine the development of the hospice movement during this period of expansion. We suggest there are a number of factors leading to the routinization of hospice care including the ways in which it was sponsored and developed at the local level, and pressures toward bureaucratization and professionalization. We make links with recent developments in the health services. Finally we consider whether it is possible for the hospice movement to sustain its founding ideals. PMID:1529374

  3. Hospice-Where Peace and Turmoil Coexist.

    PubMed

    Viswanath, Vidya

    2016-01-01

    It is often said that a hospice is much more than just a place providing supportive care for the terminally ill. This narrative describes Neha, a young mother who found her solace in the hospice and spent her last days there by choice. It reinforces the fact that the hospice is truly a philosophy of care where powerful and contrasting emotions do coexist. PMID:26862661

  4. Death representation of caregivers in hospice.

    PubMed

    Andruccioli, Jessica; Russo, Maria Maffia; Bruschi, Angela; Pedrabissi, Luigi; Sarti, Donatella; Monterubbianesi, Maria Cristina; Rossi, Sabina; Rocconi, Sabina; Raffaeli, William

    2012-11-01

    In this study, we investigated caregiver's death representation in hospice. The results presented here are a further analysis of the data collected in our previous study, concerning the evaluation of the caregiver in hospice. The data analysis of 24 caregivers of patients hospitalized in Rimini Hospice (Italy) underlined that caregivers avoiding death representation of the patient admitted to hospice had fewer protective factors (52.3%) and more risk factors (47.7%) than caregivers nonavoiding (66.5% and 33.5%, respectively). Caregivers avoiding death representation, moreover, experienced a greater distress (58%) than those nonavoiding (42%). PMID:22241459

  5. Telehospice: reasons for slow adoption in home hospice care.

    PubMed

    Whitten, Pamela; Holtz, Bree; Meyer, Emily; Nazione, Samantha

    2009-01-01

    We investigated why hospice nurses were slow to adopt videophones to care for their patients. We used the unified theory of acceptance and use of technology (UTAUT) model and the organizational readiness for change (ORC) assessment via interviews and focus groups with hospice staff. Twenty-five hospice employees participated. Eighteen (72%) were in clinical positions and seven were in non-clinical positions (28%). Thirty-nine percent of respondents reported no videophone training, despite the fact that every employee had received training. Only four staff members actually used a videophone with patients. The respondents overwhelmingly stated that they had the organizational resources necessary to use the videophone and that it was easy to operate. Despite initial enthusiasm, leaders in the hospice agency did not endorse the videophones for work, nor offer incentives for using the videophones or providing them to patients. It is important to note that videophone technology is not meant to replace face-to-face visits, but to supplement them and to provide an additional tool for the nurses. PMID:19471030

  6. Creative ritual in a hospice.

    PubMed

    Roche, J

    1994-12-01

    St. Peter's Hospice, Albany, NY, is dedicated to meeting the emotional needs of patients, families, and staff. Creative ritual, hospice leaders have found, is a powerful tool that can: Provide an "arena" for healing, affirmation, reconciliation, and celebration Serve as a reminder of the sacred Evoke heartfelt emotion Effect renewal and inspiration Offer an opportunity to cleanse the soul of grief, anger, frustration, or guilt Provide tangible experiences of bonding and interdependence Prevent staff burnout St. Peter's staff show a good deal of imagination and variety in creating rituals. Possible themes include patients' birthdays or wedding anniversaries, religious celebrations, national holidays, and changes of seasons. A lighted candle, bouquet of flowers, or incense burner may be used to give the ritual a focus. Music is often played to help set the tone. Rituals involve a major shift in consciousness. They often allow participants to express feelings it would otherwise be difficult for them to put into words. At St. Peter's, participants may begin to communicate by sharing favorite prayers, poems, photos, or works of art. Or they may make music--the hospice provides the instruments--or pass around a Native American "talking stick." Such methods facilitate the bonding of patients and their families. Particularly important are those rituals which allow patients and estranged family members to reconcile. Others enable patients to acknowledge God-given gifts. Still other rituals are held for staff members, who thereby deal with the anger and sadness their work inevitably brings. For all at St. Peter's Hospice ritual is a source of healing, affirmation, renewal, inspiration, and grace. PMID:10138592

  7. Factors Affecting Willingness to Use Hospice in Racially/Ethnically Diverse Older Men and Women.

    PubMed

    Park, Nan Sook; Jang, Yuri; Ko, Jung Eun; Chiriboga, David A

    2016-09-01

    Racial/ethnic minorities tend to underutilize hospice services. Guided by Andersen behavioral health model, the purpose of this study was to explore the predictors of the willingness to use hospice services in racially/ethnically diverse older men and women. Data were drawn from the Survey of Older Floridians: 504 non-Hispanic whites, 360 African Americans, 328 Cuban Americans, and 241 non-Cuban Hispanics. In each group, logistic regression models of the willingness to use hospice were estimated. A greater likelihood of willingness was observed among younger non-Hispanic whites and among African Americans with fewer functional disabilities. In non-Cuban Hispanics, English proficiency increased the willingness by 3.1 times. Findings of the study identified group-specific factors contributing to the willingness to use hospice services and hold implications for tailored intervention programs. PMID:26071499

  8. Regulating and Paying for Hospice and Palliative Care: Reflections on the Medicare Hospice Benefit.

    PubMed

    Mor, Vincent; Teno, Joan M

    2016-08-01

    Hospice began as a social movement outside of mainstream medicine with the goal of helping those dying alone and in unbearable pain in health care institutions. The National Hospice Study, undertaken to test whether hospice improved dying cancer patients' quality of life while saving Medicare money, found hospice care achieved comparable outcomes to traditional cancer care and was less costly as long as hospice lengths of stay were not too long. In 1982, before study results were final, Congress created a Medicare hospice benefit under a capitated per diem payment system restricting further treatment. In 1986 the benefit was extended to beneficiaries living in nursing homes. This change resulted in longer average lengths of stay, explosive growth in the number of hospices, particularly of the for-profit variety, and increases in total Medicare expenditures on hospice care. An increasingly high proportion of beneficiaries receive hospice care. However, over 30 percent are served fewer than seven days before they die, while very long stays are also increasingly common. These and other factors raise quality concerns about hospice being disconnected from the rest of the health care system. We offer suggestions regarding how hospice could be better integrated into the broader health care delivery system. PMID:27127256

  9. In the business of dying: questioning the commercialization of hospice.

    PubMed

    Perry, Joshua E; Stone, Robert C

    2011-01-01

    This article critically questions the commercialization of hospice care and the ethical concerns associated with the industry's movement toward "market-driven medicine" at the end of life. For example, the article examines issues raised by an influx of for-profit hospice providers whose business model appears at its core to have an ethical conflict of interest between shareholders doing well and terminal patients dying well. Yet, empirical data analyzing the experience of patients across the hospice industry are limited, and general claims that end-of-life patient care is inferior among for-profit providers or even that their business practices are somehow unseemly when compared to nonprofit providers cannot be substantiated. In fact, non-profit providers are not immune to potentially conflicting concerns regarding financial viability (i.e., "no margin, no mission"). Given the limitations of existing empirical data and contrasting ideological commitments of for-profit versus non-profit providers, the questions raised by this article highlight important areas for reflection and further study. Policymakers and regulators are cautioned to keep ethical concerns in the fore as an increasingly commercialized hospice industry continues to emerge as a dominant component of the U.S. health care system. Both practitioners and researchers are encouraged to expand their efforts to better understand how business practices and commercial interests may compromise the death process of the patient and patient's family--a process premised upon a philosophy and ethical tradition that earlier generations of hospice providers and proponents established as a trusted, end-of-life alternative. PMID:21561517

  10. 75 FR 67905 - National Hospice Month, 2010

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-04

    ... States of America the two hundred and thirty-fifth. (Presidential Sig.) [FR Doc. 2010-28082 Filed 11-3-10... Documents#0;#0; ] Proclamation 8594 of October 29, 2010 National Hospice Month, 2010 By the President of the United States of America A Proclamation During National Hospice Month, we recognize the dignity...

  11. Characterizing Hospice Services in the United States

    ERIC Educational Resources Information Center

    Smith, Maureen A.; Seplaki, Christopher; Biagtan, Mark; DuPreez, Amanda; Cleary, James

    2008-01-01

    Purpose: Although caregivers desire specific information about hospice programs, there is little descriptive information available. We characterized agencies that provide formal or informal hospice care in the United States according to four types of services considered important by caregivers: medications and treatments; rehabilitative care;…

  12. The Hospice Concept: Health Occupation 305.

    ERIC Educational Resources Information Center

    Schobel, Deborah A.

    A description is provided of "The Hospice Concept," an elective course offered as part of a two-year college health occupations curriculum. The course is designed to further the students understanding of the multiple facets of death and dying and to prepare them to be hospice volunteers. Following a course description and a glossary of terms,…

  13. The Hospice Farewell: Ideological Perspectives of Its Professional Practitioners.

    ERIC Educational Resources Information Center

    Rinaldi, Anoel; Kearl, Michael C.

    1990-01-01

    Questioned 48 hospice experts to elicit group judgments about hospice ideology, control over one's own death trajectory, and hospice's relevance for older individuals. Although high rate of consensus was obtained on many issues, little evidence of coherent ideology could be detected linking notions of hospice origins, issues of patient control,…

  14. 42 CFR 417.531 - Hospice care services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Hospice care services. 417.531 Section 417.531... PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.531 Hospice care services. (a) If a Medicare enrollee of... receive hospice care services, payment for these services is made to the hospice that furnishes...

  15. 42 CFR 418.25 - Admission to hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Admission to hospice care. 418.25 Section 418.25... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.25 Admission to hospice care. (a) The hospice admits a patient only on the recommendation of the medical...

  16. The grief experience of prison inmate hospice volunteer caregivers.

    PubMed

    Supiano, Katherine P; Cloyes, Kristin G; Berry, Patricia H

    2014-01-01

    Correctional institutions are obligated to provide end-of-life care to a population with complex medical needs. Prison hospices are increasingly being formed to address this demand. Few empirical studies have examined the impact of caring for dying inmates on the hospice inmate volunteers, who, in several prison health care systems, provide direct care. In this study, experiences of the inmate hospice volunteers with death were investigated to illuminate their grief processes. Understanding the bereavement needs of hospice volunteers and how prison hospice volunteers navigate grief and remain committed to providing excellent hospice care can inform the grief processes and practices of hospice care professionals. PMID:24628143

  17. Predictors of live hospice discharge: data from the National Home and Hospice Care Survey (NHHCS).

    PubMed

    Kutner, Jean S; Blake, Marcia; Meyer, Sue A

    2002-01-01

    In the context of the current regulatory environment, patients may be discharged from hospice if their condition stabilizes or improves over time and the certifying physician is unable to provide a conscientious recertification of the six-month prognosis. Little is known about the characteristics or outcomes of patients who are determined by physicians to no longer be eligible for hospice care. This retrospective study was designed to characterize the rates and predictors of live hospice discharge using data from the 1996 and 1998. National Home and Hospice Care Survey (NHHCS). We compare records of live hospice discharge with hospice discharges due to death from the discharge patient files of the 1996 and the 1998 NHHCS. Of the 807,733 patients in the combined 1996 and 1998 NHHCS discharge patient file who met study inclusion criteria, 761,858 (94 percent) were deceased and 45,875 (6 percent) were discharged alive. Those who were discharged alive were more likely to be female, have received hospice care for more than 60 days, and to have had a noncancer diagnosis, particularly advanced cardiopulmonary or neurologic disease. Mean age and total number of assistive medical devices used did not differ significantly between patients who were discharged alive and those who died in hospice care. Factors most associated with live hospice discharge, using bivariate analyses, were length of service greater than 60 days (OR, 6.60; 95 percent CI, 6.47-6.73), cardiopulmonary diagnosis (OR, 3.24; 95 percent CI, 3.19-3.30), and neurologic diagnosis (OR, 2.73; 95 percent CI, 2.67-2.79). Multivariate logistic regression identified length of service greater than 60 days, cardiopulmonary diagnosis, neurologic diagnosis, female gender, worse functional status, and living in an institutional setting as being independently associated with live hospice discharge. We found that patients who were discharged alive from hospice care were more likely to have longer lengths of service

  18. Reciprocal Suffering: Caregiver Concerns During Hospice Care

    PubMed Central

    Wittenberg-Lyles, Elaine; Demiris, George; Oliver, Debra Parker; Burt, Stephanie

    2010-01-01

    Context For many hospice caregivers, the constancy and difficulty of caregiving impact their physical quality of life and cause depression, psychological distress, guilt, loneliness, and restrictions on social activities. Objectives Deviating from traditional unidimensional research on hospice caregivers, this study explored the transactional nature of reciprocal suffering by examining caregiver concerns through four dimensions: physical, psychological, social, and spiritual. Methods Researchers analyzed audiotapes of intervention discussions between hospice caregivers and research social workers. Results Results indicated that of the 125 pain talk utterances, the majority referenced psychological concern (49%), followed by physical (28%), social (22%), and spiritual (2%). Reflections on concerns revealed a global perspective of caregiving, which highlighted the patient’s needs juxtaposed to the caregiver’s recognized limitations. Conclusion By examining the reciprocal nature of suffering for caregivers, this study reinforced the need for assessing caregivers in hospice care, with specific emphasis on the importance of providing caregiver education on pain management. PMID:21146356

  19. Hospice: enhancing the quality of life.

    PubMed

    Lamers, W M

    1990-05-01

    Hospice care is directed at the relief of the physical, social and psychologic symptoms that often accompany advanced, incurable illness. In recent years, an increasing number of physicians has come to recognize the necessity for hospice care in the treatment of some patients with cancer, HIV infection, and a number of other (as yet) incurable illnesses. Hospice care is designed to improve the quality of life through the use of medications and treatments directed at the relief of symptoms secondary to the underlying disease and its treatment. Hospice makes use of a wide range of physical, social and psychological therapies to relieve symptoms and to provide support and information for the patient's family and caregivers. PMID:2143397

  20. American Academy of Hospice and Palliative Medicine

    MedlinePlus

    ... Getting Involved Communities Advanced Lung Disease Forum Psychiatry, Psychology, Mental Health Forum Social Work Forum SIG Instructions ... HPM Lecture Series Research Scholars Mentoring Scholarship About History Position Statements Access to Palliative Care and Hospice ...

  1. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... inpatient care directly. 418.110 Section 418.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of participation... address real or potential threats to the health and safety of the patients, others, and property. (ii)...

  2. Breaking Down Barriers: Hospice Palliative Care as a Human Right in Canada

    ERIC Educational Resources Information Center

    Freeman, Shannon; Heckman, George; Naus, Peter J.; Marston, Hannah R.

    2013-01-01

    The need to attend to terminally ill persons and provide improved quality of living and dying should be a national priority in Canada. Hospice palliative care (HPC), a person-centered approach that addresses the needs of the whole person, improves the quality of living and dying of persons facing a life-threatening illness. To ensure Canadians are…

  3. Guide for Hospices. Interdisciplinary Team Training and Humanistic Patient Care for Hospices. Monograph 1.

    ERIC Educational Resources Information Center

    English, David J.; Mortenson, Lee E.

