Science.gov

Sample records for hospice center model

  1. [Elisabeth Kübler-Ross-Nurekr renewal center: health care based on the hospice model].

    PubMed

    de Santana, M T; Nascimento, M F; de Almeida, C F

    2000-01-01

    The hospice model is a movement concerned with the care of the dying patient and its family. It's main aim is to comfort and give nursing assistance to terminal patients, giving the patient and family more decision making power than it would have in regular hospitals. The Hospice is not a geographic, territorial space, defined as what we call an "institution". It is more than that, it is an attitude, a behavior towards death and dying. This paper reports on the experience of a multi-professional team' which implemented hospice model care in the Nursing School of the Federal University of Bahia. The study showed that there is a need to understand and study tanathology, to change one's changing attitude towards death and dying, and to develop the ability to deal with one's own terminability.

  2. Impact of a Centralized Inpatient Hospice Unit in an Academic Medical Center.

    PubMed

    Jegier, Briana J; O'Mahony, Sean; Johnson, Julie; Flaska, Rita; Perry, Anthony; Runge, Mary; Sommerfeld, Teri

    2016-09-01

    Rush University Medical Center (RUMC) and Horizon Hospice opened the first centralized inpatient hospice unit (CIPU) in a Chicago academic medical center in 2012. This study examined if there was a difference in cost or length of stay (LOS) in a CIPU compared to hospice care in scattered beds throughout RUMC. This retrospective, cross-sectional study compared cost and LOS for patients admitted to the CIPU (n = 141) and those admitted to hospice scattered beds (SBM) throughout RUMC (n = 56). The CIPU patients had a median LOS of 6.0 days versus 2.0 days for SBM patients. The CIPU patients had longer hospice LOS but lower hospital costs. Academic medical centers may benefit from aggregating hospice beds. © The Author(s) 2015.

  3. Hospice eligibility in patients who died in a tertiary care center

    PubMed Central

    Freund, Katherine; Weckmann, Michelle T.; Casarett, David J; Swanson, Kristi; Brooks, Mary Kay; Broderick, Ann

    2016-01-01

    Background Hospice is a service that patients, families and physicians find beneficial, yet a majority of patients die without receiving hospice care. Little is known about how many hospitalized patients are hospice eligible at the time of hospitalization. Methods Retrospective chart review was used to examine all adult deaths (n=688) at a tertiary care center during 2009. Charts were selected for full review if the death was non-traumatic and the patient had a hospital admission (penultimate admission) within 12 months of the terminal admission. The charts were examined for hospice eligibility based on medical criteria, evidence of a hospice discussion and hospice enrollment. Results 209 patients had an admission in the year preceding the terminal admission and a non-traumatic death. 60% were hospice eligible during the penultimate admission. Hospice discussions were documented in 14% of the hospice eligible patients. Patients who were hospice eligible had more subspecialty consults on the penultimate admission compared to those not hospice eligible (p=0.016), as well as more overall hospitalizations in the 12 months preceding their terminal admission (p=0.0003) and fewer days between their penultimate admission and death (p=0.001). Conclusion The majority of terminally ill inpatients did not have a documented discussion of hospice with their care provider. Educating physicians to recognize the stepwise decline of most illnesses and hospice admission criteria will facilitate a more informed decision making process for patients and their families. A consistent commitment to offer hospice earlier than the terminal admission would increase access to community or home-based care, potentially increasing quality of life. PMID:22086609

  4. 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…

  5. Meaning-centered dream work with hospice patients: A pilot study.

    PubMed

    Wright, Scott T; Grant, Pei C; Depner, Rachel M; Donnelly, James P; Kerr, Christopher W

    2015-10-01

    Hospice patients often struggle with loss of meaning, while many experience meaningful dreams. The purpose of this study was to conduct a preliminary exploration into the process and therapeutic outcomes of meaning-centered dream work with hospice patients. A meaning-centered variation of the cognitive-experiential model of dream work (Hill, 1996; 2004) was tested with participants. This variation was influenced by the tenets of meaning-centered psychotherapy (Breitbart et al., 2012). A total of 12 dream-work sessions were conducted with 7 hospice patients (5 women), and session transcripts were analyzed using the consensual qualitative research (CQR) method (Hill, 2012). Participants also completed measures of gains from dream interpretation in terms of existential well-being and quality of life. Participants' dreams generally featured familiar settings and living family and friends. Reported images from dreams were usually connected to feelings, relationships, and the concerns of waking life. Participants typically interpreted their dreams as meaning that they needed to change their way of thinking, address legacy concerns, or complete unfinished business. Generally, participants developed and implemented action plans based on these interpretations, despite their physical limitations. Participants described dream-work sessions as meaningful, comforting, and helpful. High scores on a measure of gains from dream interpretation were reported, consistent with qualitative findings. No adverse effects were reported or indicated by assessments. Our results provided initial support for the feasibility and helpfulness of dream work in this population. Implications for counseling with the dying and directions for future research were also explored.

  6. The Center for Health Care Law: the legal muscle of home care and hospice.

    PubMed

    Dombi, Bill

    2006-10-01

    The Center for Health Care Law is a unique offering for a trade association. Operating as a law firm within NAHC, the Center has strengthened NAHC's advocacy efforts on all fronts. The law provides a useful structure and a rational system for behavior, provided that the law is understood. The Center brings the necessary understanding of the law to home care and hospice.

  7. Hospice Care

    MedlinePlus

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

  8. 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 ...

  9. Hospice Value-Based Purchasing Program: A Model Design.

    PubMed

    Nowak, Bryan P

    2016-12-01

    With the implementation of the Affordable Care Act, the U.S. government committed to a transition in payment policy for health care services linking reimbursement to improved health outcomes rather than the volume of services provided. To accomplish this goal, the Department of Health and Human Services is designing and implementing new payment models intended to improve the quality of health care while reducing its cost. Collectively, these novel payment models and programs have been characterized under the moniker of value-based purchasing (VBP), and although many of these models retain a fundamental fee-for-service (FFS) structure, they are seen as essential tools in the evolution away from volume-based health care financing toward a health system that provides "better care, smarter spending, and healthier people." In 2014, approximately 20% of Medicare provider FFS payments were linked to a VBP program. The Department of Health and Human Services has committed to a four-year plan to link 90% of Medicare provider FFS payments to value-based purchasing by 2018. To achieve this goal, all items and services currently reimbursed under Medicare FFS programs will need to be evaluated in the context of VBP. To this end, the Medicare Hospice benefit appears to be appropriate for inclusion in a model of VBP. This policy analysis proposes an adaptable model for a VBP program for the Medicare Hospice benefit linking payment to quality and efficiency in a manner consistent with statutory requirements established in the Affordable Care Act. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  10. Rough set theory based prognostic classification models for hospice referral.