    This monograph, the first in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to assist hospice directors, educators, and other administrative staff members to understand the focus of the proposed training and its applicability to their…

  4. Hierarchical and joint site-edge methods for medicare hospice service region boundary analysis.

    PubMed

    Ma, Haijun; Carlin, Bradley P; Banerjee, Sudipto

    2010-06-01

    Hospice service offers a convenient and ethically preferable health-care option for terminally ill patients. However, this option is unavailable to patients in remote areas not served by any hospice system. In this article, we seek to determine the service areas of two particular cancer hospice systems in northeastern Minnesota based only on death counts abstracted from Medicare billing records. The problem is one of spatial boundary analysis, a field that appears statistically underdeveloped for irregular areal (lattice) data, even though most publicly available human health data are of this type. In this article, we suggest a variety of hierarchical models for areal boundary analysis that hierarchically or jointly parameterize both the areas and the edge segments. This leads to conceptually appealing solutions for our data that remain computationally feasible. While our approaches parallel similar developments in statistical image restoration using Markov random fields, important differences arise due to the irregular nature of our lattices, the sparseness and high variability of our data, the existence of important covariate information, and most importantly, our desire for full posterior inference on the boundary. Our results successfully delineate service areas for our two Minnesota hospice systems that sometimes conflict with the hospices' self-reported service areas. We also obtain boundaries for the spatial residuals from our fits, separating regions that differ for reasons yet unaccounted for by our model. PMID:19645704

  5. Hierarchical and Joint Site-Edge Methods for Medicare Hospice Service Region Boundary Analysis

    PubMed Central

    Ma, Haijun; Carlin, Bradley P.; Banerjee, Sudipto

    2011-01-01

    Summary Hospice service offers a convenient and ethically preferable health care option for terminally ill patients. However, this option is unavailable to patients in remote areas not served by any hospice system. In this paper we seek to determine the service areas of two particular cancer hospice systems in northeastern Minnesota based only on death counts abstracted from Medicare billing records. The problem is one of spatial boundary analysis, a field that appears statistically underdeveloped for irregular areal (lattice) data, even though most publicly available human health data are of this type. In this paper, we suggest a variety of hierarchical models for areal boundary analysis that hierarchically or jointly parameterize both the areas and the edge segments. This leads to conceptually appealing solutions for our data that remain computationally feasible. While our approaches parallel similar developments in statistical image restoration using Markov random fields, important differences arise due to the irregular nature of our lattices, the sparseness and high variability of our data, the existence of important covariate information, and most importantly, our desire for full posterior inference on the boundary. Our results successfully delineate service areas for our two Minnesota hospice systems that sometimes conflict with the hospices' self-reported service areas. We also obtain boundaries for the spatial residuals from our fits, separating regions that differ for reasons yet unaccounted for by our model. PMID:19645704

  6. Barriers to Hospice Use among African Americans: A Systematic Review

    ERIC Educational Resources Information Center

    Washington, Karla T.; Bickel-Swenson, Denise; Stephens, Nathan

    2008-01-01

    The present review was undertaken to explore recent evidence in the professional literature pertaining to use of hospice services by African Americans. The article addresses the research methods that have been used to study African American hospice use, obstacles to African American participation in hospice that have been identified, and…

  7. 42 CFR 418.24 - Election of hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Election of hospice care. 418.24 Section 418.24... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.24 Election of hospice care. (a) Filing an election statement. An individual who meets the eligibility requirement...

  8. 42 CFR 418.24 - Election of hospice care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Election of hospice care. 418.24 Section 418.24... (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.24 Election of hospice care. (a) Filing an election statement. An individual who meets the...

  9. 42 CFR 418.30 - Change of the designated hospice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Change of the designated hospice. 418.30 Section... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.30 Change of the designated hospice. (a) An individual or representative may change, once in each election...

  10. A Comparative Study of Terminally Ill Hospice and Hospital Patients.

    ERIC Educational Resources Information Center

    Labus, Janet G.; Dambrot, Faye H.

    1986-01-01

    Investigated differences between 28 hospice and 28 hospital patients who died. Comparison found that hospice patients were younger, had more people living in the home, and had shorter disease history. Age, number of people living in the home, and primary cancer site significantly discriminated between hospice and hospital patients and predicted…

  11. 42 CFR 417.585 - Special rules: Hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules: Hospice care. 417.585 Section 417... PREPAYMENT PLANS Medicare Payment: Risk Basis § 417.585 Special rules: Hospice care. (a) No payment is made to an HMO or CMP on behalf of a Medicare enrollee who has elected hospice care under § 418.24 of...

  12. Oncology Social Workers' Attitudes toward Hospice Care and Referral Behavior

    ERIC Educational Resources Information Center

    Becker, Janet E.

    2004-01-01

    Members of the Association of Oncology Social Workers completed a survey, which included the Hospice Philosophy Scale (HPS) assessing the likelihood of the worker referring a terminally ill patient to hospice, background and experience, and demographics. The respondents held overwhelmingly favorable attitudes toward hospice philosophy and care,…

  13. 42 CFR 418.24 - Election of hospice care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Election of hospice care. 418.24 Section 418.24... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.24 Election of hospice care. (a) Filing an election statement. An individual who meets the eligibility requirement...

  14. Hospice Education Program for Nurses. Health Manpower References.

    ERIC Educational Resources Information Center

    HCS, Inc., Potomac, MD.

    This publication contains a curriculum to prepare nurses for delivery of hospice care for the terminally ill. It provides training manuals for both participant and facilitator in a preservice or inservice Hospice Education Program. Each manual (participant and facilitator) includes nine modules: (1) Hospice Care Concept; (2) Communication Skills;…

  15. Predicting patient survival before and after hospice enrollment.

    PubMed

    Christakis, N A

    1998-01-01

    Despite the apparent advantages of hospice care, several barriers exist in terms of patient referral. Physicians' prognoses play a large role in determining when hospice care should begin. Predicting patient survival is a subjective decision dependent on several factors that vary before and after hospice enrollment. Currently, the stay of patients in hospice is very short; this can be attributed to late referral by physicians. Additional research on physician behavior and prognostication could help optimize the use of hospice as a valuable health care resource, thereby improving end of life care for terminally ill patients. PMID:9644394

  16. Ethical dilemmas faced by hospice social workers.

    PubMed

    Dennis, Mary Kate; Washington, Karla T; Koenig, Terry L

    2014-10-01

    Ethical decision making is critically important in hospice social work. Through in-depth interviews, researchers explored ethical dilemmas faced by 14 hospice social workers and the processes they used to move toward resolution. The dilemmas were integrated into a framework focused on the sources of ethical conflict: the client system, the agency, and the profession. Processes involved in resolving ethical dilemmas included consulting with other professionals, weighing the pros and cons of options, and bringing about desired outcomes. Findings suggest that hospice teams should be provided with opportunities to meaningfully discuss ethical decision making. Further, the involvement of social workers in administrative leadership is recommended to increase the likelihood that discipline-specific perspectives are incorporated into formal policies and procedures that shape practice in ethically complex situations. PMID:25397348

  17. Guest at hospice: time for consideration.

    PubMed

    Warrén Stomberg, Margareta

    2009-01-01

    This study focuses on daily life situation of terminally ill guests residing at a hospice. In the study, interviews were conducted with 9 such guests. Data were analyzed using a method similar to content analysis. Categories emerged that were related to aspects regarded as external and internal essentials for the well-being of the individual at the hospice. These essentials were as follows: encouragement from the staff, the alleviation of pain, a pleasant and calm atmosphere at the hospice, the significance of visits from relatives, the regret of not being able to take care of oneself, and time to reconcile to one's life. These results not only show the need for close community with both family and staff but also the need for privacy to reflect on life. PMID:19244475

  18. Hospice benefits and phase I cancer trials.

    PubMed

    Byock, Ira; Miles, Steven H

    2003-02-18

    Medicare denies hospice coverage to patients with terminal illnesses who enroll as participants in phase I studies, which assess the toxicity and dosing of potential treatments for incurable diseases. Federal regulations require patients to forgo curative therapies, and they interpret phase I agents as treatment for the terminal condition for which hospice care was elected. Thus, by enrolling as a participant in a phase I trial, a patient otherwise eligible for hospice is rendered ineligible. Private insurers have similar provisions for children and adults younger than 65 years of age. Such exclusions are not defensible on ethical or clinical grounds. Policymakers, insurers, and institutional review boards all have a role in resolving this problem. PMID:12585832

  19. Hospice quality improvement programs: an initial examination.

    PubMed

    D'Onofrio, C N

    1998-05-01

    Recognizing that little is known about use of quality improvement (QI) processes to enhance care of the dying, 11 large hospices exchanged information about their QI programs. These hospices reported monitoring from 3 to 50 outcomes measured by various indicators and methods. Agencies that related QI to their organization's mission, goals, and strategic plan were more likely to have dedicated QI staff; a more intense, comprehensive, and participatory QI program; and more QI projects resulting in performance enhancement. Both accomplishments and difficulties were identified in several areas, including establishing benchmarks, involving staff, and using computer technology to manage and analyze QI data. PMID:10179273

  20. From hospice to hospital: short-term follow-up study of hospice patient outcomes in a US acute care hospital surveillance system

    PubMed Central

    Pathak, Elizabeth Barnett; Wieten, Sarah; Djulbegovic, Benjamin

    2014-01-01

    Objectives In the USA, there is little systematic evidence about the real-world trajectories of patient medical care after hospice enrolment. The objective of this study was to analyse predictors of the length of stay for hospice patients who were admitted to hospital in a retrospective analysis of the mandatorily reported hospital discharge data. Setting All acute-care hospitals in Florida during 1 January 2010 to 30 June 2012. Participants All patients with source of admission coded as ‘hospice’ (n=2674). Primary outcome measures The length of stay and discharge status: (1) died in hospital; (2) discharged back to hospice; (3) discharged to another healthcare facility; and (4) discharged home. Results Patients were elderly (median age=81) with a high burden of disease. Almost half died (46%), while the majority of survivors were discharged to hospice (80% of survivors, 44% of total). A minority went to a healthcare facility (5.6%) or to home (5.2%). Only 9.2% received any procedure. Respiratory services were received by 29.4% and 16.8% were admitted to the intensive care unit. The median length of stay was 1 day for those who died. In an adjusted survival model, discharge to a healthcare facility resulted in a 74% longer hospital stay compared with discharge to hospice (event time ratio (ETR)=1.74, 95% CI 1.54 to 1.97 p<0.0001), with 61% longer hospital stays among patients discharged home (ETR=1.61, 95% CI 1.39 to 1.86 p<0.0001). Total financial charges for all patients exceeded $25 million; 10% of patients who appeared to exit hospice incurred 32% of the charges. Conclusions Our results raise significant questions about the ethics and pragmatics of end-of-life medical care, and the intentions and scope of hospices in the USA. Future studies should incorporate prospective linkage of subjective patient-centred data and objective healthcare encounter data. PMID:25052170

  1. The Hospice: Advocate for the Dying.

    ERIC Educational Resources Information Center

    Anspaugh, David J.

    1978-01-01

    The hospice philosophy seeks to meet the needs of dying patients and their families. These needs include: effective control of pain; to be loved and to alleviate loneliness; to retain dignity and maintain control of as many aspects of life as possible; and to help the family be supportive and adapt to their inevitable loss. (JMF)

  2. Hospice Decision Making: Diagnosis Makes a Difference

    ERIC Educational Resources Information Center

    Waldrop, Deborah P.; Meeker, Mary Ann

    2012-01-01

    Purpose: This study explored the process of decision making about hospice enrollment and identified factors that influence the timing of that decision. Methods: This study employed an exploratory, descriptive, cross-sectional design and was conducted using qualitative methods. In-depth in-person semistructured interviews were conducted with 36…

  3. Characteristics of Hospice Patients and their Caregivers.

    ERIC Educational Resources Information Center

    Bass, David M.; And Others

    1986-01-01

    Describes selected characteristics of 146 terminal patients enrolled in a home-based hospice program and similar characteristics of the patients' primary caregivers. Examines relationships between the characteristics of patients and caregivers and relationships between these characteristics and the rate at which various services were utilized.…

  4. Utilization of Pets in a Hospice Program.

    ERIC Educational Resources Information Center

    Doyle, Kathleen; Kukowski, Thomas

    1989-01-01

    The therapeutic use of animals with specific populations has gained increased attention and interest. Pet placement in special settings such as prisons, mental institutions and hospices have shown beneficial results. Development of a pet visitation program requires specific planning and organization. (JD)

  5. A VNA-Organized Hospice Volunteer Program.

    ERIC Educational Resources Information Center

    Dorang, Edith S.

    1981-01-01

    Factors contributing to the success of a hospice volunteer program, organized by a visiting nurse association, include patient involvement in defining agency expectations of a volunteer, careful selection of candidates, a well-planned training program, contractual agreements, and record-keeping. (CT)

  6. Successful Interprofessional Collaboration on the Hospice Team.

    ERIC Educational Resources Information Center

    Reese, Dona J.; Sontag, Mary-Ann

    2001-01-01

    Despite the holistic approach inherent in the hospice philosophy, social work may be viewed as ancillary to medicine. Social work, in turn, may lack sensitivity about other professions' expertise and values and therefore be unprepared to collaborate across cultural boundaries between professions. This article outlines the barriers and proposes…

  7. Volunteers: The Life-Line of Hospice.

    ERIC Educational Resources Information Center

    Patchner, Michael A.; Finn, Mark B.

    1988-01-01

    Survey of 68 hospice volunteers found volunteers to be relatively young, well-educated, in good health, motivated by religious beliefs and personal experience, and prepared for jobs after training and some on-the-job experience. Volunteers were most satisfied when working in direct contact with patients and families and in the hospital.…

  8. A Survey of Hospices Use of Complementary Therapy

    PubMed Central

    Running, Alice; Shreffler-Grant, Jean; Andrews, Wendy

    2009-01-01

    As people live longer with chronic illnesses, the need for hospice services will increase. Complementary therapies have been shown to increase ease, relieve pain, and improve quality of life; all relevant for people with chronic illness at the end of their lives. The first aim of this study was to identify complementary therapy services available to, and provided for, clients receiving hospice care in Nevada and Montana. The second aim was to identify differences in those therapies for urban and rural hospice clients. Using a descriptive survey design, data were collected from surveys sent to all hospice administrators in Nevada and Montana (N=54). A 50% (n=27) response rate was obtained. Most (70.4%, n=19) of the participating hospices offered complementary therapy; slightly more than half (52.9%, n=9) provided the services for less than 25% of their clients. No significant differences were found between rural and urban hospices. PMID:19756253

  9. Key Results of Interaction Models with Centering

    ERIC Educational Resources Information Center

    Afshartous, David; Preston, Richard A.

    2011-01-01

    We consider the effect on estimation of simultaneous variable centering and interaction effects in linear regression. We technically define, review, and amplify many of the statistical issues for interaction models with centering in order to create a useful and compact reference for teachers, students, and applied researchers. In addition, we…

  10. EPA CENTER FOR EXPOSURE ASSESSMENT MODELING (CEAM)

    EPA Science Inventory

    The EPA Center for Exposure Assessment Modeling (CEAM) supports the Agency and professional community in environmental, risk-based decision-making by expanding their applications expertise for quantitatively assessing pollutant exposure via aquatic, terrestrial, and multimedia pa...