    PubMed

    Gil-Herrera, Eleazar; Aden-Buie, Garrick; Yalcin, Ali; Tsalatsanis, Athanasios; Barnes, Laura E; Djulbegovic, Benjamin

    2015-11-25

    This paper explores and evaluates the application of classical and dominance-based rough set theory (RST) for the development of data-driven prognostic classification models for hospice referral. In this work, rough set based models are compared with other data-driven methods with respect to two factors related to clinical credibility: accuracy and accessibility. Accessibility refers to the ability of the model to provide traceable, interpretable results and use data that is relevant and simple to collect. We utilize retrospective data from 9,103 terminally ill patients to demonstrate the design and implementation RST- based models to identify potential hospice candidates. The classical rough set approach (CRSA) provides methods for knowledge acquisition, founded on the relational indiscernibility of objects in a decision table, to describe required conditions for membership in a concept class. On the other hand, the dominance-based rough set approach (DRSA) analyzes information based on the monotonic relationships between condition attributes values and their assignment to the decision class. CRSA decision rules for six-month patient survival classification were induced using the MODLEM algorithm. Dominance-based decision rules were extracted using the VC-DomLEM rule induction algorithm. The RST-based classifiers are compared with other predictive and rule based decision modeling techniques, namely logistic regression, support vector machines, random forests and C4.5. The RST-based classifiers demonstrate average AUC of 69.74 % with MODLEM and 71.73 % with VC-DomLEM, while the compared methods achieve average AUC of 74.21 % for logistic regression, 73.52 % for support vector machines, 74.59 % for random forests, and 70.88 % for C4.5. This paper contributes to the growing body of research in RST-based prognostic models. RST and its extensions posses features that enhance the accessibility of clinical decision support models. While the non-rule-based methods

  11. Hospice Care

    MedlinePlus

    ... Caregiver Questions to Ask about Advanced Cancer Research Hospice Care On This Page What is hospice, and how ... used in cancer care? Who is eligible for hospice care? How can people get help paying for hospice ...

  12. National Hospice Survey Results

    PubMed Central

    Aldridge, Melissa D.; Schlesinger, Mark; Barry, Colleen L.; Morrison, R. Sean; McCorkle, Ruth; Hürzeler, Rosemary; Bradley, Elizabeth H.

    2015-01-01

    IMPORTANCE The impact of the substantial growth in for-profit hospices in the United States on quality and hospice access has been intensely debated, yet little is known about how for-profit and nonprofit hospices differ in activities beyond service delivery. OBJECTIVE To determine the association between hospice ownership and (1) provision of community benefits, (2) setting and timing of the hospice population served, and (3) community outreach. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional survey (the National Hospice Survey), conducted from September 2008 through November 2009, of a national random sample of 591 Medicare-certified hospices operating throughout the United States. EXPOSURES For-profit or nonprofit hospice ownership. MAIN OUTCOMES AND MEASURES Provision of community benefits; setting and timing of the hospice population served; and community outreach. RESULTS A total of 591 hospices completed our survey (84% response rate). For-profit hospices were less likely than nonprofit hospices to provide community benefits including serving as training sites (55% vs 82%; adjusted relative risk [ARR], 0.67 [95% CI, 0.59–0.76]), conducting research (18% vs 23%; ARR, 0.67 [95% CI, 0.46–0.99]), and providing charity care (80% vs 82%; ARR, 0.88 [95% CI, 0.80–0.96]). For-profit compared with nonprofit hospices cared for a larger proportion of patients with longer expected hospice stays including those in nursing homes (30% vs 25%; P = .009). For-profit hospices were more likely to exceed Medicare’s aggregate annual cap (22% vs 4%; ARR, 3.66 [95% CI, 2.02–6.63]) and had a higher patient disenrollment rate (10% vs 6%; P < .001). For-profit were more likely than nonprofit hospices to engage in outreach to low-income communities (61% vs 46%; ARR, 1.23 [95% CI, 1.05–1.44]) and minority communities (59% vs 48%; ARR, 1.18 [95% CI, 1.02–1.38]) and less likely to partner with oncology centers (25% vs 33%; ARR, 0.59 [95% CI, 0.44–0.80]). CONCLUSIONS AND

  13. A Flexible Alternative to the Cox Proportional Hazards Model for Assessing the Prognostic Accuracy of Hospice Patient Survival

    PubMed Central

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

    2012-01-01

    Prognostic models are often used to estimate the length of patient survival. The Cox proportional hazards model has traditionally been applied to assess the accuracy of prognostic models. However, it may be suboptimal due to the inflexibility to model the baseline survival function and when the proportional hazards assumption is violated. The aim of this study was to use internal validation to compare the predictive power of a flexible Royston-Parmar family of survival functions with the Cox proportional hazards model. We applied the Palliative Performance Scale on a dataset of 590 hospice patients at the time of hospice admission. The retrospective data were obtained from the Lifepath Hospice and Palliative Care center in Hillsborough County, Florida, USA. The criteria used to evaluate and compare the models' predictive performance were the explained variation statistic R2, scaled Brier score, and the discrimination slope. The explained variation statistic demonstrated that overall the Royston-Parmar family of survival functions provided a better fit (R2 = 0.298; 95% CI: 0.236–0.358) than the Cox model (R2 = 0.156; 95% CI: 0.111–0.203). The scaled Brier scores and discrimination slopes were consistently higher under the Royston-Parmar model. Researchers involved in prognosticating patient survival are encouraged to consider the Royston-Parmar model as an alternative to Cox. PMID:23082220

  14. A flexible alternative to the Cox proportional hazards model for assessing the prognostic accuracy of hospice patient survival.

    PubMed

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

    2012-01-01

    Prognostic models are often used to estimate the length of patient survival. The Cox proportional hazards model has traditionally been applied to assess the accuracy of prognostic models. However, it may be suboptimal due to the inflexibility to model the baseline survival function and when the proportional hazards assumption is violated. The aim of this study was to use internal validation to compare the predictive power of a flexible Royston-Parmar family of survival functions with the Cox proportional hazards model. We applied the Palliative Performance Scale on a dataset of 590 hospice patients at the time of hospice admission. The retrospective data were obtained from the Lifepath Hospice and Palliative Care center in Hillsborough County, Florida, USA. The criteria used to evaluate and compare the models' predictive performance were the explained variation statistic R(2), scaled Brier score, and the discrimination slope. The explained variation statistic demonstrated that overall the Royston-Parmar family of survival functions provided a better fit (R(2) =0.298; 95% CI: 0.236-0.358) than the Cox model (R(2) =0.156; 95% CI: 0.111-0.203). The scaled Brier scores and discrimination slopes were consistently higher under the Royston-Parmar model. Researchers involved in prognosticating patient survival are encouraged to consider the Royston-Parmar model as an alternative to Cox.

  15. 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

  16. Is there a model for demonstrating a beneficial financial impact of initiating a palliative care program by an existing hospice program?