  11. Hospice in a zoologic medicine setting.

    PubMed

    Jessup, David A; Scott, Cheryl A

    2011-06-01

    Forty years ago, Dr. Elizabeth Kubler-Ross in her landmark book On death and dying observed "maybe at the end of our days, when we have worked and given, enjoyed ourselves and suffered, we are going back to the stage that we started out with and the circle of life is closed." Just as human life expectancy has steadily increased over the last 4 or 5 decades, animal life expectancy has increased, including that of zoologic species. With this has come a need for humans to openly and frankly deal with end-of-life issues for themselves and for their animals, including those in zoos. By necessity, zoos have been dealing with problems such as aggressive pain management and triage, and efforts to incorporate end-of-life care into zoologic medicine. But these efforts have yet to include formal acknowledgment that they are a basic form of hospice. Hospice for humans, and now for companion animals, includes much more than pain relief and geriatric care. This article reviews the concepts and basic practices of hospice and the closely related field of palliative care, their relatively recent application to companion animal care, potential applications to zoologic medicine, and the ways this could provide opportunities for personal growth of zoo visitors and staff, including veterinary staff. PMID:22946395

  12. Human Centered Hardware Modeling and Collaboration

    NASA Technical Reports Server (NTRS)

    Stambolian Damon; Lawrence, Brad; Stelges, Katrine; Henderson, Gena

    2013-01-01

    In order to collaborate engineering designs among NASA Centers and customers, to in clude hardware and human activities from multiple remote locations, live human-centered modeling and collaboration across several sites has been successfully facilitated by Kennedy Space Center. The focus of this paper includes innovative a pproaches to engineering design analyses and training, along with research being conducted to apply new technologies for tracking, immersing, and evaluating humans as well as rocket, vehic le, component, or faci lity hardware utilizing high resolution cameras, motion tracking, ergonomic analysis, biomedical monitoring, wor k instruction integration, head-mounted displays, and other innovative human-system integration modeling, simulation, and collaboration applications.

  13. Coulombic contribution and fat center vortex model

    SciTech Connect

    Rafibakhsh, Shahnoosh; Deldar, Sedigheh

    2007-02-27

    The fat (thick) center vortex model is one of the phenomenological models which is fairly successful to interpret the linear potential between static sources. However, the Coulombic part of the potential has not been investigated by the model yet. In an attempt to get the Coulombic contribution and to remove the concavity of the potentials, we are studying different vortex profiles and vortex sizes.

  14. The Community Transition Center (CTC) Model.

    ERIC Educational Resources Information Center

    Coker, Charles C.; Costello, James

    This paper describes the Community Transition Center (CTC) model, being tested in six districts in rural Wisconsin. The model is a way of conceptualizing and organizing the employment-related needs of mainstreamed mildly handicapped youths who are exiting secondary schools. The model emphasizes the role of secondary school transition programming,…

  15. Antibiotic Policies and Utilization in Oregon Hospice Programs.

    PubMed

    Novak, Rachel L; Noble, Brie N; Fromme, Erik K; Tice, Michael O; McGregor, Jessina C; Furuno, Jon P

    2016-09-01

    Antibiotics are frequently used in hospice care, despite limited data on safety and effectiveness in this patient population. We surveyed Oregon hospice programs on antibiotic policies and prescribing practices. Among 39 responding hospice programs, the median reported proportion of current census using antibiotics was 10% (interquartile range = 3.5%-20.0%). Approximately 31% of responding hospice programs had policies for antibiotic initiation, 17% of hospice programs had policies for antibiotic discontinuation, and 95% of hospice programs had policies for managing drug interactions. Diarrhea, nausea/vomiting, and yeast infections were the most frequently reported antibiotic-associated adverse events, occurring "sometimes" or "often" among 62%, 47%, and 62% of respondents, respectively. In conclusion, less than a third of participating hospice programs reported having a policy for antibiotic initiation and even less frequently a policy for discontinuation. More data are needed on the risks and benefits of antibiotic use in hospice care to inform these policies and optimize outcomes in this vulnerable patient population. PMID:26268730

  16. Examining Variables Related to Successful Collaboration on the Hospice Team

    ERIC Educational Resources Information Center

    Parker-Oliver, Debra; Bronstein, Laura R.; Kurzejeski, Lori

    2005-01-01

    Although social work participation on interdisciplinary teams is long-standing, little research has been done to examine its effectiveness. This study used the Index of Interdisciplinary Collaboration to explore relationships between selected variables and teamwork in the hospice setting. The findings indicate that hospice social workers report a…

  17. Creating Decent Prisons: A Serendipitous Finding about Prison Hospice

    ERIC Educational Resources Information Center

    Wright, Kevin N.; Bronstein, Laura

    2007-01-01

    Limited research has been conducted on the creation or impact of "decent" prisons, institutions where prisoners are treated with care and respect. This study set out to explore organizational factors associated with locating hospice programs into prison settings. Yet, the research produced unexpected findings about the contribution of hospice to…

  18. Mental Health Training and the Hospice Community: A National Survey.

    ERIC Educational Resources Information Center

    Garfield, Charles A.; And Others

    1982-01-01

    Summarizes a national survey of the hospice community. Results indicated that the hospice community is attempting to meet the mental health training needs of its paid staff members and volunteers. However, more than half expressed a need for further training and a more systematic and comprehensive curriculum. (Author)

  19. The Administrative Role in Hospice Planning and Organization.

    ERIC Educational Resources Information Center

    Sallady, Susan A.

    1982-01-01

    Addresses the specific advantages to new hospices of incorporating administrative resource people in the planning and organization phases of their programs. Describes organizational structure and the role of the interdisciplinary team. An annotated bibliography summarizes hospice adminstrative resources and research. (Author/JAC)

  20. The Viability of Pediatric Hospices: A Case Study.

    ERIC Educational Resources Information Center

    Wilson, Dottie C.

    1982-01-01

    Identifies the special characteristics needed by hospices caring for terminally ill children, based on a feasibility study for a pediatric hospital. Concludes that the needs of terminally ill children and their families are not being met currently and that the hospice is as appropriate for children as for adults. (Author)

  1. 42 CFR 418.28 - Revoking the election of hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Revoking the election of hospice care. 418.28... Revoking the election of hospice care. (a) An individual or representative may revoke the individual's election of hospice care at any time during an election period. (b) To revoke the election of hospice...

  2. 42 CFR 418.308 - Limitation on the amount of hospice payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Limitation on the amount of hospice payments. 418... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.308 Limitation on the amount of hospice payments. (a) Except as specified in paragraph (b) of this section,...

  3. Hospice nurses' emotional challenges in their encounters with the dying.

    PubMed

    Ingebretsen, Lina Paola; Sagbakken, Mette

    2016-01-01

    The purpose of this study was to explore nurses' emotional challenges when caring for the dying in hospices. The study has a qualitative design, and knowledge was developed through a dialectical exchange between theory and data. Ten individual in-depth interviews were conducted with nurses recruited from two hospices in Denmark. Although all of the nurses said that they experienced emotional challenges or felt emotionally touched during their work, the study found a variety of opinions related to the extent to which their emotional reactions should be revealed in their role as a hospice professional. The participants described their emotional challenges as being simultaneously draining and enriching experiences leading to personal and professional growth and development. The study may contribute to increased awareness of emotional challenges for hospice nurses, which involve continuous reflection and balancing between meeting the dying as a human being and meeting the dying as a hospice professional. PMID:27258584

  4. Hospice nurses’ emotional challenges in their encounters with the dying

    PubMed Central

    Ingebretsen, Lina Paola; Sagbakken, Mette

    2016-01-01

    The purpose of this study was to explore nurses’ emotional challenges when caring for the dying in hospices. The study has a qualitative design, and knowledge was developed through a dialectical exchange between theory and data. Ten individual in-depth interviews were conducted with nurses recruited from two hospices in Denmark. Although all of the nurses said that they experienced emotional challenges or felt emotionally touched during their work, the study found a variety of opinions related to the extent to which their emotional reactions should be revealed in their role as a hospice professional. The participants described their emotional challenges as being simultaneously draining and enriching experiences leading to personal and professional growth and development. The study may contribute to increased awareness of emotional challenges for hospice nurses, which involve continuous reflection and balancing between meeting the dying as a human being and meeting the dying as a hospice professional. PMID:27258584

  5. 78 FR 27823 - Medicare Program; FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... Hospice Wage Index final rule (74 FR 39384) finalized a 10 percent reduced BNAF for FY 2010 as the first... Conditions of Participation final rule (73 FR 32088), palliative care is an approach that ``optimizes quality... Hospice Conditions of Participation final rule (73 FR 32088), we stated ``the medical director...

  6. 78 FR 48233 - Medicare Program; FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-07

    ... Calendar Year DME Durable Medical Equipment FEHC Family Evaluation of Hospice Care FR Federal Register FY... described in section IV.C.3. The August 6, 2009 FY 2010 Hospice Wage Index final rule (74 FR 39384... Conditions of Participation final rule (73 FR 32088), palliative care is an approach that ``optimizes...

  7. The Use of Videophones for Patient and Family Participation in Hospice Interdisciplinary Team Meetings: A Promising Approach

    PubMed Central

    Oliver, Debra Parker; Demiris, George; Wittenberg-Lyles, Elaine; Porock, Davina

    2009-01-01

    Inclusion of patients and caregivers in decisions related to the delivery of care is inherent in the hospice philosophy. Telemedicine technologies offer a potential solution to the challenges presented by the geographic distance between team meetings and the home environment. While inclusion requires additional coordination by the hospice team, it also offers an important opportunity to improve communication between the team and the patient and family. A modified conceptual model based on two previous frameworks is outlined to support patient and family involvement in hospice team meetings. Further research is suggested to determine the structural feasibility of patient and family involvement via videophone as well as the structural and procedural changes resulting from this inclusion. Finally, clinical outcomes and family evaluation of the inclusion experience need to be thoroughly researched before final conclusions may be reached. PMID:19832889

  8. A national survey of health professionals and volunteers working in voluntary hospice services in the UK. I. Attitudes to current issues affecting hospices and palliative care.

    PubMed

    Addington-Hall, Julia M; Karlsen, Saffron

    2005-01-01

    This paper reports results from a national survey in 1999 of voluntary hospice services in the UK. It focuses on volunteer and staff views of the purposes of hospice care, and on current debates within palliative care. Twenty-five hospice services, stratified by region, services provided (inpatient care, day care and/or home care) and number of beds were randomly sampled from amongst 175 voluntary hospices in the UK. Nineteen participated. Seventy per cent of a random sample of professional and voluntary staff within these hospices returned a postal questionnaire. Both volunteers and professionals considered care of the whole person, pain and symptom control, quality of life and dying peacefully to be important aspects of hospice care. Most doctors chose care of the whole person as the most important aspect, and they were more likely to choose this option than other staff. Hospice volunteers were less positive than hospice staff (particularly doctors and nurses) in their attitudes to extending hospice care to noncancer patients (where many volunteers held no strong view), to restricting care to patients with specialist palliative care needs, and less negative about euthanasia. These findings illustrate the importance of including hospice volunteers and the general public, as well as hospice staff, in debates about the future of hospice and palliative care in the UK. Further research is needed into lay and professional views of the role of hospices and palliative care services. PMID:15690867

  9. Patient experience key in hospice refurb.

    PubMed

    Beach, Matt

    2015-03-01

    A major design and build scheme which has seen the inpatient unit at St. Luke's Hospice in Sheffield extended and refurbished to provide a more comfortable and homely environment, and bring the facilities up to the best 21st century standards, has benefited significantly from both high quality architecture and stakeholder commitment. The result, reports Matt Beach, associate at scheme architects, Race Cottam Associates, is an even better and 'more personal'environment for delivery of end-of-life-care at a facility that, as one patient puts it,'has something very rare and special about it'. PMID:26268027

  10. Determining Community Provider Practices in Hospices: The Challenges of Documentation

    PubMed Central

    Bergen-Jackson, Kimberly; Sanders, Sara; Herr, Keela; Fine, Perry G.; Titler, Marita; Forcucci, Chris; Reyes, Jimmy; McNichol, Patricia

    2010-01-01

    Documentation is a key factor in supporting consistency and quality of patient care in the hospice setting, however variation among program provider practices, including documentation, were observed during the initial data collection phase of our National Cancer Institute (NCI) funded study, Cancer Pain in Elders: Promoting Evidence-Based Practices (EBPs) in Hospices. The study is a randomized trial to test a multifaceted intervention to promote adoption and maintenance of EBPs for cancer pain management involving 16 Midwestern hospices of varied size and structure. In the face of such variance, and especially in the absence of uniformly adopted outcome measures and documentation standards, quality improvement initiatives in this important and growing healthcare sector will be difficult to manage. This paper provides background on the importance of documentation, quality measures, outcomes of care, and regulatory imperatives in the hospice setting with specific observations from our research study and suggestions for changes in documentation practices. From our observations, we posit the necessity of pertinent outcome measures supported by standardized documentation processes in hospice. Uniformity in key practice indicators and patient outcome measures in documentation systems would advance the movement to improve quality and consistency of care in hospices. Standardization of documentation systems and language would also facilitate the conduct of research in the hospice setting, a population for which advancing knowledge is essential to assure quality care at the end of life. PMID:20419047

  11. Center for Advanced Modeling and Simulation Intern

    SciTech Connect

    Gertman, Vanessa

    2010-01-01

    Some interns just copy papers and seal envelopes. Not at INL! Check out how Vanessa Gertman, an INL intern working at the Center for Advanced Modeling and Simulation, spent her summer working with some intense visualization software. Lots more content like this is available at INL's facebook page http://www.facebook.com/idahonationallaboratory.

  12. Infiltration Model for Center Pivot Sprinkler Irrigation

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The marked reduction in infiltration rate caused by formation of a soil surface seal due to water droplet impact on bare soil is a well known phenomenon but is rarely considered in infiltration models, especially under center pivot irrigation. The objective of this study was to develop a soil infil...

  13. Center for Advanced Modeling and Simulation Intern

    ScienceCinema

    Gertman, Vanessa

    2013-05-28

    Some interns just copy papers and seal envelopes. Not at INL! Check out how Vanessa Gertman, an INL intern working at the Center for Advanced Modeling and Simulation, spent her summer working with some intense visualization software. Lots more content like this is available at INL's facebook page http://www.facebook.com/idahonationallaboratory.

  14. An Analysis Model for Center Governance.

    ERIC Educational Resources Information Center

    Priselac, Nancy J.; Priselac, Stephen M.

    This paper discusses the development and design of an analysis model for governance of teacher centers organized in consortium form. A consortium is descirbed as "an organization of autonomous bodies or individuals which bond together by some relatively formal agreement to secure some benefit." The consortium generally functions in a collaborative…

  15. Hospice enrollment saves money for Medicare and improves care quality across a number of different lengths-of-stay.

    PubMed

    Kelley, Amy S; Deb, Partha; Du, Qingling; Aldridge Carlson, Melissa D; Morrison, R Sean

    2013-03-01

    Despite its demonstrated potential to both improve quality of care and lower costs, the Medicare hospice benefit has been seen as producing savings only for patients enrolled 53-105 days before death. Using data from the Health and Retirement Study, 2002-08, and individual Medicare claims, and overcoming limitations of previous work, we found $2,561 in savings to Medicare for each patient enrolled in hospice 53-105 days before death, compared to a matched, nonhospice control. Even higher savings were seen, however, with more common, shorter enrollment periods: $2,650, $5,040, and $6,430 per patient enrolled 1-7, 8-14, and 15-30 days prior to death, respectively. Within all periods examined, hospice patients also had significantly lower rates of hospital service use and in-hospital death than matched controls. Instead of attempting to limit Medicare hospice participation, the Centers for Medicare and Medicaid Services should focus on ensuring the timely enrollment of qualified patients who desire the benefit. PMID:23459735

  16. [Continuing hospice care of cancer--a three-year experience].

    PubMed

    Lai, Y L; Young, A; Lai, E Y; Yeh, C Y; Chiou, J F; Chang, K H; Chung, C H; Hsieh, A L

    1994-09-01

    The hospice at Mackay Memorial Hospital was established in February 1990. A group of team workers including physicians, nurses, social workers and the clergy were involved in this holistic care program for terminal cancer patients. Four hundred and seventy-nine patients were eligible for the program up to February 1993. Regarding duration of stay, 62.5% of patients resided for 14 days. Those surviving under 90 days constituted 75.5% of patients. Fifty-one point eight percent of patients died in the hospice and 18.2% died at home soon after being discharged from the hospice. Pain is the most common symptom among the patients. Treatment strategies vary according to the three-step-ladder protocol designed by WHO. Total pain relief was achieved in 80% of patients. Opportune private talking and family conferences formed the basis of the "peer model". Through this model, treatment decisions including physical, psychosocial and spiritual issues were made. Before the peer model, only 36 (10.3%) patients agreed with the idea of hospice care, while 257 (73.6%) patients agreed after the model was established. Awareness of dying was evident in 412 (86%) patients. Two hundred and eighty (68%) patients became aware of the prospect of death through guessing, while the other 132 (32%) patients were informed by medical staff. Problems encountered by the team workers included 1) needs in education and training, 2) psychological pressure, 3) management of loss and grief, 4) needs in supportive system and 5) troubles caused by families' lying to patients. The team workers were satisfied with the quality of care in 38.4% of patients and fairly satisfied with 30.7% of patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7536505

  17. Family Perspectives on the Hospice Experience in Adult Family Homes

    PubMed Central

    Washington, Karla T.; Oliver, Debra Parker; Demiris, George; Wittenberg-Lyles, Elaine; Shaunfield, Sara

    2011-01-01

    Growing numbers of terminally ill older adults receive hospice services in adult family homes (AFHs); however, little is known about the provision and receipt of end-of-life care in such environments. This paper reports findings from a qualitative exploration of family members’ perspectives of the hospice experience in AFHs. Analysis of data obtained during interviews of fifteen residents’ family members exposed significant challenges associated with transition to an AFH, highlighted the importance of AFH and hospice staff in family members’ assessment of overall quality of care, and emphasized the critical nature of communication in AFH settings. PMID:21240714

  18. Predictors of Intention to Refer to Pediatric Palliative or Hospice Care.

    PubMed

    Conner, Norma E; Uddin, Nizam

    2016-08-01

    The purpose of this descriptive correlational study was to determine whether nurse characteristics, level of comfort with care of the dying, and spirituality predict intention to refer and timing of referral to pediatric palliative/hospice care. The Behavioral Model of Health Services Use served as the framework for this study. Data were collected from 105 pediatric nurses recruited from 7 patient units of one pediatric hospital. Regression analysis revealed several nurse factors (practice unit, years of experience, age, race/ethnicity) that predicted intent to refer and timing of referral to pediatric palliative/hospice care. The relationship between nurse characteristics and intent to refer was specific to certain medical conditions (HIV, extreme prematurity, brain injuries). Healthcare providers can use these findings to improve care for children with life-limiting illnesses. PMID:26150677

  19. Hospice and palliative care development in India: a multimethod review of services and experiences.

    PubMed

    McDermott, Elizabeth; Selman, Lucy; Wright, Michael; Clark, David

    2008-06-01

    Palliative care has been developing in India since the mid-1980s, but there is a dearth of evidence about service provision on which to base national policy and practice. The aim of this study was to assess the current state of palliative care in India, mapping the existence of services state by state, and documenting the perspectives and experiences of those involved. A multimethod review was used, which included synthesis of evidence from published and grey literature, ethnographic field visits, qualitative interviews with 87 individuals from 12 states, and collation of existing public health data. The review identified 138 hospice and palliative care services in 16 states and union territories. These are mostly concentrated in large cities, with the exception of Kerala, where they are much more widespread. Nongovernmental organizations, public and private hospitals, and hospices are the predominant sources of provision. We were unable to identify palliative care services in 19 states/union territories. Development of services is uneven, with greater provision evident in the south than the north, but for the majority of states, coverage is poor. Barriers to the development of palliative care include: poverty, population density, geography, opioid availability, workforce development, and limited national palliative care policy. Successful models exist for the development of affordable, sustainable community-based palliative care services. These have arisen from adapting Western models of hospice and palliative care for implementation in the Indian cultural context. Further work is required to ensure that the growing interest in hospice and palliative care in India is used to increase the momentum of progress. PMID:18395401

  20. Medicare program; FY 2015 hospice wage index and payment rate update; hospice quality reporting requirements and process and appeals for Part D payment for drugs for beneficiaries enrolled in hospice. Final rule.

    PubMed

    2014-08-22

    This final rule will update the hospice payment rates and the wage index for fiscal year (FY) 2015 and continue the phase-out of the wage index budget neutrality adjustment factor (BNAF). This rule provides an update on hospice payment reform analyses, potential definitions of "terminal illness'' and "related conditions,'' and information on potential processes and appeals for Part D payment for drugs while beneficiaries are under a hospice election. This rule will specify timeframes for filing the notice of election and the notice of termination/revocation; add the attending physician to the hospice election form, and require hospices to document changes to the attending physician; require hospices to complete their hospice aggregate cap determinations within 5 months after the cap year ends, and remit any overpayments; and update the hospice quality reporting program. In addition, this rule will provide guidance on determining hospice eligibility; information on the delay in the implementation of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM); and will further clarify how hospices are to report diagnoses on hospice claims. Finally, the rule will make a technical regulations text change. PMID:25167592

  1. Stress and Burnout: Concerns for the Hospice Volunteer.

    ERIC Educational Resources Information Center

    Glass, J. Conrad, Jr.; Hastings, Janice L.

    1992-01-01

    Sources of stress for hospice volunteers are environmental, ideological, and personal. Attention to volunteer stress and burnout involves defining job requirements and responsibilities, frequent communication and feedback, stress management techniques, flexibility in assignments, and opportunities to verbalize emotions. (SK)

  2. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings. (c) The...

  3. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings. (c) The...

  4. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings. (c) The...

  5. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings. (c) The...

  6. The benefits of expanded physician assistant practice in hospice and palliative medicine.

    PubMed

    Boucher, Nathan A; Nix, Harvey

    2016-09-01

    Patients with advanced or terminal illness, especially racial and ethnic minorities, would benefit from greater access to hospice and palliative care. Expanding the PA role in these areas would help fill gaps in both access and patients' understanding of what hospice and palliative care can offer. This article describes why hospice and palliative care are needed, what PAs can and do offer hospice and palliative care delivery, and what challenges should be overcome to expand PA practice in hospice and palliative care. The article also reviews the legislative outlook for PA practice in hospice care. PMID:27575903

  7. Hospice clinical experiences for nursing students: living to the fullest.

    PubMed

    Spicer, Sherri; Heller, Rebecca; Troth, Sarah

    2015-01-01

    Preparing future nurses to provide appropriate care for patients and their families at the end of life can be a formidable challenge for nurse educators. Most nursing schools thread end-of-life concepts throughout the curriculum. Grand Canyon University includes a 40-hour hospice clinical as a component of a home healthcare practicum. Students' weekly written reflections reveal the depth of affective learning that occurs during this experience. Article includes hospice materials and resources. PMID:25585469

  8. Validation of Space Weather Models at Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Kuznetsova, M. M.; Pulkkinen, A.; Rastaetter, L.; Hesse, M.; Chulaki, A.; Maddox, M.

    2011-01-01

    The Community Coordinated Modeling Center (CCMC) is a multiagency partnership, which aims at the creation of next generation space weather modes. CCMC goal is to support the research and developmental work necessary to substantially increase space weather modeling capabilities and to facilitate advanced models deployment in forecasting operations. The CCMC conducts unbiased model testing and validation and evaluates model readiness for operational environment. The presentation will demonstrate the recent progress in CCMC metrics and validation activities.

  9. External validation of a web-based prognostic tool for predicting survival for patients in hospice care.

    PubMed

    Miladinovic, Branko; Mhaskar, Rahul; Kumar, Ambuj; Kim, Sehwan; Schonwetter, Ronald; Djulbegovic, Benjamin

    2013-01-01

    Prognostat is an interactive Web-based prognostic tool for estimating hospice patient survival based on a patient's Palliative Performance Scale (PPS) score, age, gender, and cancer status. The tool was developed using data from 5,893 palliative care patients, which was collected at the Victoria Hospice in Victoria, British Columbia, Canada, beginning in 1994. This study externally validates Prognostat with a retrospective cohort of 590 hospice patients at LifePath Hospice and Palliative Care in Florida, USA. The criteria used to evaluate the prognostic performance were the Brier score, area under the receiver operating curve, discrimination slope, and Hosmer-Lemeshow goodness-of-fit test. Though the Kaplan-Meier curves show each PPS level to be distinct and significantly different, the findings reveal low agreement between observed survival in our cohort of patients and survival predicted by the prognostic tool. Before developing a new prognostic model, researchers are encouraged to update survival estimates obtained using Prognostat with the information from their cohort of patients. If it is to be useful to patients and clinicians, Prognostat needs to explicitly report patient risk scores and estimates of baseline survival. PMID:24380212

  10. The Hospice Environmental Survey (HES): Pilot Test of a New Measurement Instrument.

    ERIC Educational Resources Information Center

    Taylor, Jean H.; Perrill, Norman K.

    1988-01-01

    Describes development of the Hospice Environmental Survey (HES) to measure user's perception of the homelike atmosphere provided by a hospital inpatient unit called Hospice House. Presents the HES instrument, methodology, and pilot study data. (Author/NB)

  11. Costs and implications of discarded medication in hospice.

    PubMed

    Speer, Nathan D; Dioso, Jhanina; Casner, Paul R

    2013-08-01

    Symptom control for hospice patients frequently involves the use of pharmacologic agents for control of pain, dyspnea, and anxiety. Other troubling symptoms that will often require pharmacologic agents include nausea, vomiting, constipation, and delirium. While the Medicare requirement for hospice is a prognosis of six months or less, accurately predicting prognosis is very difficult. Because of this, medications for symptom control will often have to be prescribed and refilled without knowing exactly how much the hospice patient may require. The objective of the current study was to determine the amount of medication discarded at death. Additionally we wanted to estimate the cost related to discarded medication. We reviewed the records of 296 patients over a three-year period in a community hospice to characterize the medications that were discarded at death. Seventeen patients were not eligible for evaluation because of lack of complete information, leaving 279 study subjects. Cost calculations were used using a website cost calculator (HealthTrans.com). Fifty-six percent of the decedents were female and the majority were Hispanic (62%). The five most common diagnoses were cancer (36%); dementia (22%); and COPD, CVA, and congestive heart failure (CHF) (8%). The median length of stay in hospice was 16 days. The most frequent medication unused at the time of death was morphine solution followed by lorazepam. The cost of discarded morphine including tablets as well as solution totaled over $6,000 for the study period. The next highest medication cost was lorazepam for both solution and tablets, which came to over $1,600. The total estimated cost for all medications for the study period amounted to $14,980. The results of this study indicate that hospice patients have variable amounts of discarded medication at the time of death and that the cost involved of these unused medications can be significant. Hospice organizations should investigate creative ways to reduce

  12. Massage, Music and Art Therapy in Hospice: Results of a National Survey

    PubMed Central

    Dain, Aleksandra S.; Bradley, Elizabeth H.; Hurzeler, Rosemary; Aldridge, Melissa D.

    2015-01-01

    Context Complementary and alternative medicine (CAM) provides clinical benefits to hospice patients, including decreased pain and improved quality of life. Yet little is known about the extent to which U.S. hospices employ CAM therapists. Objectives To report the most recent national data regarding the inclusion of art, massage, and music therapists on hospice interdisciplinary teams and how CAM therapist staffing varies by hospice characteristics. Methods A national cross-sectional survey of a random sample of hospices (n=591; 84% response rate) from September 2008 to November 2009. Results Twenty-nine percent of hospices (169 of 591) reported employing an art, massage, or music therapist. Of those hospices, 74% employed a massage therapist, 53% a music therapist, and 22% an art therapist, and 42% expected the therapist to attend interdisciplinary staff meetings, indicating a significant role for these therapists on the patient’s care team. In adjusted analyses, larger hospices compared with smaller hospices had significantly higher odds of employing a CAM therapist (adjusted odds ratio (AOR) = 6.38, 95% CI 3.40, 11.99) and forprofit hospices had lower odds of employing a CAM therapist compared with nonprofit hospices (AOR = 0.52, 95% CI 0.32, 0.85). Forty-four percent of hospices in the Mountain/Pacific region reported employing a CAM therapist versus 17% in the South Central region. Conclusion Less than one-third of U.S. hospices employ art, massage, or music therapists despite the benefits these services may provide to patients and families. A higher proportion of large hospices, nonprofit hospices and hospices in the Mountain/Pacific region employ CAM therapists, indicating differential access to these important services. PMID:25555445

  13. Energy Modeling for the Artisan Food Center

    SciTech Connect

    Goel, Supriya

    2013-05-01

    The Artisan Food Center is a 6912 sq.ft food processing plant located in Dayton, Washington. PNNL was contacted by Strecker Engineering to assist with the building’s energy analysis as a part of the project’s U.S. Green Building Council’s Leadership in Energy and Environmental Design (LEED) submittal requirements. The project is aiming for LEED Silver certification, one of the prerequisites to which is a whole building energy model to demonstrate compliance with American Society of Heating Refrigeration and Air Conditioning Engineers (ASHRAE) 90.1 2007 Appendix G, Performance Rating Method. The building incorporates a number of energy efficiency measures as part of its design and the energy analysis aimed at providing Strecker Engineering with the know-how of developing an energy model for the project as well as an estimate of energy savings of the proposed design over the baseline design, which could be used to document points in the LEED documentation. This report documents the ASHRAE 90.1 2007 baseline model design, the proposed model design, the modeling assumptions and procedures as well as the energy savings results in order to inform the Strecker Engineering team on a possible whole building energy model.

  14. Space Weather Modeling Services at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Hesse, Michael

    2006-01-01

    The Community Coordinated Modeling Center (CCMC) is a multi-agency partnership, which aims at the creation of next generation space weather models. The goal of the CCMC is to support the research and developmental work necessary to substantially increase the present-day modeling capability for space weather purposes, and to provide models for transition to the Rapid Prototyping Centers at the space weather forecast centers. This goal requires close collaborations with and substantial involvement of the research community. The physical regions to be addressed by CCMC-related activities range from the solar atmosphere to the Earth's upper atmosphere. The CCMC is an integral part of the National Space Weather Program Implementation Plan, of NASA's Living With a Star (LWS) initiative, and of the Department of Defense Space Weather Transition Plan. CCMC includes a facility at NASA Goddard Space Flight Center. CCMC also provides, to the research community, access to state-of-the-art space research models. In this paper we will provide a description of the current CCMC status, discuss current plans, research and development accomplishments and goals, and describe the model testing and validation process undertaken as part of the CCMC mandate. Special emphasis will be on solar and heliospheric models currently residing at CCMC, and on plans for validation and verification.