    PubMed

    Passik, Steven D; Ruggles, Carol; Brown, Gretchen; Snapp, Janet; Swinford, Susan; Gutgsell, Terrence; Kirsh, Kenneth L

    2004-12-01

    The value of integrating palliative with curative modes of care earlier in the course of disease for people with life threatening illnesses is well recognized. Whereas the now outdated model of waiting for people to be actively dying before initiating palliative care has been clearly discredited on clinical grounds, how a better integration of modes of care can be achieved, financed and sustained is an ongoing challenge for the health care system in general as well as for specific institutions. When the initiative comes from a hospital or academic medical center, which may, for example, begin a palliative care consultation service, financial benefits have been well documented. These palliative care services survive mainly by tracking cost savings that can be realized in a number of ways around a medical center. We tried to pilot 3 simple models of potential cost savings afforded to hospice by initiating a palliative care program. We found that simple models cannot capture this benefit (if it in fact exists). By adding palliative care, hospice, while no doubt improving and streamlining care, is also taking on more complex patients (higher drug costs, shorter length of stay, more outpatient, emergency room and physician visits). Indeed, the hospice was absorbing the losses associated with having the palliative care program. We suggest that an avenue for future exploration is whether partnering between hospitals and hospice programs can defray some of the costs incurred by the palliative care program (that might otherwise be passed on to hospice) in anticipation of cost savings. We end with a series of questions: Are there financial benefits? Can they be modeled and quantified? Is this a dilemma for hospice programs wanting to improve the quality of care but who are not able on their own to finance it?

  17. Marketing imperatives for hospice and hospitals: implications of hospice headway.

    PubMed

    Dwyer, F R; Kolbe, R H

    1986-01-01

    This study reports physician perceptions of the administrative fluency of hospice programming and the comparative service qualities of hospice and acute care hospitals on 11 care needs of the terminally ill. Hospice programs evidence organizational sophistication levels which belie their institutional youth. Hospice had a clear advantage within our stacked comparison of care delivery for the terminally ill. Supporting our model of organizational adaptation, however, the performance gap was smallest on those attributes physicians rate as most important to the terminally ill. Finally, hospice referral rates are statistically explained more by administrative prowess than perceived advantages in care delivery. This compels hospital and hospice attention to informational and relational marketing to physicians.

  18. The Broward County jails hospice program: hospice in the jail.

    PubMed

    Bauersmith, Joan; Gent, Ruth

    2002-10-01

    Broward County's jail hospice program initiated service in 1995. Infirmary services for both men and women in the jail system are housed in one of Broward County's four jail sites. The County, in partnership with the local Medicare certified hospice, Hospice by the Sea, provides care to inmates both in the detention center and on release to the community. Compassionate release, "community control," and expedited case disposition are sometimes utilized. Jail stays are typically shorter than prison sentences. Consequently, expedient identification and enrollment of hospice-appropriate detainees differentiates hospice in a jail setting from prison hospice. Initial attitudinal resistance to hospice services for detainees has for the most part been overcome. Ongoing challenges largely consist of institutional impediments regarding supplies, special dietary needs of hospice patients, visitation procedures, and potential patient isolation.

  19. An update on efforts by the hospice community and the National Hospice Organization to improve access to quality hospice care.

    PubMed

    Mahoney, J

    1998-01-01

    More than a year has passed since the Center to Improve Care of the Dying and the Corcoran Gallery of Art sponsored the symposium entitled: A Good Dying: Shaping Health Care for the Last Months of Life. Using the National Hospice Foundation sponsored exhibition, Hospice: A Photographic Inquiry, as a backdrop, the symposium included presentations on the current state of hospice care as well as the obstacles that limit access to hospice care. This article represents an update on many of the activities of the National Hospice Organization and the greater hospice community as we continue to improve access to quality hospice care.

  20. Hospice Care

    MedlinePlus

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Hospice Care Updated:Aug 9,2013 Hospice – or “comfort” – care ... cardiologist or neurologist. A patient being moved into hospice care must meet several requirements, including: Having a life- ...

  1. 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.

  2. Association Between Elder Self-Neglect and Hospice Utilization in a Community Population

    PubMed Central

    Dong, XinQi; Simon, Melissa A.

    2012-01-01

    Elder self-neglect is associated with substantial 1-year mortality. However, hospice utilization among those with self-neglect remain unclear. The objective of this study is to quantify the prospective relation between self-neglect and risk for hospice utilization in a community population of older adults. Prospective population-based study in a geographically-defined community in Chicago of older adults who participated in the Chicago Health and Aging Project. Of the 8,669 participants in the Chicago Health and Aging Project, a subset of 1,438 participants was reported to social services agency for suspected elder self-neglect. Outcome of interest was the hospice utilization obtained from the Center for Medicare and Medicaid System. Cox proportional hazard models were used to assess independent association of self-neglect with risk of hospice utilization using time-varying covariate analyses. After adjusting for potential confounding factors, elders who self-neglect was associated with increased risk for hospice utilization (HR, 2.43, 95% CI, 2.10-2.81). Greater self-neglect severity (Mild: (HR, 2.12 (1.61-2.79); Moderate: (HR, 2.36 (1.95-2.84); Severe: (HR, 4.66 (2.98-7.30)) were associated with increased risk for hospice utilization. Interaction term analyses suggest that the significant relationship between self-neglect and hospice utilization was not mediated through medical conditions, cognitive impairment and physical disability. Moreover, self-neglect was associated with shorter length of stay in hospice (PE, −0.27, SE, 0.12, p<0.02) and shorter time from hospice admission to death (PE, −0.32, SE, 0.13, p<0.01). Elder self-neglect was associated with increased risk of hospice use in this community population. Elder self-neglect is associated with shorter length of stay in hospice care and shorter time from hospice admission to death. PMID:22770866

  3. Association between elder self-neglect and hospice utilization in a community population.

    PubMed

    Dong, XinQi; Simon, Melissa A

    2013-01-01

    Elder self-neglect is associated with substantial 1-year mortality. However, hospice utilization among those with self-neglect remain unclear. The objective of this study is to quantify the prospective relation between self-neglect and risk for hospice utilization in a community population of older adults. Prospective population-based study in a geographically defined community in Chicago of older adults who participated in the Chicago Health and Aging Project. Of the 8669 participants in the Chicago Health and Aging Project, a subset of 1438 participants was reported to social services agency for suspected elder self-neglect. Outcome of interest was the hospice utilization obtained from the Center for Medicare and Medicaid System. Cox proportional hazard models were used to assess independent association of self-neglect with risk of hospice utilization using time-varying covariate analyses. After adjusting for potential confounding factors, elders who self-neglect was associated with increased risk for hospice utilization (HR, 2.43, 95% CI, 2.10-2.81). Greater self-neglect severity (mild: (HR, 2.12 (1.61-2.79); moderate: (HR, 2.36 (1.95-2.84); severe: (HR, 4.66 (2.98-7.30)) were associated with increased risk for hospice utilization. Interaction term analyses suggest that the significant relationship between self-neglect and hospice utilization was not mediated through medical conditions, cognitive impairment and physical disability. Moreover, self-neglect was associated with shorter length of stay in hospice (PE, -0.27, SE, 0.12, p<0.02) and shorter time from hospice admission to death (PE, -0.32, SE, 0.13, p<0.01). Elder self-neglect was associated with increased risk of hospice use in this community population. Elder self-neglect is associated with shorter length of stay in hospice care and shorter time from hospice admission to death.

  4. 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…

  5. Correlates of Family Satisfaction with Hospice Care: General Inpatient Hospice Care versus Routine Home Hospice Care.

    PubMed

    Ong, Jeremy; Brennsteiner, Alex; Chow, Elizabeth; Hebert, Randy S

    2016-01-01

    The quality of communication and support provided to families is associated with greater satisfaction with hospice care. Prior work has not explored whether the predictors of family satisfaction are different in different hospice care settings. The study objective was to explore whether correlates of family satisfaction are different in general inpatient hospice care versus routine home hospice care. Survey data from bereaved family members of approximately 1600 patients from a nonprofit, midsized hospice in western Pennsylvania were used. Data was obtained from Family Evaluation of Hospice Care (FEHC) survey responses from 2008-2013 and separated into two groups, general inpatient hospice care and routine home hospice care. The analysis was completed using a binomial logistic regression model. Three variables were associated with greater overall satisfaction in both care settings: being kept informed about the patient's condition (adjusted odds ratio [AOR]: 9.64, CI: 6.56-14.36); being provided with clear/consistent information (AOR: 2.34, CI: 1.47-3.72); and the perception that patients were provided with adequate treatment for anxiety (AOR: 2.64, CI: 1.19-5.81). Two variables, sufficient discussion with hospice team members concerning family members' religious or spiritual beliefs (AOR: 1.64, CI: 1.17-2.30) and being provided with the correct amount of emotional support after the patient's death (AOR: 2.01, CI: 1.10-3.66), were correlated with greater satisfaction in routine home hospice care only. Good communication is strongly associated with greater family satisfaction across hospice care settings. Hospices must ensure that they provide patients and families with consistent information and support.

  6. Hospice Care

    MedlinePlus

    Hospice care is end-of-life care. A team of health care professionals and volunteers provides it. They give medical, psychological, and spiritual support. The goal of the care is to help people who ...

  7. Hospice Care

    MedlinePlus

    ... nurses, social workers, spiritual counselors, home health aides, bereavement counselors and volunteers. The hospice team helps patients ... physical symptomsBereavement and support groups for familiesWhat is bereavement support?Bereavement support is help in coping with ...

  8. Towards a classification model to identify hospice candidates in terminally ill patients.

    PubMed

    Gil-Herrera, Eleazar; Yalcin, Ali; Tsalatsanis, Athanasios; Barnes, Laura E; Djulbegovic, Benjamin

    2012-01-01

    This paper presents a Rough Set Theory (RST) based classification model to identify hospice candidates within a group of terminally ill patients. Hospice care considerations are particularly valuable for terminally ill patients since they enable patients and their families to initiate end-of-life discussions and choose the most desired management strategy for the remainder of their lives. Unlike traditional data mining methodologies, our approach seeks to identify subgroups of patients possessing common characteristics that distinguish them from other subgroups in the dataset. Thus, heterogeneity in the data set is captured before the classification model is built. Object related reducts are used to obtain the minimum set of attributes that describe each subgroup existing in the dataset. As a result, a collection of decision rules is derived for classifying new patients based on the subgroup to which they belong. Results show improvements in the classification accuracy compared to a traditional RST methodology, in which patient diversity is not considered. We envision our work as a part of a comprehensive decision support system designed to facilitate end-of-life care decisions. Retrospective data from 9105 patients is used to demonstrate the design and implementation details of the classification model.

  9. A model of strategic marketing alliances for hospices: horizontal alliances.

    PubMed

    Self, D R; Starnes, B J

    1999-01-01

    This article develops two previous research efforts. William J. Winston (1994, 1995) has proposed a set of strategies by which health care organizations can benefit from forging strategic alliances. Raadt and Self (1997) have proposed a classification model of alliances including horizontal, vertical, internal and osmotic. In the first of two articles, this paper presents a model of horizontal alliances. The subsets include transregional, service mergers, networks, venture capital investments, trade and professional organizations, and promotional alliances. Advantages and disadvantages of each are discussed.

  10. 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

  11. 'The worst thing about hospice is that they talk about death': contrasting hospice decisions and experience among immigrant Central and South American Latinos with US-born White, non-Latino cancer caregivers.

    PubMed

    Kreling, Barbara; Selsky, Claire; Perret-Gentil, Monique; Huerta, Elmer E; Mandelblatt, Jeanne S

    2010-06-01

    Hospice care is promoted as a model for improving end of life care and decreasing burden on caregivers. However, hospice use is low in Latinos and little is known about how Latinos make hospice decisions and experience hospice once enrolled. Qualitative methods were used in this study to conduct in-depth interviews and focus groups with 15 Latino bereaved hospice family caregivers and 15 White non-Latino bereaved hospice family caregivers to describe hospice experiences and evaluate whether cultural factors affected the experience. Differences in decision-making and caregiving experience were identified that were influenced by culture. For example, cultural values of denial, secrecy about prognosis and a collective, family-centered system influenced hospice decisions and experience in Latinos but not non-Latinos. This study identifies a significant dilemma: that is, how to discuss hospice with a patient and family who prefer not to discuss a terminal prognosis. Future research is needed to extend these preliminary results; such results may be useful for designing interventions to improve end of life care and caregiving in Latinos.

  12. 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…

  13. Barriers to hospice for children as perceived by hospice organizations in North Carolina.

    PubMed

    Varela, Ana Milena Sanchez; Deal, Allison M; Hanson, Laura C; Blatt, Julie; Gold, Stuart; Dellon, Elisabeth P

    2012-05-01

    Despite improving organization of hospice for children with life-limiting illnesses, services may be underutilized. We asked representatives of all 76 existing North Carolina hospice organizations about barriers to serving children. Representatives of 61 agencies responded (80%). Hospices serving children differed from hospices not serving children on perception of barriers: 1) Lack of pediatric trained staff (8% vs 42%, p = 0.01); 2) lack of pediatrician consultation (23% vs 50%, p = 0.03); 3) lack of pediatric pharmacy (4% vs 32%, p = 0.006), and inconsistent plan of care between pediatrician and hospice (12% vs 47%, p = 0.01). Lack of pediatric referrals (78%) and families wanting to continue curative therapies while receiving hospice care (77%) were felt to be the most important barriers overall. Enhanced training of pediatric providers and a model of care which blends disease-specific treatment with hospice may improve access to hospice services for children.