  15. 3 CFR 8594 - Proclamation 8594 of October 29, 2010. National Hospice Month, 2010

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... provide tailored support to meet the needs of these heroes. The Affordable Care Act signed into law this... receive hospice care before first discontinuing treatments to cure their disease. The Affordable Care Act... Proclamation During National Hospice Month, we recognize the dignity hospice care can provide to patients...

  16. 42 CFR 418.205 - Special requirements for hospice pre-election evaluation and counseling services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    .... (ii) The physician furnishing these services must be an employee or medical director of the hospice billing for this service. (iii) The services cannot be furnished by hospice personnel other than employed... employee of the hospice. (iv) If the beneficiary's attending physician is also the medical director or...

  17. 42 CFR 418.205 - Special requirements for hospice pre-election evaluation and counseling services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    .... (ii) The physician furnishing these services must be an employee or medical director of the hospice billing for this service. (iii) The services cannot be furnished by hospice personnel other than employed... employee of the hospice. (iv) If the beneficiary's attending physician is also the medical director or...

  18. Guide for Trainers. Interdisciplinary Team Training and Humanistic Patient Care for Hospices. Monograph 2.

    ERIC Educational Resources Information Center

    Wilson, Dottie C.; Grady, Kathleen A.

    This monograph, the second in a series of five, provides information for trainers on interdisciplinary team training and humanistic patient care in hospices. Designed to help outside trainers who may be invited by a hospice to conduct its training, the materials help instructors to understand the nature of hospices, to determine whether or not the…

  19. Social Workers' Participation in the Resolution of Ethical Dilemmas in Hospice Care

    ERIC Educational Resources Information Center

    Csikai, Ellen L.

    2004-01-01

    Ethical dilemmas are inherent in every health care setting. A sample of hospice social workers with no direct access to a hospice ethics committee (N = 110) was surveyed regarding ethical issues in hospice care, how the issues were managed, and the extent to which social workers participated in resolution of ethical dilemmas. Common issues…

  20. 42 CFR 417.423 - Special rules: ESRD and hospice patients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules: ESRD and hospice patients. 417.423... Special rules: ESRD and hospice patients. (a) ESRD patients. (1) A Medicare beneficiary who has been... not disenroll the beneficiary except as provided in § 417.460. (b) Hospice patients. A...

  1. 42 CFR 418.21 - Duration of hospice care coverage-Election periods.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Duration of hospice care coverage-Election periods... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.21 Duration of hospice care coverage—Election periods. (a) Subject to the conditions set forth...

  2. Interpersonal Communication Instruction in the Non-Traditional Context: Teaching Communication Strategies in a Hospice Setting.

    ERIC Educational Resources Information Center

    Fieweger, Margaret A.

    While many health care delivery systems are criticized for the dehumanizing way they treat patients, hospice care presents a refreshing alternative to health care for the terminally ill. Patients appropriate for hospice care are those with six months or less to live. Interpersonal communication education is an important component of hospice care…

  3. 75 FR 42943 - Medicare Program; Hospice Wage Index for Fiscal Year 2011

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-22

    ... new OMB standards that included CBSAs. In the FY 2006 hospice wage index final rule (70 FR 45130), we.... Specifically, in the Hospice Wage Index for FY 2010 Final Rule, published on August 6, 2009 (74 FR 39384), we... August 8, 1997 hospice wage index final rule (62 FR 42860), the pre-floor and pre-reclassified...

  4. Validation of Space Weather Models at Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Kuznetsova, M. M.; Hesse, M.; Pulkkinen, A.; Maddox, M.; Rastaetter, L.; Berrios, D.; Zheng, Y.; MacNeice, P. J.; Shim, J.; Taktakishvili, A.; Chulaki, A.

    2011-01-01

    The Community Coordinated Modeling Center (CCMC) is a multi-agency partnership to support the research and developmental work necessary to substantially increase space weather modeling capabilities and to facilitate advanced models deployment in forecasting operations. Space weather models and coupled model chains hosted at the CCMC range from the solar corona to the Earth's upper atmosphere. CCMC has developed a number of real-time modeling systems, as well as a large number of modeling and data products tailored to address the space weather needs of NASA's robotic missions. The CCMC conducts unbiased model testing and validation and evaluates model readiness for operational environment. CCMC has been leading recent comprehensive modeling challenges under GEM, CEDAR and SHINE programs. The presentation will focus on experience in carrying out comprehensive and systematic validation of large sets of. space weather models

  5. Center for Extended Magnetohydrodynamic Modeling Cooperative Agreement

    SciTech Connect

    Carl R. Sovinec

    2008-02-15

    The Center for Extended Magnetohydrodynamic Modeling (CEMM) is developing computer simulation models for predicting the behavior of magnetically confined plasmas. Over the first phase of support from the Department of Energy’s Scientific Discovery through Advanced Computing (SciDAC) initiative, the focus has been on macroscopic dynamics that alter the confinement properties of magnetic field configurations. The ultimate objective is to provide computational capabilities to predict plasma behavior—not unlike computational weather prediction—to optimize performance and to increase the reliability of magnetic confinement for fusion energy. Numerical modeling aids theoretical research by solving complicated mathematical models of plasma behavior including strong nonlinear effects and the influences of geometrical shaping of actual experiments. The numerical modeling itself remains an area of active research, due to challenges associated with simulating multiple temporal and spatial scales. The research summarized in this report spans computational and physical topics associated with state of the art simulation of magnetized plasmas. The tasks performed for this grant are categorized according to whether they are primarily computational, algorithmic, or application-oriented in nature. All involve the development and use of the Non-Ideal Magnetohydrodynamics with Rotation, Open Discussion (NIMROD) code, which is described at http://nimrodteam.org. With respect to computation, we have tested and refined methods for solving the large algebraic systems of equations that result from our numerical approximations of the physical model. Collaboration with the Terascale Optimal PDE Solvers (TOPS) SciDAC center led us to the SuperLU_DIST software library [http://crd.lbl.gov/~xiaoye/SuperLU/] for solving large sparse matrices using direct methods on parallel computers. Switching to this solver library boosted NIMROD’s performance by a factor of five in typical large

  6. Hospice management of patients receiving cytotoxic chemotherapy: problems and opportunities.

    PubMed

    Hicks, F; Corcoran, G

    1993-12-01

    In Britain, the specialty of palliative medicine continues to develop, encouraging the referral of patients early in the palliative phase of their illness. This had led to an increased number of patients receiving palliative chemotherapy and hospice care concurrently, posing special problems to the professionals involved. In this retrospective study, 52 patients were identified who received chemotherapy and hospice care simultaneously. Case notes were reviewed to reveal problems arising from sharing the duty of care. The poor quality of communication between professionals, perhaps reflecting a limited understanding of the various roles in patient care, we found to cause significant difficulties. The duration and discontinuation of cytotoxic therapy seems to be a particularly difficult matter. Hospice admission often signalled the end of this treatment. In a third of the patients, no decision was taken to stop chemotherapy despite the last dose being an average of just 1 week before death. The value of chemotherapy for patients who are too ill to return home is questioned. Seven patients were diagnosed as suffering from chemotherapy-induced sepsis and neutropenia either by hospice inpatient or home care teams, and were admitted to their acute centres accordingly. Most patients who died during the study period received terminal care in the hospice. Suggestions are made on improving professional education and communication, including the use of a 'chemotherapy card'. PMID:7505105

  7. Combining information from two data sources with misreporting and incompleteness to assess hospice-use among cancer patients: a multiple imputation approach.

    PubMed

    He, Yulei; Landrum, Mary Beth; Zaslavsky, Alan M

    2014-09-20

    Combining information from multiple data sources can enhance estimates of health-related measures by using one source to supply information that is lacking in another, assuming the former has accurate and complete data. However, there is little research conducted on combining methods when each source might be imperfect, for example, subject to measurement errors and/or missing data. In a multisite study of hospice-use by late-stage cancer patients, this variable was available from patients' abstracted medical records, which may be considerably underreported because of incomplete acquisition of these records. Therefore, data for Medicare-eligible patients were supplemented with their Medicare claims that contained information on hospice-use, which may also be subject to underreporting yet to a lesser degree. In addition, both sources suffered from missing data because of unit nonresponse from medical record abstraction and sample undercoverage for Medicare claims. We treat the true hospice-use status from these patients as a latent variable and propose to multiply impute it using information from both data sources, borrowing the strength from each. We characterize the complete-data model as a product of an 'outcome' model for the probability of hospice-use and a 'reporting' model for the probability of underreporting from both sources, adjusting for other covariates. Assuming the reports of hospice-use from both sources are missing at random and the underreporting are conditionally independent, we develop a Bayesian multiple imputation algorithm and conduct multiple imputation analyses of patient hospice-use in demographic and clinical subgroups. The proposed approach yields more sensible results than alternative methods in our example. Our model is also related to dual system estimation in population censuses and dual exposure assessment in epidemiology. PMID:24804628

  8. Combining information from two data sources with misreporting and incompleteness to assess hospice-use among cancer patients: a multiple imputation approach

    PubMed Central

    He, Yulei; Landrum, Mary Beth; Zaslavsky, Alan M.

    2014-01-01

    Combining information from multiple data sources can enhance estimates of health-related measures by using one source to supply information that is lacking in another, assuming the former has accurate and complete data. However, there is little research conducted on combining methods when each source might be imperfect, for example, subject to measurement errors and/or missing data. In a multisite study of hospice-use by late-stage cancer patients, this variable was available from patients’ abstracted medical records, which may be considerably underreported because of incomplete acquisition of these records. Therefore, data for Medicare-eligible patients were supplemented with their Medicare claims that contained information on hospice-use, which may also be subject to underreporting yet to a lesser degree. In addition, both sources suffered from missing data because of unit nonresponse from medical record abstraction and sample undercoverage for Medicare claims. We treat the true hospice-use status from these patients as a latent variable and propose to multiply impute it using information from both data sources, borrowing the strength from each. We characterize the complete-data model as a product of an ‘outcome’ model for the probability of hospice-use and a ‘reporting’ model for the probability of underreporting from both sources, adjusting for other covariates. Assuming the reports of hospice-use from both sources are missing at random and the underreporting are conditionally independent, we develop a Bayesian multiple imputation algorithm and conduct multiple imputation analyses of patient hospice-use in demographic and clinical subgroups. The proposed approach yields more sensible results than alternative methods in our example. Our model is also related to dual system estimation in population censuses and dual exposure assessment in epidemiology. PMID:24804628

  9. Medicare Program; FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements. Final rule.

    PubMed

    2015-08-01

    This final rule will update the hospice payment rates and the wage index for fiscal year (FY) 2016 (October 1, 2015 through September 30, 2016), including implementing the last year of the phase-out of the wage index budget neutrality adjustment factor (BNAF). Effective on January 1, 2016, this rule also finalizes our proposals to differentiate payments for routine home care (RHC) based on the beneficiary's length of stay and implement a service intensity add-on (SIA) payment for services provided in the last 7 days of a beneficiary's life, if certain criteria are met. In addition, this rule will implement changes to the aggregate cap calculation mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), align the cap accounting year for both the inpatient cap and the hospice aggregate cap with the federal fiscal year starting in FY 2017, make changes to the hospice quality reporting program, clarify a requirement for diagnosis reporting on the hospice claim, and discuss recent hospice payment reform research and analyses. PMID:26248391

  10. An examination of the effect of reimbursement and organizational structure on the allocation of hospice staff time.

    PubMed

    Mor, V; Schwartz, R; Laliberte, L; Hiris, J

    1985-01-01

    The unique needs of the terminally ill patient may require more planning and service coordination than those of the non-terminal patient. The hospice interdisciplinary team was a response to these additional needs. This paper examines the pattern of patient care and administrative activities of paid hospice staff by hospice organizational type and demonstration status in the National Hospice Study. Data gathered over a one year period revealed that demonstration hospices, in which all allowable costs were Medicare reimbursed, spent significantly more time in general and patient related administrative activities than non-demonstration hospices, which operated within existing Medicare cost limits. Staff in demonstration home care-based hospices reported significantly longer home visits than staff in non-demonstration hospices. In both groups, home care-based hospice visits were of longer duration than those home visits conducted by staff of hospital-based hospices. PMID:10300373

  11. Perceptions About Hospice From a Community-Based Pilot Study: Lessons and Findings

    PubMed Central

    Van Dussen, Daniel; Culler, Krystal L.; Cagle, John G.

    2016-01-01

    Research investigating the knowledge and attitudes of diverse older adults about hospice care and end-of-life issues is needed to expand service utilization. This pilot study explored an urban area’s perceptions and awareness of hospice through local churches. The sample consisted of 148 adults age 43 and older. Although recruitment efforts resulted in a relatively homogenous sample, findings suggest a lack of knowledge about whether hospice is covered by Medicare, Medicaid, or private insurance. Perceptions of the expense of hospice, however, were not associated with knowledge of coverage. Respondents generally agreed that hospice is important and would recommend its services for their family members. PMID:21208898

  12. In-patient hospice: A qualitative study with Portuguese patients, family and staff.

    PubMed

    Hilário, Ana Patrícia

    2016-05-27

    The present study aims to provide insights on the role of in-patient hospices, which are sometimes described as disconnecting spaces. Researchers complement participant observation with in-depth interviews with 10 hospice patients, 20 family members, and 20 members of hospice staff. The findings suggest that the hospice provides a space where patients could enjoy the company of their loved ones without concerns regarding the dying process. The study reveals that the hospice offers a proper alternative to the home setting even in countries characterized by a strong familialistic culture like Portugal. PMID:26765681

  13. Staff Efficiency Trends Among Pediatric Hospices, 2002-2011.

    PubMed

    Cozad, Melanie J; Lindley, Lisa C; Mixer, Sandra J

    2016-01-01

    This study provided the first examination of staff efficiency trends among pediatric hospices. Although pediatric staff efficiency demonstrated large variability from 2002 to 2011, the general trend in efficiency from 2003 to 2010. The decline in efficiency means, on average, pediatric hospices had higher operating expenses and used more capacity, but greater amounts of these greater outputs as measured by visits per patient. The study also highlights the crucial role pediatric hospice nurse managers play in developing effective workforce strategies that allow for responsive changes to workload fluctuations. Due to the associations between efficiency, regulation, and growth, nurse leaders' abilities to develop effective strategies are more imperative than ever to ensure quality end-of-life care for children and their families. PMID:27265950

  14. Family Members' Experience With Hospice in Nursing Homes.

    PubMed

    Gage, L Ashley; Washington, Karla; Oliver, Debra Parker; Kruse, Robin; Lewis, Alexandra; Demiris, George

    2016-05-01

    Research has documented numerous benefits and challenges associated with receipt of hospice care in nursing homes; however, study of this partnership from the perspective of residents' family members has been limited. The purpose of this qualitative investigation was to explore family members' experience with hospice services received in the nursing home setting. Researchers conducted a secondary data analysis of 175 family member interviews using a thematic analytic approach. Findings highlighted the critical role of communication in supporting residents and their family members. Care coordination, support and oversight, and role confusion also impacted family members' experience of hospice care in the nursing home. Efforts directed at enhancing communication and more clearly articulating the roles of members of the health care team are indicated. PMID:25422516