  14. 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)

  15. 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

  16. 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)

  17. Access to bereavement services in hospice.

    PubMed

    Dean, Stephanie; Libby, Katherine; McAuley, William J; Van Nostrand, Joan

    2014-01-01

    Hospice bereavement services, though often overlooked in hospice research, are an important area of study due not only to the potential value of bereavement support but also the emphasis placed on such services by the Centers for Medicare and Medicaid Services. Moreover, access to these services is seldom understood or researched. Therefore, using the patient public use file of the 2007 National Home and Hospice Care Survey, we explored the relationships between patient, informal caregiver, and agency characteristics as well as discharges from hospice to gain perspective into bereavement service access to informal caregivers. Findings suggested that death at discharge from hospice may be an important moderator variable between access to hospice bereavement support and many other factors. However, even under controls for death at discharge, two agency characteristics remain significantly associated with access. Bereavement access tends to be more likely in agencies that provide only hospice care as opposed to other services, and in micropolitan agencies. Furthermore, death at discharge is less likely among African Americans, suggesting the value of enhanced culturally-appropriate and more targeted hospice care and hospice bereavement support for this population. Future research should explore the strategies used to effectively deliver bereavement services and how these strategies may benefit from targeted and culturally sensitive approaches.

  18. Hospice Use Among Nursing Home Patients

    PubMed Central

    Unroe, Kathleen Tschantz; Sachs, Greg A.; Hickman, Susan E.; Stump, Timothy E.; Tu, Wanzhu; Callahan, Christopher M.

    2013-01-01

    Objectives Among hospice patients who lived in nursing homes, we sought to: (1) report trends in hospice use over time, (2) describe factors associated with very long hospice stays (>6 months), and (3) describe hospice utilization patterns. Design, setting, and participants We conducted a retrospective study from an urban, Midwest cohort of hospice patients, aged ≥65 years, who lived in nursing homes between 1999 and 2008. Measurements Demographic data, clinical characteristics, and health care utilization were collected from Medicare claims, Medicaid claims, and Minimum Data Set assessments. Patients with overlapping nursing home and hospice stays were identified. χ2 and t tests were used to compare patients with less than or longer than a 6-month hospice stay. Logistic regression was used to model the likelihood of being on hospice longer than 6 months. Results A total of 1452 patients received hospice services while living in nursing homes. The proportion of patients with noncancer primary hospice diagnoses increased over time; the mean length of hospice stay (114 days) remained high throughout the 10-year period. More than 90% of all patients had 3 or more comorbid diagnoses. Nearly 20% of patients had hospice stays longer than 6 months. The hospice patients with stays longer than 6 months were observed to have a smaller percentage of cancer (25% vs 30%) as a primary hospice diagnosis. The two groups did not differ by mean cognitive status scores, number of comorbidities, or activities of daily living impairments. The greater than 6 months group was much more likely to disenroll before death: 33.9% compared with 13.8% (P < .0001). A variety of patterns of utilization of hospice across settings were observed; 21 % of patients spent some of their hospice stay in the community. Conclusions Any policy proposals that impact the hospice benefit in nursing homes should take into account the difficulty in predicting the clinical course of these patients, varying

  19. Examining family meetings at end of life: The model of practice in a hospice inpatient unit.

    PubMed

    Meeker, Mary Ann; Waldrop, Deborah P; Seo, Jin Young

    2015-10-01

    Our purpose was to rigorously examine the nature of family meetings as conducted in an inpatient hospice care unit in order to generate an inductive theoretical model. In this two-phase project, we first interviewed eight members of the interdisciplinary care team who participated in multiple family meetings each week. Interview questions explored why and how they conducted family meetings. Using an observation template created from these interview data, we subsequently conducted ethnographic observations during family meetings. Using the methods of grounded theory, our findings were synthesized into a theoretical model depicting the structure and process of formal family meetings within this setting. The core of the family meeting was characterized by cognitive and affective elements aimed at supporting the family and facilitating quality care by clarifying the past, easing the present, and protecting the future. This inductive model was subsequently found to be highly aligned with a sense of coherence, an important influence on coping, and adaptation to the stress of a life-limiting illness. Provider communication with family members is particularly critical during advanced illness and end-of-life care. The National Consensus Project clinical practice guidelines for quality palliative care list regular family meetings among the recommended practices for excellent communication during end-of-life care, but do not provide specific guidance on how and when to provide such meetings. Our findings provide a theoretical model that can inform the design of a family meeting to address family members' needs for meaningful and contextualized information, validation of their important contributions to care, and preparation for the patient's death.

  20. American Hospice Foundation

    MedlinePlus

    ... 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. ...

  1. 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)

  2. Operational and financial performance of publicly traded hospice companies.

    PubMed

    McCue, Michael J; Thompson, Jon M

    2005-12-01

    The performance of hospices owned by investor-owned, publicly traded hospice companies has been largely ignored by the literature. The objective of this study was to perform a descriptive analysis that compares the operating and financial performance of hospices owned by publicly traded companies to private, for-profit hospices and to nonprofit hospices within small- and large-size categories based on patient days. A nonparametric median test was conducted using comparisons of median values for each measure between comparison ownership groups within the small and large size categories. Financial and operational data for the three ownership groups included in our sample were obtained from the Centers for Medicare and Medicaid Services Cost Report Data over a 3-year period with the most recent fiscal year ending between September 30, 2002 and September 29, 2003. We measured the operational and financial performance of hospices in three areas: utilization, services, and financial performance. Small hospices owned by publicly traded companies incurred a longer length of stay, lower operating expenses, generated higher revenue per day and profit margin, and served a greater proportion of Medicare patients compared to nonprofit counterparts. Large hospices owned by publicly traded hospices served a greater proportion of Medicare patients, offered fewer non-core services, had higher revenue per day and profit margin and incurred lower salary and benefit expense per day. Results suggest publicly traded for-profit hospices, in comparison to for-profit and nonprofit hospices, are able to earn substantially higher profits.

  3. Are Hospice Admission Practices Associated With Hospice Enrollment for Older African Americans and Whites?

    PubMed

    Johnson, Kimberly S; Payne, Richard; Kuchibhatla, Maragatha N; Tulsky, James A

    2016-04-01

    Hospices that enroll patients receiving expensive palliative therapies may serve more African Americans because of their greater preferences for aggressive end-of-life care. Examine the association between hospices' admission practices and enrollment of African Americans and whites. This was a cross-sectional study of 61 North and South Carolina hospices. We developed a hospice admission practices scale; higher scores indicate less restrictive practices, that is, greater frequency with which hospices admitted those receiving chemotherapy, inotropes, and so forth. In separate multivariate analyses for each racial group, we examined the relationship between the proportion of decedents (age ≥ 65) served by a hospice in their service area (2008 Medicare Data) and admission practices while controlling for health care resources (e.g., hospital beds) and market concentration in the area, ownership, and budget. Nonprofit hospices and those with larger budgets reported less restrictive admission practices. In bivariate analyses, hospices with less restrictive admission practices served a larger proportion of patients in both racial groups (P < 0.001). However, in the multivariate models, nonprofit ownership and larger budgets but not admission practices predicted the outcome. Hospices with larger budgets served a greater proportion of African Americans and whites in their service area. Although larger hospices reported less restrictive admission practices, they also may have provided other services that may be important to patients regardless of race, such as more in-home support or assistance with nonmedical expenses, and participated in more outreach activities increasing their visibility and referral base. Future research should explore factors that influence decisions about hospice enrollment among racially diverse older adults. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  4. Dying is a Living Process: A Study of the Cost-Effectiveness of Initiating a Hospice at Madigan Army Medical Center with Implications for Army-Wide Utilization

    DTIC Science & Technology

    1982-04-01

    payroll and bene- fits costs for social medicine services to inpatients. Hospice costs were developed from time data collected for the NCI Hospice Cost...workers times the Sunset 1979 Medicare inpatient to total social medicine cost ratio divided by total Sunset days. Social worker costs were obtained

  5. Hospice Admission Assessment.

    PubMed

    Moon, Paul J

    2017-04-01

    Hospice admission assessment is a pivotal encounter for patient/family and hospice representative. For patient/family, the admission is the threshold by which a particular level of care can commence and, symbolically, a certain marker in health status trajectory is reached. For hospice representative, the admission episode is an occasion to inaugurate an ambience that can serve to frame future hospice care experiences for the patient/family. Through a narrative lens, hospice admission assessment can be seen as experiential time and space, where patient's and family's stories are mindfully and deliberately witnessed and explored. Through the practice of narrative mining, the hospice representative can better understand others' offered stories of reality, which will better inform the plan of palliation and hospice care.

  6. Characteristics of Hospice Programs With Problematic Live Discharges.

    PubMed

    Teno, Joan M; Bowman, Jason; Plotzke, Michael; Gozalo, Pedro L; Christian, Thomas; Miller, Susan C; Williams, Cindy; Mor, Vincent

    2015-10-01

    Little is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation. To characterize hospices with high rates of problematic patterns of live discharges. Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located. In 2010, 3028 hospice programs had 996,208 discharges, with 18.0% being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2% vs. 12.1%, P < 0.001), whereas not-for-profit providers had the lowest rate of burdensome transitions (1.4%). About one in three (33.8%) for-profit providers exhibited one or more of these discharge patterns compared with 9.0% of not-for-profit providers. Problematic patterns of live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain. Copyright © 2015 American Academy of Hospice and Palliative Medicine. All rights reserved.

  7. Hospice agencies' hospital contract status and differing levels of hospice care.

    PubMed

    Chung, Kyusuk; Richards, Nicole; Burke, Sloane

    2015-05-01

    In response to a 2011 finding that approximately 27% of Medicare-certified hospices do not provide a single day of general inpatient care (GIP), the authors explored the extent to which hospices have contracts with hospitals for GIP. Using the 2007 National Home and Hospice Care Survey, we estimated that 1119 (32%) agencies had no contract with any hospitals in 2007 and half of those with no contract did not have a contract with a skilled nursing facility (SNF) either. As a result, these hospices were unable to provide GIP referrals for those in need of inpatient care for acute pain and symptom management. More importantly, not having a contract with a hospital was just one of the factors influencing GIP provision. In the multivariate logistic model, after controlling for contract status with a hospital and other hospice characteristics, agencies in the second quartile of hospice patient census (12-29 vs 73 or more, adjusted odds ratio = 14.10; 95% confidence interval 4.26-46.62) were independently related to providing only routine home care. These hospices are more likely to rely solely on scatter beds for GIP provision. Given that a significant portion of hospices do not have a contract with a hospital, policy makers need to understand barriers to contracts with a hospital/SNF for GIP and consider a hospice's contract status as one of the standards for hospice certification. In addition, further research is necessary to understand why hospices that do have a contract with a hospital do not make GIP referral. © The Author(s) 2014.

  8. 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

  9. 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

  10. 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...

  11. 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...

  12. 42 CFR 418.402 - Individual liability for services that are not considered hospice care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  13. 42 CFR 418.402 - Individual liability for services that are not considered hospice care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  14. 42 CFR 418.402 - Individual liability for services that are not considered hospice care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  15. 42 CFR 418.402 - Individual liability for services that are not considered hospice care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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...

  16. 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.

  17. 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)

  18. Hospice Agencies’ Hospital Contract Status and Differing Levels of Hospice Care

    PubMed Central

    Chung, Kyusuk; Richards, Nicole; Burke, Sloane C.

    2014-01-01

    In response to a 2011 finding that approximately 27% of Medicare-certified hospices do not provide a single day of general inpatient (GIP) level of care, the authors explored the extent to which hospices have contracts with hospitals for GIP. Using the 2007 National Home and Hospice Care Survey (NHHCS), we estimated that 1,119 agencies (32%) had no contract with any hospitals in 2007 and half of those with no contract did not have a contract with a skilled nursing facility (SNF) either. As a result, these hospices were unable to provide GIP patient referrals for those in need of inpatient care for acute pain and symptom management. More importantly, not having a contract with a hospital was just one of the factors influencing GIP provision. In the multivariate logistic model, after controlling for contract status with a hospital and other hospice characteristics, agencies in the second quartile of hospice patient census (12 to 29 vs. 73 or more, Adjusted OR=14.10; 95% CI: 4.26–46.62) were independently related to providing only routine home care. These hospices are more likely to rely solely on scatter beds for GIP provision. Given that a significant portion of hospices do not have a contract with a hospital, policy makers need to understand barriers to contracts with a hospital/SNF for GIP and consider a hospice’s contract status as one of the standards for hospice certification. In addition, further research is necessary to understand why hospices that do have a contract with a hospital do not make GIP referral. PMID:24576832

  19. Are Hospice Admission Practices Associated with Hospice Enrollment for Older African Americans and Whites?

    PubMed Central

    Johnson, Kimberly S.; Payne, Richard; Kuchibhatla, Maragatha N.; Tulsky, James A.

    2016-01-01

    Context Hospices that enroll patients receiving expensive palliative therapies may serve more African Americans because of their greater preferences for aggressive end-of-life care. Objectives Examine the association between hospices’ admission practices and enrollment of African Americans and Whites. Methods This was a cross-sectional study of 61 North and South Carolina hospices. We developed a hospice admission practices scale; higher scores indicate less restrictive practices, i.e., greater frequency with which hospices admitted those receiving chemotherapy, inotropes, etc. In separate multivariate analyses for each racial group, we examined the relationship between the proportion of decedents (age ≥65) served by a hospice in their service area (2008 Medicare Data) and admission practices while controlling for health care resources (e.g., hospital beds) and market concentration in the area, ownership and budget. Results Nonprofit hospices and those with larger budgets reported less restrictive admission practices. In bivariate analyses, hospices with less restrictive admission practices served a larger proportion of patients in both racial groups (P<0.001). However, in the multivariate models, nonprofit ownership and larger budgets but not admission practices predicted the outcome. Conclusion Hospices with larger budgets served a greater proportion of African Americans and Whites in their service area. Although larger hospices reported less restrictive admission practices, they also may have provided other services that may be important to patients regardless of race, such as more in-home support or assistance with nonmedical expenses, and participated in more outreach activities increasing their visibility and referral base. Future research should explore factors that influence decisions about hospice enrollment among racially diverse older adults. PMID:26654945