  15. Designing research with hospice and palliative care populations.

    PubMed

    Wohleber, Ashley M; McKitrick, Daniel S; Davis, Shawn E

    2012-08-01

    Research in palliative care and hospice populations is important for improving quality of care, quality of life, and provider understanding of individuals at the end of life. However, this research involves many potential challenges. This review seeks to inform and assist researchers targeting to design studies targeting hospice and palliative care patients by presenting a thorough review of the published literature. This review covers English-language articles published from 1990 through 2009 listed in the PsycInfo, Medline, or CINAHL research databases under relevant keywords. Articles on pediatric hospice were not included. Issues discussed include study design, informed consent, and recruitment for participants. Synthesized recommendations for researchers in these populations are presented. PMID:22104045

  16. Pain in Hospice Patients With Dementia: The Informal Caregiver Experience

    PubMed Central

    Tarter, Robin; Demiris, George; Pike, Kenneth; Washington, Karla; Oliver, Debra Parker

    2016-01-01

    Introduction At the end of life, patients with dementia often experience high levels of pain due to complex interplay of disease processes and numerous barriers to symptom management. In the hospice setting, informal caregivers play an essential role in pain management. This study describes their experience managing pain in hospice patients with dementia. Methods We conducted a qualitative analysis of audio-recorded interviews with informal caregivers of hospice patients with dementia who had chosen pain as the challenge they wanted to work on within a problem-solving therapy intervention. Results The thematic analysis of sessions with 51 caregivers identified 4 themes: difficulty in communicating with patients, lack of consistent guidance from health-care professionals, perceived uncertainty about the etiology of pain, and secondary suffering. Discussion Our findings indicate the possible need for increased support for caregivers, including educational interventions targeting pain etiology and assessment, and improved communication with health-care professionals. PMID:27303062

  17. CFD Modeling Activities at the NASA Stennis Space Center

    NASA Technical Reports Server (NTRS)

    Allgood, Daniel

    2007-01-01

    A viewgraph presentation on NASA Stennis Space Center's Computational Fluid Dynamics (CFD) Modeling activities is shown. The topics include: 1) Overview of NASA Stennis Space Center; 2) Role of Computational Modeling at NASA-SSC; 3) Computational Modeling Tools and Resources; and 4) CFD Modeling Applications.

  18. Heliophysical Modeling at the Community Coordinated Modeling Center

    NASA Astrophysics Data System (ADS)

    MacNeice, P. J.; Taktakishvili, A.; Mays, M. L.; Mullinix, R.; Chulaki, A.; Mendoza, A. M. M.

    2015-12-01

    The Community Coordinated Modeling Center (CCMC) at NASA/GSFC provides the heliophysics research community with access to state of the art modeling resources, and facilitates modeling challenges for model validation or for mission support. In this presentation we report on new additions to the CCMC's inventory of heliophysical models, and on a community wide modeling effort in support of the New Horizons flyby of Pluto.During the last year we have added a number of significant new models to our model inventory. In this presentation we describe these new models. These include a Non-Linear Force Free Field model of the coronal field which can use a spherical grid and so can model large surface patches containing multiple active regions, and which is configured to use HMI data.We have also installed the SRPM irradiance model.We will also discuss work being done to install an 'eruption generator' capability that operates within the SWMF coronal MHD component, and an updated version of EMMREM which can couple with the ENLIL MHD model of the inner heliosphere to model particle fluences.Shortly before the New Horizons flyby, the Planetary Division at NASA HQ requested that the CCMC provide a forecast of the state of the Solar Wind at the spacecraft.The CCMC's primary mission is to provide the research and forecasrting community with heliophysical models of relevance to Space Weather. Prior to the New Horizons flyby the CCMC's focus had been on models of the inner heliosphere. To respond to the New Horizons opportunity, modelers of the outer heliosphere were invited to contribute. As a result, by the time of closest approach six different model forecasts were posted publically at the CCMC web site dedicated to this project.In this presentation we will describe the community wide effort which the CCMC facilitated in response to this request, detailing the different models which participated and illustrating the results.

  19. Effectively training the hospice and palliative medicine physician workforce for improved end-of-life health care in the United States.

    PubMed

    Bui, Thomas

    2012-09-01

    The widening gap between the demand for palliative care services and the supply of trained palliative care professionals has resulted in considerable end-of-life distress for patients. Without formal training in palliative medicine and end-of-life symptom management, physicians in the United States are less equipped to competently address seriously ill and dying patients' medical, emotional, and spiritual needs. Recent attempts within graduate medical education training deliberately seek to prepare a critical mass of physicians as the new hospice and palliative medicine workforce in the United States. In addition, healthcare reform proposals may re-define the National Health Service Corps (NHSC) post-graduate training over the next five years and the Hospice Medicare Benefit altogether. Healthcare policy options include steady changes at multiple levels of medical training -namely, medical school curriculum mandates, requiring all graduate physician residency training to foster patient-centered communication skills and discussions about advanced directives, and instituting palliative medicine proficiency Continuing Medical Education (CME) requirements for all states' medical licensing boards. Attracting qualified physicians to serve patients at the end of life, innovative medical school loan repayment programs and scholarships will also foster excellence in the field of hospice and palliative medicine. Correcting our current paucity of formal training in palliative medicine better utilizes hospice and restores patients' dignity at the end of life. PMID:22174315

  20. National Space Science Data Center Information Model

    NASA Astrophysics Data System (ADS)

    Bell, E. V.; McCaslin, P.; Grayzeck, E.; McLaughlin, S. A.; Kodis, J. M.; Morgan, T. H.; Williams, D. R.; Russell, J. L.

    2013-12-01

    The National Space Science Data Center (NSSDC) was established by NASA in 1964 to provide for the preservation and dissemination of scientific data from NASA missions. It has evolved to support distributed, active archives that were established in the Planetary, Astrophysics, and Heliophysics disciplines through a series of Memoranda of Understanding. The disciplines took over responsibility for working with new projects to acquire and distribute data for community researchers while the NSSDC remained vital as a deep archive. Since 2000, NSSDC has been using the Archive Information Package to preserve data over the long term. As part of its effort to streamline the ingest of data into the deep archive, the NSSDC developed and implemented a data model of desired and required metadata in XML. This process, in use for roughly five years now, has been successfully used to support the identification and ingest of data into the NSSDC archive, most notably those data from the Planetary Data System (PDS) submitted under PDS3. A series of software packages (X-ware) were developed to handle the submission of data from the PDS nodes utilizing a volume structure. An XML submission manifest is generated at the PDS provider site prior to delivery to NSSDC. The manifest ensures the fidelity of PDS data delivered to NSSDC. Preservation metadata is captured in an XML object when NSSDC archives the data. With the recent adoption by the PDS of the XML-based PDS4 data model, there is an opportunity for the NSSDC to provide additional services to the PDS such as the preservation, tracking, and restoration of individual products (e.g., a specific data file or document), which was unfeasible in the previous PDS3 system. The NSSDC is modifying and further streamlining its data ingest process to take advantage of the PDS4 model, an important consideration given the ever-increasing amount of data being generated and archived by orbiting missions at the Moon and Mars, other active projects

  1. Stress Management Training for Hospice Personnel: An Exploratory Study.

    ERIC Educational Resources Information Center

    Clark, Susan; And Others

    There is very little published research specifically addressing the stress management skills of hospice caregivers. In order to ascertain if breathing exercises, biofeedback training, relaxation exercises, and cognitive therapy would be beneficial, pre- and post-treatment questionnaires and six 30-minute treatment sessions were administered to…

  2. At the Eleventh Hour: Psychosocial Dynamics in Short Hospice Stays

    ERIC Educational Resources Information Center

    Waldrop, Deborah P.

    2006-01-01

    Purpose: This study explored the psychosocial dynamics of short hospice stays (less than 2 weeks) of cancer patients age 65 and older. Design and Methods: In-depth interviews with 59 caregivers of 50 patients were audiotaped, transcribed, and coded by using Atlas ti software. Results: A descriptive typology is presented. A late diagnosis (n = 22…

  3. Art Therapy in Hospice: A Catalyst for Insight and Healing

    ERIC Educational Resources Information Center

    Safrai, Mary B.

    2013-01-01

    The reach of art therapy in assisting a hospice patient in confronting existential issues at the end of life is illustrated in this article with a case that took place over the course of 22 semiweekly sessions. Painting with an art therapist allowed the patient to shift from a state of anxiety and existential dread to a more accepting, fluid…

  4. 42 CFR 418.26 - Discharge from hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.26 Discharge... stabilize or otherwise change such that the patient cannot continue to be certified as terminally ill. (2... education, or other services before the patient is discharged because he or she is no longer terminally ill....

  5. Assessment of Need for a Children's Hospice Program.

    ERIC Educational Resources Information Center

    Davies, Betty

    1996-01-01

    Discusses the development of Canuck Place, North America's first free-standing pediatric hospice of its kind, opened in British Columbia, Canada, in 1995. Discusses the process of assessing the need for Canuck Place. Data from traditional quantitative and less-traditional qualitative sources were used to document and develop an argument in support…

  6. Methodological Research Priorities in Palliative Care and Hospice Quality Measurement.

    PubMed

    Dy, Sydney Morss; Herr, Keela; Bernacki, Rachelle E; Kamal, Arif H; Walling, Anne M; Ersek, Mary; Norton, Sally A

    2016-02-01

    Quality measurement is a critical tool for improving palliative care and hospice, but significant research is needed to improve the application of quality indicators. We defined methodological priorities for advancing the science of quality measurement in this field based on discussions of the Technical Advisory Panel of the Measuring What Matters consensus project of the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association and a subsequent strategy meeting to better clarify research challenges, priorities, and quality measurement implementation strategies. In this article, we describe three key priorities: 1) defining the denominator(s) (or the population of interest) for palliative care quality indicators, 2) developing methods to measure quality from different data sources, and 3) conducting research to advance the development of patient/family-reported indicators. We then apply these concepts to the key quality domain of advance care planning and address relevance to implementation of indicators in improving care. Developing the science of quality measurement in these key areas of palliative care and hospice will facilitate improved quality measurement across all populations with serious illness and care for patients and families. PMID:26596877

  7. Hospice placement reminded me that nursing is about caring.

    PubMed

    Short, Camille

    2011-08-24

    I did not expect to learn much during my two weeks in the day hospice. Indeed, I was unsure what a nurse could do in such an environment. I had a vague impression that there would be arts and crafts, and people passing the time. PMID:27317072

  8. Factors affecting satisfaction among community-based hospice volunteer visitors.

    PubMed

    Chevrier, F; Steuer, R; MacKenzie, J

    1994-01-01

    Trained volunteers are an essential component in the delivery of care to clients and families facing a terminal and/or life-threatening illness. As the need for hospice care increases, so does the need to increase the number of volunteers available for visiting. Hospice of London, which is a community based hospice, proposed that volunteers who felt satisfied would remain with the organization longer, thereby, decreasing the costs associated with training new volunteers and enhancing the ability of the agency to provide high-quality volunteer client matches. Accordingly, a survey was conducted in August 1992 to determine which factors were related to hospice volunteer satisfaction. One hundred and five volunteer were surveyed over the telephone. Results demonstrated a positive correlation between satisfaction and feeling like a team member, receiving feedback from staff, feeling valuable and having the volunteer's expectations match the position. Differences in the factors related to satisfaction were noted when the groups were divided by age and gender. PMID:7893559

  9. The Learning Center: A Comprehensive Model for Colleges and Universities.

    ERIC Educational Resources Information Center

    Martin, Deanna C.; And Others

    Intended for use by educators responsible for developing post-secondary learning centers, this manual emphasizes the design and administration of such centers rather than the various aspects of skill instruction. Its seven chapters discuss the concept of a learning center; the components of the model, including a supplemental course, recruitment…

  10. The Restorative Healing Model: Implementation at the Woodbourne Center

    ERIC Educational Resources Information Center

    Park, Juyoung; Carlson, George; Weinstein, Stanley; Lee, Bethany

    2008-01-01

    This study describes the Restorative Healing Model used at the Woodbourne Center (Baltimore) to improve socially adaptive functioning and behaviors among youth residing in a residential treatment center. This treatment model requires collaborative work with youth, their families, staff members, and community members. Unlike program models built on…

  11. Security at a "model" psychiatric center.

    PubMed

    Camacho, H S; Cottrell, P A

    1997-01-01

    The security problems faced by a recently opened psychiatric center located on the campus of a hospital--including staffing, fire safety, access control, patient restraints, and budget cuts--and how they are being dealt with. PMID:10173429

  12. Exploring differences in referrals to a hospice at home service in two socio-economically distinct areas of Manchester, UK.

    PubMed

    Campbell, Malcolm; Grande, Gunn; Wilson, Charlotte; Caress, Ann-Louise; Roberts, Dai

    2010-06-01

    In order to provide equitable access to hospice at home palliative care services, it is important to identify the socio-economic factors associated with poorer access. In this population-based study we aimed to test the inverse care law by exploring how socio-economic status and other key demographic indicators were associated with referral rates in two distinct areas (Salford and Trafford) served by the same service. Secondary data from the UK National Census 2001, North West Cancer Intelligence Service (2004) and hospice at home service referral data (2004-06) was collated for both areas. Descriptive analysis profiled electoral ward characteristics whilst simple correlations and regression modelling estimated associations with referral rates. Referral rates were lower and cancer mortality higher in the most deprived areas (Salford). Referral rates were significantly associated with deprivation, particularly multiple deprivation, but not significantly associated with cancer mortality (service model and resources available were held constant). At the population level, the socio-economic characteristics of those referred to hospice at home rather than service provision strongly predicted referral rates. This has implications for the allocation and targeting of resources and contributes important findings to future work exploring equitable access at organizational and professional levels. PMID:20015917

  13. Overcoming the Obstacles in Promoting Hospice Palliative Care--Sharing Experiences of the Taiwan Changhua Christian Hospital.

    PubMed

    Tsai, Pei-Yu

    2015-01-01

    Hospice palliative care for terminal patients is necessary, yet challenges are on the way worldwide. This study demonstrated that hospice palliative care has been quickly developed in Taiwan due to the support of the National Health Insurance system, the promotion by civil societies and religious groups, patient's legal right for DNR, easier access to pain killers through medical prescription, and well-planned hospice staff training programs. This paper introduces how hospice consultation is provided by a comprehensive hospice palliative team at Changhua Christian Hospital to establish trust and cooperation with the medical team, and to improve hospice-palliative care referral and utilization rates. PMID:26867341

  14. IHY Modeling Support at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Chulaki, A.; Hesse, Michael; Kuznetsova, Masha; MacNeice, P.; Rastaetter, L.

    2005-01-01

    The Community Coordinated Modeling Center (CCMC) is a US inter-agency activity aiming at research in support of the generation of advanced space weather models. As one of its main functions, the CCMC provides to researchers the use of space science models, even if they are not model owners themselves. In particular, the CCMC provides to the research community the execution of "runs-onrequest" for specific events of interest to space science researchers. Through this activity and the concurrent development of advanced visualization tools, CCMC provides, to the general science community, unprecedented access to a large number of state-of-the-art research models. CCMC houses models that cover the entire domain from the Sun to the Earth. In this presentation, we will provide an overview of CCMC modeling services that are available to support activities during the International Heliospheric Year. In order to tailor CCMC activities to IHY needs, we will also invite community input into our IHY planning activities.