  20. A new quality assurance package for hospital palliative care teams: the Trent Hospice Audit Group model.

    PubMed

    Hunt, J; Keeley, V L; Cobb, M; Ahmedzai, S H

    2004-07-19

    Cancer patients in hospitals are increasingly cared for jointly by palliative care teams, as well as oncologists and surgeons. There has been a considerable growth in the number and range of hospital palliative care teams (HPCTs) in the United Kingdom. HPCTs can include specialist doctors and nurses, social workers, chaplains, allied health professionals and pharmacists. Some teams work closely with existing cancer multidisciplinary teams (MDTs) while others are less well integrated. Quality assurance and clinical governance requirements have an impact on the monitoring of such teams, but so far there is no standardised way of measuring the amount and quality of HPCTs' workload. Trent Hospice Audit Group (THAG) is a multiprofessional research group, which has been developing standards and audit tools for palliative care since the 1990s. These follow a format of structure-process-outcome for standards and measures. We describe a collaborative programme of work with HPCTs that has led to a new set of standards and audit tools. Nine HPCTs participated in three rounds of consultation, piloting and modification of standard statements and tools. The final pack of HPCT quality assurance tools covers: policies and documentation; medical notes review; questionnaires for ward-based staff. The tools measure the HPCT workload and casemix; the views of ward-based staff on the supportive role of the HPCT and the effectiveness of HPCT education programmes, particularly in changing practice. The THAG HPCT quality assurance pack is now available for use in cancer peer review.

  1. A model of strategic marketing alliances for hospices: vertical, internal, osmotic alliances and the complete model.

    PubMed

    Starnes, B J; Self, D R

    1999-01-01

    This article develops two previous research efforts. William J. Winston (1994, 1995) has proposed a set of strategies by which health care organizations can benefit from forging strategic alliances. Raadt and Self (1997) have proposed a classification model of alliances including horizontal, vertical, internal, and osmotic. In the second of two articles, this paper presents a model of vertical, internal, and osmotic alliances. Advantages and disadvantages of each are discussed. Finally, the complete alliance system model is presented.

  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.

  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. Medication costs across the hospice stay: an evaluation of medication costs in response to the MedPAC proposed reimbursement model.

    PubMed

    Gibson, Marliese A; Kimbrel, Jason M; Protus, Bridget McCrate; Perdue, Willie J; Arradaza, Nicole

    2013-11-01

    The Medicare Payment Advisory Committee (MedPAC) recommended that the per diem reimbursement for the Medicare Hospice Benefit change to a U-shaped scheme reflecting spending based on nursing visit frequency. This study investigated the change in drug cost over patients' length of stay (LOS) as current drug cost trends are unknown and were not evaluated in the MedPAC proposed reimbursement scheme. An analysis of patient utilizers of a national pharmacy claims database from 2007 to 2010 was completed to determine the trend in average daily pharmaceutical cost per utilizer (PCPU) over the patient's LOS. The average daily PCPU for 144,119 patients demonstrated a U-shaped curve. Indexed values in the first and last periods were significantly higher than in all other periods overall and by diagnosis (P < .001). Although indexed medication costs showed a U-shaped curve, it is imperative that hospice reimbursement be adequately evaluated for all medication costs including variations within the diagnosis mix. Payer sources and hospices must work together to determine adequate reimbursement models that will provide patients with effective and efficient high-quality care through the end of life.

  5. Hospice Care in America

    MedlinePlus

    ... management and service delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Volunteer commitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Bereavement support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Additional Statistics for NHPCO Members. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 ... or medical director, nurses, hospice aides, social workers, bereavement counselors, clergy or other spiritual counselors, trained volunteers, ...

  6. Medicare Hospice Benefits

    MedlinePlus

    ... 4 Care for a condition other than your terminal illness ......................................... 4 How your Medicare hospice benefit works ..................................................... ... care, counseling, drugs, equipment, and supplies for the terminal illness and related conditions. ■■ Care is generally provided ...

  7. Hospice Care in America

    MedlinePlus

    ... Hospice services are available to patients with any terminal illness or of any age, religion, or race. ... with the majority of deaths due to other terminal diseases. 4 The top four non-cancer primary ...

  8. Medicare Hospice Benefits

    MedlinePlus

    ... 4 Care for a condition other than a terminal illness ............................................ 5 How your Medicare hospice benefit works ..................................................... ... care, counseling, drugs, equipment, and supplies for the terminal illness and related conditions. ■■ Care is generally provided ...

  9. Exploring the dreams of hospice workers.

    PubMed

    Hess, Shirley A; Knox, Sarah; Hill, Clara E; Byers, Tara; Spangler, Patricia

    2014-06-01

    Nine adults who worked at least 1 year with patients at US hospice centers completed an in-person audiotaped dream session focusing on a dream about a patient. Data were analyzed using consensual qualitative research. Patients were generally manifestly present in participants' dreams, and dreams were typically realistic (i.e., not bizarre). In the dream, the dreamer typically interacted with the patient as a caretaker but was also typically frustrated by an inability to help as fully as desired. Dreams gave dreamers insight into the stress of hospice work, their own fears of death, and inter-/intrapersonal interactions beyond hospice work. Dreamers generally sought to take better care of themselves and find balance in their lives after the dream session. Implications for research and practice are discussed.

  10. Racial differences in hospice revocation to pursue aggressive care.

    PubMed

    Johnson, Kimberly S; Kuchibhatla, Maragatha; Tanis, David; Tulsky, James A

    2008-01-28

    Hospice provides supportive care to terminally ill patients at the end of life. However, some enrollees leave hospice before death in search of therapies that may prolong survival. Because of a greater preference for life-sustaining therapies at the end of life, African American patients may be more likely than white patients to withdraw from hospice to seek life-prolonging therapies. In a secondary data analysis of African American and white patients discharged from VITAS hospice programs between January 1, 1999, and December 31, 2003, we used logistic regression to examine the association between race and discharge disposition defined as hospice revocation to pursue aggressive care (eg, emergency medical care, chemotherapy, or invasive medical intervention) vs all other discharges. We used a Cox proportional hazards model to examine survival at 1 year after hospice revocation in a subgroup of enrollees from Florida hospice programs. Of the 166 197 enrollees, 2.8% revoked hospice to pursue aggressive care, and African American patients were more likely than white patients to do so (4.5% vs 2.5%; P< .001). In multivariate analysis, African American patients had a 70% higher odds of leaving hospice to pursue life-prolonging therapies (odds ratio, 1.70; 95% confidence interval, 1.57-1.84). In the subgroup analysis, 48.4% of the enrollees who revoked hospice to pursue life-prolonging therapies were still alive at 1 year. African American patients were more likely than white patients to revoke hospice to pursue life-prolonging therapies. Models of health care that couple curative and palliative therapies may be more attractive to African American patients and more effective at maximizing continuity throughout life-limiting illness.