  15. Comprehensive Career Education Center Model. Final Report.

    ERIC Educational Resources Information Center

    Stauber, Dick

    The objective of this project was to establish the Moraine Park Technical Institute as a Career Education Center to coordinate and provide a focus for the career education efforts of the public and private secondary schools in the Moraine Park Vocational, Technical and Adult Education District. The District service area covers several counties in…

  16. Validating a Technology Enhanced Student-Centered Learning Model

    ERIC Educational Resources Information Center

    Kang, Myunghee; Hahn, Jungsun; Chung, Warren

    2015-01-01

    The Technology Enhanced Student Centered Learning (TESCL) Model in this study presents the core factors that ensure the quality of learning in a technology-supported environment. Although the model was conceptually constructed using a student-centered learning framework and drawing upon previous studies, it should be validated through real-world…

  17. Ethical considerations in the treatment of pain in a hospice environment.

    PubMed

    Zylicz, Z

    2000-08-01

    Most people treated in hospices suffer from pain. The hospice environment offers them a place where they may feel safe and get rest before they die. This particular environment was originally created to solve the many problems terminal patients encountered in busy modern hospitals. However, it is clear that solving some problems frequently means creating new ones. For people who are about to complete their life's journey, a hospice is a place of care and autonomy. Previous losses and severe spiritual distress complicate most of the severe pain conditions seen in hospices. In this paper, some specific ethical problems encountered in hospice practice will be discussed. Patients' autonomy with all its advantages and disadvantages will be highlighted. Acceptance of death may result in an active and creative attitude. Although scientific evidence of the processes taking place is still lacking, the modern hospice may be seen as a complementary, main-stream institution contributing to the development of whole medicine. PMID:10900366

  18. Hospice Nurse Communication with Patients with Cancer and their Family Caregivers

    PubMed Central

    Reblin, Maija; Clayton, Margaret F.; Berry, Patricia; Mooney, Kathleen

    2012-01-01

    Abstract Background Effective communication by hospice nurses enhances symptom management for the patient, reduces family caregiver burden and distress, and potentially improves bereavement adjustment. However, research has not kept pace with the rising use of hospice by patients with cancer and thus we know little about how hospice nurses communicate. Methods The overriding objective of this pilot study was to provide insight into these in-home visits. Hospice nurses audiorecorded their interactions over time with family caregivers and patients with cancer. The communication within these tapes was coded using Roter Interaction Analysis System (RIAS) and analyzed. Results We found that tape recording home hospice nurse visits was feasible. RIAS was suited to capture the general content and process of the home hospice encounter and the coded interactions show the range of topics and emotions that are evident in the dialogue. Implications and future directions for research are discussed. PMID:22339285

  19. Geographic access to hospice care for children with cancer in Tennessee, 2009 to 2011.

    PubMed

    Lindley, Lisa C; Edwards, Sheri L

    2015-12-01

    The geographic interface between the need for and the supply of pediatric hospice may be critical in whether children with cancer access care. This study sought to describe the geographic distribution of pediatric hospice need and supply and identify areas lacking pediatric hospice care in Tennessee over a 3-year time period. Using ArcGIS, a series of maps were created. There was a consistent need for care among children with cancer across the state. Most urban areas were supplied by pediatric hospices, except the Knoxville area. Areas within the state were identified where the supply of pediatric hospice care declined, while the need for hospice care was unchanging. This study has important regulatory implications for clinicians practicing in certificate of need states such as Tennessee. PMID:25028742

  20. Settings of Care within Hospice: New Options and Questions about Dying “At Home”

    PubMed Central

    Lysaght, Susan; Ersek, Mary

    2012-01-01

    Although place of death has been routinely studied in end-of-life (EOL) care, more analysis on place of death within hospice is needed because of the recent, dramatic rise in the number of hospice patients dying in inpatient settings. Using a case study to illustrate the complexity of determinants of place of death within hospice, this article highlights important known factors and elucidate gaps for further research. Individual and system level factors, sociocultural meanings, caregiving and preferences are shown to have important implications. Additionally, the unique components of home hospice, inpatient hospice and transitions between these settings may have a fundamental role in the future of quality EOL care. Further research on determinants of hospice settings of care is essential to the care of older adults at the end of life. PMID:23853526

  1. Is there congruence in hospice nurses' view of their patients' quality of life and their hospice patients' view of their own quality of life?

    PubMed

    Mueller-Marquez, B J

    1993-01-01

    Since the development of the hospice movement in the United States, care of the terminally ill has undergone vital change. This change involves the alternative of home care for the terminally ill. It allows the patients, the primary caregiver, and the rest of the family to be in control of care. As stated by Masters, hospice is unique in that the patient and family controls the environment, and lifestyle, including treatment modalities, more than in any other concept in health care. Hospice was developed to give people with a terminal illness an option to traditional medicine. Hospice is a concept of care that has been established to improve the quality of life of the terminally ill. Therefore, the ultimate goal of hospice care is to enhance the quality of life of patients with terminal illness, mainly cancer. In the hospice setting, the nurse applies a holistic approach when planning and providing primary care. The nurse becomes increasingly more knowledgeable about the problems and strengths of the patient and family to whom he/she is caring for. The nurse must make the transition in her philosophy from cure-to-care in hospice, and symptom control being the nurses' priority in order to enhance the patients quality of life. Curtis and Fernsler explain that hospice care focuses on helping patients to communicate effectively and to share life agendas with their primary caregiver and the hospice nurse. These researchers continue to state that these efforts promote congruence between patient, primary caregiver, and the hospice nurses' view of the patients quality of life.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8398476

  2. Complicated grief symptoms in caregivers of persons with lung cancer: the role of family conflict, intrapsychic strains, and hospice utilization.

    PubMed

    Kramer, Betty J; Kavanaugh, Melinda; Trentham-Dietz, Amy; Walsh, Matthew; Yonker, James A

    Guided by a stress process conceptual model, this study examines social and psychological determinants of complicated grief symptoms focusing on family conflict, intrapsychic strains, and the potential moderating effect of care quality and hospice utilization. Relying on data from 152 spouse and adult child lung cancer caregiver survey respondents, drawn from an ancillary study of the Assessment of Cancer CarE and SatiSfaction (ACCESS) in Wisconsin, hierarchical multiple regression analysis was used to examine determinants of complicated grief. After controlling for contextual factors and time since death, complicated grief symptoms were higher among caregivers with less education, among families with lower prior conflict but higher conflict at the end-of-life, who had family members who had difficulty accepting the illness, and who were caring for patients with greater fear of death. Additionally, hospice utilization moderated the effect of fear of death on complicated grief. Findings suggest that family conflict, intrapsychic strains, and hospice utilization may help to explain the variability found in complicated grief symptoms among bereaved caregivers. Implications for enhancing complicated grief assessment tools and preventative interventions across the continuum of cancer care are highlighted. PMID:21495532

  3. Hospice Use Following Implantable Cardioverter-Defibrillator Implantation in Older Patients

    PubMed Central

    Reynolds, Matthew R.; Normand, Sharon-Lise; Parzynski, Craig S.; Spertus, John A.; Mor, Vincent; Mitchell, Susan L.

    2016-01-01

    Background— Older recipients of implantable cardioverter-defibrillators (ICDs) are at increased risk for short-term mortality in comparison with younger patients. Although hospice use is common among decedents aged >65, its use among older ICD recipients is unknown. Methods and Results— Medicare patients aged >65 matched to data in the National Cardiovascular Data Registry – ICD Registry from January 1, 2006 to March 31, 2010 were eligible for analysis (N=194 969). The proportion of ICD recipients enrolled in hospice, cumulative incidence of hospice admission, and factors associated with time to hospice enrollment were evaluated. Five years after device implantation, 50.9% of patients were either deceased or in hospice. Among decedents, 36.8% received hospice services. The cumulative incidence of hospice enrollment, accounting for the competing risk of death, was 4.7% (95% confidence interval [CI], 4.6%–4.8%) within 1 year and 21.3% (95% CI, 20.7%–21.8%) at 5 years. Factors most strongly associated with shorter time to hospice enrollment were older age (adjusted hazard ratio, 1.77; 95% CI, 1.73–1.81), class IV heart failure (versus class I; adjusted hazard ratio, 1.79; 95% CI, 1.66–1.94); ejection fraction <20 (adjusted hazard ratio, 1.57; 95% CI, 1.48–1.67), and greater hospice use among decedents in the patients’ health referral region. Conclusions— More than one-third of older patients dying with ICDs receive hospice care. Five years after implantation, half of older ICD recipients are either dead or in hospice. Hospice providers should be prepared for ICD patients, whose clinical trajectories and broader palliative care needs require greater focus. PMID:27016104

  4. 76 FR 26731 - Medicare Program; Hospice Wage Index for Fiscal Year 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-09

    ... methodology. In the April 24, 2009 ``Hospice Wage Index For FY 2010'' proposed rule (74 FR 18,912, 18,920-22) and in the July 22, 2010 ``Hospice Wage Index for FY 2011'' notice with comment period (75 FR 42,944... supplies. 42 U.S.C. 1395x(dd)(1); see also 48 FR 56,008, 56,008 (Dec. 16, 1983) (describing hospice...

  5. A needs assessment: Fellowship Directors Forum of the American Academy of Hospice and Palliative Medicine.

    PubMed

    Scott, Judy Opatik; Hughes, Lorraine

    2006-04-01

    The Fellowship Directors Forum, a special interest group of the American Academy of Hospice and Palliative Medicine (AAHPM) initiated an assessment of the needs of directors of fellowship programs in the emerging specialty of hospice and palliative care. One major finding, which may contribute to understanding the needs of other new disciplines, is that directors come into this role with clinical and teaching experience, but lacking administrative, educational, and management skills perceived as necessary to success. A study team collected data from current and former fellowship directors across the United States using an online survey and telephone interviews. The survey was sent to 60 current and former directors, with a 60% response rate, and 16 randomly selected directors were interviewed. Results showed that directors believe development of an outcome-based standardized curriculum is vitally important to advancement of the field, and that this should be developed collaboratively through the Forum. Although directors were confident of their own clinical and teaching skills, directors identified a lack of adequate training and experience in several management and educational skill areas critical to running a successful fellowship program. The study team made several recommendations: develop models from parts of existing programs that can be incorporated into a standardized curriculum to meet Accreditation Council of Graduate Medical Education (ACGME) requirements; provide workshops and toolkits for new directors to address the lack of management and educational skills; and establish new communication methods through more or longer forum meetings, a dedicated website, and an online discussion group. PMID:16629556

  6. Hospice care for patients living alone: results of a demonstration program.

    PubMed

    Bly, J L; Kissick, P

    1994-01-01

    The Wissahickon Hospice initiated a demonstration program in 1988 to provide home hospice care to individuals living at home without primary care persons. This paper describes the planning process and admission requirements for the Live Alone Program and the evaluation results for 34 Live Alone patients compared to 105 regular hospice patients. Principal findings were that the hospice was able to maintain patients at home, to provide care safely to patients, and to enable home deaths for patients living alone. Patients living alone tended to require more supportive services than regular patients and to incur higher patient care costs. PMID:7829035

  7. Influence of hospice use on hospital inpatient mortality: a state-level analysis.

    PubMed

    Chang, Cyril F; Steinberg, Stephanie C

    2006-01-01

    This study tests the hypothesis that high hospice enrollment is associated with lower Medicare inpatient mortality. The results show that Medicare inpatient mortality in a state can be explained by hospice enrollment and a host of demographic and market environment variables. An increase in hospice population by 100 individuals is associated with a reduction of 28 inpatient deaths, ceteris paribus. The results suggest, among other things, that opportunities exist for greater expansion of hospice capacity in low-use states to reduce deaths in the expensive hospital setting and improve the quality of end-of-life care for terminally ill patients. PMID:16708687

  8. Psychosocial and spiritual care in hospice: differences between nursing, social work, and clergy.

    PubMed

    Reese, D J; Brown, D R

    1997-01-01

    A chart review of the most recent home visits from nursing, social work, and clergy to 37 home hospice patients indicated that all but two psychosocial and spiritual issues examined were addressed by hospice staff on home visits. Spirituality and, secondly, death anxiety were the most frequently discussed variables. Clergy addressed more spiritual issues than the other two professions, and social work addressed more psychosocial issues than the other two professions. These findings underscore the important roles that clergy and social work play on the hospice team, and imply that hospice should make a renewed commitment to psychosocial and spiritual care. PMID:9248405

  9. Qualitative pain classification in hospice and pain therapy unit.

    PubMed

    Raffaeli, William; Andruccioli, Jessica; Florindi, Stefania; Ferioli, Isabella; Monterubbianesi, Maria Cristina; Sarti, Donatella; Castellani, Francesca; Giarelli, Guido

    2012-12-01

    In this study, we investigated patient's meaning attribution to pain in hospice and pain therapy unit, using a qualitative approach: narrative-based medicine. The data presented here were related to patients (n = 17) hospitalized in Rimini Hospice (Italy). These data were compared to those of patients (n = 21) with noncancer pain (control sample). The interviews were then analyzed according to the technique of thematic narrative analysis. The results of our research identified a differential process in pain processing in relationship to the meaning that the patient attributed to pain. The thematic analysis of the interviews allowed the inductive construction of a specific network of pain dimensions, which were summarized in "the pain chronogram." PMID:22310024

  10. Caregivers' experiences seeking hospice care for loved ones with dementia.

    PubMed

    Lewis, Laura Foran

    2014-09-01

    As the prevalence of dementia continues to grow, informal caregivers face unique challenges as they approach the end of life, and access to support and palliative care is often limited. I used a phenomenological approach to explore the experiences of caregivers actively seeking formal end-of-life care, in particular hospice care, for a loved one with dementia. In-depth interviews with 11 caregivers about 14 patients revealed five themes, including: setting the stage for heartbreak, reaching the boiling point, getting through the front lines, settling for less, and welcoming death. Nurses must recognize the complex needs of caregivers, educate caregivers on the disease process, and adjust to palliative goals sooner to meet the needs of caregivers. Prevalence of these issues must be further examined through quantitative study to evaluate the need to reconsider current hospice eligibility criteria based on prognosis. PMID:25079503

  11. A Review of Barriers to Utilization of the Medicare Hospice Benefits in Urban Populations and Strategies for Enhanced Access

    PubMed Central

    McHenry, Janet; Snow, Daniel; Cassin, Carolyn; Schumacher, Donald; Selwyn, Peter A.

    2008-01-01

    Disparities in access to health care extend to end-of-life care. Lack of access to hospice mirrors lack of access to health maintenance and primary care. Patients who are served by hospice nationally are disproportionately white and likely to reside in economically stable communities. In many urban low-income communities, less than 5% of decedents receive hospice care in the last 6 months of life. This review focuses on barriers to palliative care and hospice in urban, predominantly low-income communities, including cultural and reimbursement factors and the paucity of hospice providers, outreach projects, and in-patient hospice beds in urban communities. This review will also address some strategies that are being implemented by hospices locally and nationally to overcome demographic barriers to hospice care. PMID:18240022

  12. A patient-centered care ethics analysis model for rehabilitation.

    PubMed

    Hunt, Matthew R; Ells, Carolyn

    2013-09-01

    There exists a paucity of ethics resources tailored to rehabilitation. To help fill this ethics resource gap, the authors developed an ethics analysis model specifically for use in rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a process model to guide careful moral reasoning for particularly complex or challenging matters in rehabilitation. The Patient-Centered Care Ethics Analysis Model for Rehabilitation was developed over several iterations, with feedback at different stages from rehabilitation professionals and bioethics experts. Development of the model was explicitly informed by the theoretical grounding of patient-centered care and the context of rehabilitation, including the International Classification of Functioning, Disability and Health. Being patient centered, the model encourages (1) shared control of consultations, decisions about interventions, and management of the health problems with the patient and (2) understanding the patient as a whole person who has individual preferences situated within social contexts. Although the major process headings of the Patient-Centered Care Ethics Analysis Model for Rehabilitation resemble typical ethical decision-making and problem-solving models, the probes under those headings direct attention to considerations relevant to rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a suitable tool for rehabilitation professionals to use (in real time, for retrospective review, and for training purposes) to help arrive at ethical outcomes. PMID:23636083

  13. Informal hospice caregiver pain management concerns: A qualitative study

    PubMed Central

    Kelley, Marjorie; Demiris, George; Nguyen, Huong; Oliver, Debra P; Wittenberg-Lyles, Elaine

    2014-01-01

    Background Informal, unpaid, family caregivers provide much hospice care in the United States. These caregivers suffer physically, psychologically, emotionally, and socially from the burden of caring. The most often identified area of caregiver burden is the management of end-of-life pain. However, little empirical evidence exists of effective interventions to help caregivers manage end-of-life pain, and issues surrounding caregiver pain management remain vague and undefined. Understanding these concerns will inform the design of effective caregiver interventions. Aim The purpose of this study was to describe and organize caregiver pain management challenges faced by home hospice caregivers of cancer patients. Design A content analysis of secondary data, namely, recordings of caregiver interviews, was conducted to describe pain management issues. These interviews were part of a larger clinical trial. Setting/participants Multiple sessions with 29 informal caregivers, of patients dying of cancer, were audio-recorded. Subjects were purposively selected from two hospice programs in the Northwestern United States. Caregivers of noncancer patients were excluded from the study sample. Results A framework of six major themes with subordinate subthemes was developed through a literature review and peer review. The framework was used to organize the content of 87 caregiver interviews. The six major themes identified in the analysis included Caregiver-Centric Issues, Caregiver Medication Skills and Knowledge Issues, End-of-Life Symptom Knowledge Issues, Communication and Teamwork Issues, Organizational Skill Issues, and Patient-Centric Issues. Conclusion This analysis clearly articulated and classified caregiver issues surrounding pain management. Future hospice research may benefit from the use of this analysis and framework in the development of tools to alleviate this major cause of caregiver burden. PMID:23612959

  14. Dignity Therapy Implementation in a Community-Based Hospice Setting

    PubMed Central

    Montross, Lori; Winters, Kathryn D.

    2011-01-01

    Abstract Background Dignity Therapy is a brief, empirically supported, individualized psychotherapy designed to address legacy needs among patients at the end of life. To date, this psychotherapy has not been implemented in a “real-world” community-based hospice setting. This study was designed to offer information about the pragmatic aspects of implementing Dignity Therapy for patients receiving hospice care. Method Twenty-seven patients completed Dignity Therapy as part of a clinical service newly offered at a community-based hospice. Referral and enrollment procedures, as well as the logistics of therapy implementation were monitored. Patients' legacy transcripts were also qualitatively analyzed to measure emergent themes. Results Patients were most commonly referred by social workers, and on average produced Dignity Therapy legacy transcripts approximately 3000 words/8 pages in length. The mean number of sessions spent with patients was 4, equating to an average of 380 minutes of clinician time per patient. Qualitative analyses revealed the most commonly discussed topics among patients were (in rank order): autobiographical information, love, lessons learned in life, defining roles in vocations or hobbies, accomplishments, character traits, unfinished business, hopes and dreams, catalysts, overcoming challenges, and guidance for others. Discussion This was the first study to implement Dignity Therapy in a community sample, with results highlighting the practical aspects of treatment as well as the most common themes discussed by clinical patients in a hospice setting. These findings provide useful data for clinicians or organizational leaders who may consider offering Dignity Therapy in their setting, and offer general insight regarding the legacy topics most frequently discussed by patients near the end of life. PMID:21548823

  15. Implementation of hydrologic models at Goddard Space Flight Center

    NASA Technical Reports Server (NTRS)

    1974-01-01

    Major watershed simulation models were implemented on the computer system at NASA Goddard Space Flight Center, and their operation was verified. Historical and physiographic data were acquired for two Maryland river basins (Monocasy River above Jug Bridge and Patuxent River near Laurel, Maryland) and the models were calibrated to simulate them. GSFC personnel were instructed in model operation after the models were implemented.

  16. Staff Evaluation of the JCCC Success Center Model.

    ERIC Educational Resources Information Center

    Weglarz, Shirley G.

    This report describes a survey conducted at Johnson County Community College (JCCC) (Kansas) to measure staff perceptions, attitudes, and satisfaction with a variety of aspects of the Success Center/Student Services model, upon which the college's two-year old Success Center is based. Surveys were distributed in December 2001 to 107 Student Center…

  17. The impact of volunteering in hospice palliative care.

    PubMed

    Claxton-Oldfield, Stephen; Claxton-Oldfield, Jane

    2007-01-01

    The goal of this study was to examine the impact of hospice palliative care work on volunteers' lives. In-depth interviews were conducted with 23 direct-patient care volunteers. More than half of the volunteers became involved in hospice palliative care because of their own experiences with family members and/or friends who have died. Most of the volunteers reported that they were different now or had changed in some way since they have been volunteering (e.g., they had grown in some way, have learned how to keep things in perspective). In addition, most of the volunteers felt that their outlook on life had changed since they started volunteering (e.g., they were more accepting of death, and they learned the importance of living one day at a time). Volunteers reported doing a number of different things to prevent compassion fatigue or burnout (e.g., reading a book, listening to music, talking to others, and taking time off from volunteering). Most of the volunteers said that they would tell anyone who might be thinking of volunteering in hospice palliative care that it is a very rewarding activity and/or that they should try it. Finally, many of the volunteers offered suggestions for doing things differently in their programs. PMID:17895491

  18. Discharge Hospice Referral and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries Hospitalized for Heart Failure

    PubMed Central

    Kheirbek, Raya E.; Fletcher, Ross D.; Bakitas, Marie A.; Fonarow, Gregg C.; Parvataneni, Sridivya; Bearden, Donna; Bailey, F. Amos; Morgan, Charity J.; Singh, Steven; Blackman, Marc R.; Zile, Michael R.; Patel, Kanan; Ahmed, Momanna B.; Tucker, Rodney O.; Brown, Cynthia J.; Love, Thomas E.; Aronow, Wilbert S.; Roseman, Jeffrey M.; Rich, Michael W.; Allman, Richard M.; Ahmed, Ali

    2015-01-01

    Background Heart failure (HF) is the leading cause for hospital readmission. Hospice care may help palliate HF symptoms but its association with 30-day all-cause readmission remains unknown. Methods and Results Of the 8032 Medicare beneficiaries hospitalized for HF in 106 Alabama hospitals (1998–2001), 182 (2%) received discharge hospice referrals. Of the 7850 patients not receiving hospice referrals, 1608 (20%) died within 6 months post-discharge (the hospice-eligible group). Propensity scores for hospice referral were estimated for each of the 1790 (182+1608) patients and were used to match 179 hospice-referral patients with 179 hospice-eligible patients who were balanced on 28 baseline characteristics (mean age, 79 years, 58% women, 18% African American). Overall, 22% (1742/8032) died in 6 months, of whom 8% (134/1742) received hospice referrals. Among the 358 matched patients, 30-day all-cause readmission occurred in 5% and 41% of hospice-referral and hospice-eligible patients, respectively (hazard ratio {HR} associated with hospice referral, 0.12; 95% confidence interval {CI}, 0.06–0.24). HRs (95% CIs) for 30-day all-cause readmission associated with hospice referral among the 126 patients who died and 232 patients who survived 30-day post-discharge were 0.03 (0.04–0.21) and 0.17 (0.08–0.36), respectively. Although 30-day mortality was higher in the hospice referral group (43% vs. 27%), it was similar at 90 days (64% vs. 67% among hospice-eligible patients). Conclusions A discharge hospice referral was associated with lower 30-day all-cause readmission among hospitalized HF patients. However, most HF patients who died within 6 months of hospital discharge did not receive a discharge hospice referral. PMID:26019151

  19. Two dimensional thick center vortex model

    NASA Astrophysics Data System (ADS)

    Rafibakhsh, Shahnoosh; Ahmadi, Alireza

    2016-01-01

    The potential between static color source is calculated in the SU (3) gauge group by introducing a two dimensional vortex flux. To generalize the model, the length of the Wilson loop is equal to R oriented along the x axis, and the vortex flux is considered as a function of x and y. The comparison between the generalized model and the original one shows that the intermediate linear regime is increased significantly and better agreement with Casimir scaling is achieved. Furthermore, the model is applied to calculate the potential between baryons.

  20. 72. VISITOR'S CENTER, MODEL OF BOILER CHAMBER, AUXILIARY CHAMBER, REACTOR ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    72. VISITOR'S CENTER, MODEL OF BOILER CHAMBER, AUXILIARY CHAMBER, REACTOR AND CANAL (LOCATION T) - Shippingport Atomic Power Station, On Ohio River, 25 miles Northwest of Pittsburgh, Shippingport, Beaver County, PA

  1. The Wisconsin Small Business Development Center Information Service: A Model.

    ERIC Educational Resources Information Center

    Awe, Susan C.

    1986-01-01

    Presents the model of the Information Service of the Wisconsin Small Business Development Center Information Service, including the objectives and tasks necessary to develop an information service, and staffing and funding guidelines for the first two years. (EJS)

  2. Interdisciplinary Team Training: Content and Methodology. Interdisciplinary Team Training and Humanistic Patient Care for Hospices. Monograph 4.

    ERIC Educational Resources Information Center

    Wilson, Dottie C.; Grady, Kathleen A.

    This monograph, the fourth in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to prepare a skilled team of trainers with information about hospices that is relevant to hospice interdisciplinary team training and to document experiences in…

  3. Research Tools Available at the Community Coordinated Modeling Center

    NASA Astrophysics Data System (ADS)

    Berrios, D. H.; Maddox, M.; Rastaetter, L.; Chulaki, A.; Hesse, M.

    2007-12-01

    The Community Coordinated Modeling Center (CCMC), located at NASA Goddard Space Flight Center, provides access to state-of-the-art space weather models to the research community. The majority of the models residing at the CCMC are comprehensive computationally intensive physics-based models. The CCMC also provides free services and tools to assist the research community in analyzing the results from the space weather model simulations. We present an overview of the available services at the CCMC: the Runs-On-Request system, the online visualizations, the Kameleon access and interpolation library, and the CCMC Space Weather Widget. Finally, we discuss the future services and tools in development.

  4. Supramolecular structures modeling photosynthetic reaction center function

    SciTech Connect

    Wasielewski, M.R.; Gaines, G.L. III; Gosztola, D.; Niemczyk, M.P.; Svec, W.A.

    1992-08-20

    Work in our laboratory has focused on the influence of solvent motion on the rates and energetics of photochemical charge separation in glassy solids. The efficiencies of many nonadiabatic electron transfer reactions involving photochemical electron donors with relatively low excited state energies, such as porphyrins and chlorophylls, are poor in the solid state. Recent work has shown that placing a porphyrin-acceptor system in a glassy solid at low temperature significantly raises the energy of ks ion-pair state. This destabilization can be as much as 0.8 eV relative to the ion pair state energy in a polar liquid. This contrasts sharply with photosynthetic reaction centers, which maintain medium-independent electron transfer rates with relatively small free energies of charge separation. Using this information we have set out to design photochemical systems that produce long-lived radical ion pairs in glassy solids with high quantum efficiency. These systems maintain their efficiency when placed in other glassy matrices, such as polymers. An important consequence of this effort is the design of molecules that minimize the electronic interaction between the oxidized donor and reduced acceptor. This minimization can be attained by careful design of the spacer groups linking the donor and acceptor and by using more than a single electron transfer step to increase the distance between the separated charges as is done in natural photosynthesis.

  5. In Search of Models of Care

    ERIC Educational Resources Information Center

    Davidson, Glen W.

    1978-01-01

    Without careful definition of "spiritual," hospice care will be little different in quality from that offered in acute and chronic care centers. Also discussed is the challenge to hospice care staff to defy trends in recent health care allowing staff rather than patients to determine what dignity means. (Author)

  6. To center or not to center? Investigating inertia with a multilevel autoregressive model

    PubMed Central

    Hamaker, Ellen L.; Grasman, Raoul P. P. P.

    2015-01-01

    Whether level 1 predictors should be centered per cluster has received considerable attention in the multilevel literature. While most agree that there is no one preferred approach, it has also been argued that cluster mean centering is desirable when the within-cluster slope and the between-cluster slope are expected to deviate, and the main interest is in the within-cluster slope. However, we show in a series of simulations that if one has a multilevel autoregressive model in which the level 1 predictor is the lagged outcome variable (i.e., the outcome variable at the previous occasion), cluster mean centering will in general lead to a downward bias in the parameter estimate of the within-cluster slope (i.e., the autoregressive relationship). This is particularly relevant if the main question is whether there is on average an autoregressive effect. Nonetheless, we show that if the main interest is in estimating the effect of a level 2 predictor on the autoregressive parameter (i.e., a cross-level interaction), cluster mean centering should be preferred over other forms of centering. Hence, researchers should be clear on what is considered the main goal of their study, and base their choice of centering method on this when using a multilevel autoregressive model. PMID:25688215

  7. Models of Urban Redevelopment: Renaissance Center or the Solidary Neighborhood.

    ERIC Educational Resources Information Center

    Bolger, Rory

    This paper examines the attempts to rebuild downtown Detroit. Two models for redevelopment are examined: (1) the use of private sector investment as exemplified by the Renaissance Center Complex; and (2) the "solidary neighborhood" model, which involves the use of community labor and participation. The "Renaissance model" of redevelopment is…

  8. Conducting Research: A Student-Centered Model.

    ERIC Educational Resources Information Center

    Duffield, Judith A.

    1998-01-01

    Claims that the importance of gaining information literacy skills is in the use of information rather than the finding of information but that many students undertaking research projects do not understand this. Describes a research process model developed for use in a classroom setting and gives a sample lesson using its steps: presearch, search,…

  9. Training Program Design. Interdisciplinary Team Training and Humanistic Patient Care for Hospices. Monograph 3.

    ERIC Educational Resources Information Center

    English, David J.; Mortenson, Lee E.

    This monograph, the third in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to describe the steps in designing a training program for a particular hospice and the activities undertaken between the selection of the trainers and the…

  10. 42 CFR 418.76 - Condition of participation: Hospice aide and homemaker services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... the need for respect for the patient, his or her privacy, and his or her property. (ix) Appropriate... Participation: Patient Care Non-Core Services § 418.76 Condition of participation: Hospice aide and homemaker... other hospice staff. (ii) Observation, reporting, and documentation of patient status and the care...