  11. 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)

  12. Medicare Program; FY 2017 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements. Final rule.

    PubMed

    2016-08-05

    This final rule will update the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2017. In addition, this rule changes the hospice quality reporting program, including adopting new quality measures. Finally, this final rule includes information regarding the Medicare Care Choices Model (MCCM).

  13. 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…

  14. Racial and ethnic differences in hospice enrollment among children with cancer.

    PubMed

    Thienprayoon, Rachel; Lee, Simon Craddock; Leonard, David; Winick, Naomi

    2013-10-01

    Hospice is an important provider of end of life care. Adult minorities are less likely to enroll on hospice; little is known regarding the prevalence of pediatric hospice use or the characteristics of its users. Our primary objective was to determine whether race/ethnicity was associated with hospice enrollment in children with cancer. We hypothesized that minority (Latino) race/ethnicity is negatively associated with hospice enrollment in children with cancer. In this single-center retrospective cohort study, inclusion criteria were patients who died of cancer or stem cell transplant between January 1, 2006 and December 31, 2010. The primary outcome variable was hospice enrollment and primary predictor was race/ethnicity. Of the 202 patients initially identified, 114 met inclusion criteria, of whom 95 were enrolled on hospice. Patient race/ethnicity was significantly associated with hospice enrollment (P = 0.02), the association remained significant (P = 0.024) after controlling for payor status (P = 0.995), patient diagnosis (P = 0.007), or religion (P = 0.921). Latinos enrolled on hospice significantly more often than patients of other races. Despite initial enrollment on hospice however, 34% of Latinos and 50% of non-Latinos had withdrawn from hospice at the time of death (P = 0.10). Race/ethnicity was not significantly associated with dying on hospice. These results indicate that race/ethnicity and diagnosis are likely to play a role in hospice enrollment during childhood. A striking number of patients of all race/ethnicities left hospice prior to death. More studies describing the impact of culture on end of life decision-making and the hospice experience in childhood are warranted. Copyright © 2013 Wiley Periodicals, Inc.

  15. Quality of Palliative Care at U.S. Hospices: Results of a National Survey

    PubMed Central

    Carlson, Melissa D.A.; Barry, Colleen; Schlesinger, Mark; McCorkle, Ruth; Morrison, R. Sean; Cherlin, Emily; Herrin, Jeph; Thompson, Jennifer; Twaddle, Martha L.; Bradley, Elizabeth H.

    2011-01-01

    Background The National Quality Forum (NQF) identified hospice services as a national priority area for healthcare quality improvement and endorsed a set of preferred practices for quality palliative and hospice care. This study reports the first national data regarding hospices’ self-reported implementation of the NQF preferred practices and identifies hospice characteristics associated with more comprehensive implementation. Methods We conducted a national cross-sectional survey of a random sample of hospices (n=591; response rate 84%) from September 2008 to November 2009. We evaluated the reported implementation of NQF preferred practices in the care of both patients and families. Results The range of reported implementation of individual NQF preferred practices among hospices was 45–97%. Twenty-one percent of hospices reported having implemented all patient-centered preferred practices, 26% all family-centered preferred practices, and 10% all patient and family-centered preferred practices. In adjusted analyses, large hospices (100 or more patients per day) were significantly more likely than small hospices (less than 20 patients per day) to report having implemented all patient-centered preferred practices (OR=2.46, 95%CI 1.24, 4.90) and all family-centered preferred practices (OR=1.88, 95%CI 1.02, 3.45). Similarly, chain-affiliated hospices were significantly more likely than free-standing hospices to report having implemented all patient-centered preferred practices (OR=2.45, 95%CI 1.23, 4.87) and all family-centered preferred practices (OR=1.85, 95%CI 1.01, 3.41). Conclusions Hospices’ reported implementation of individual preferred practices for palliative and hospice care quality was high; however, reported comprehensive implementation of preferred practices was rare and may be difficult to achieve for small, free-standing hospices. PMID:21685811

  16. Medicare Care Choices Model Enables Concurrent Palliative and Curative Care.

    PubMed

    2015-01-01

    On July 20, 2015, the federal Centers for Medicare & Medicaid Services (CMS) announced hospices that have been selected to participate in the Medicare Care Choices Model. Fewer than half of the Medicare beneficiaries use hospice care for which they are eligible. Current Medicare regulations preclude concurrent palliative and curative care. Under the Medicare Choices Model, dually eligible Medicare beneficiaries may elect to receive supportive care services typically provided by hospice while continuing to receive curative services. This report describes how CMS has expanded the model from an originally anticipated 30 Medicare-certified hospices to over 140 Medicare-certified hospices and extended the duration of the model from 3 to 5 years. Medicare-certified hospice programs that will participate in the model are listed.

  17. National hospice survey results: for-profit status, community engagement, and service.

    PubMed

    Aldridge, Melissa D; Schlesinger, Mark; Barry, Colleen L; Morrison, R Sean; McCorkle, Ruth; Hürzeler, Rosemary; Bradley, Elizabeth H

    2014-04-01

    IMPORTANCE The impact of the substantial growth in for-profit hospices in the United States on quality and hospice access has been intensely debated, yet little is known about how for-profit and nonprofit hospices differ in activities beyond service delivery. OBJECTIVE To determine the association between hospice ownership and (1) provision of community benefits, (2) setting and timing of the hospice population served, and (3) community outreach. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional survey (the National Hospice Survey), conducted from September 2008 through November 2009, of a national random sample of 591 Medicare-certified hospices operating throughout the United States. EXPOSURES For-profit or nonprofit hospice ownership. MAIN OUTCOMES AND MEASURES Provision of community benefits; setting and timing of the hospice population served; and community outreach. RESULTS A total of 591 hospices completed our survey (84% response rate). For-profit hospices were less likely than nonprofit hospices to provide community benefits including serving as training sites (55% vs 82%; adjusted relative risk [ARR], 0.67 [95% CI, 0.59-0.76]), conducting research (18% vs 23%; ARR, 0.67 [95% CI, 0.46-0.99]), and providing charity care (80% vs 82%; ARR, 0.88 [95% CI, 0.80-0.96]). For-profit compared with nonprofit hospices cared for a larger proportion of patients with longer expected hospice stays including those in nursing homes (30% vs 25%; P = .009). For-profit hospices were more likely to exceed Medicare's aggregate annual cap (22% vs 4%; ARR, 3.66 [95% CI, 2.02-6.63]) and had a higher patient disenrollment rate (10% vs 6%; P < .001). For-profit were more likely than nonprofit hospices to engage in outreach to low-income communities (61% vs 46%; ARR, 1.23 [95% CI, 1.05-1.44]) and minority communities (59% vs 48%; ARR, 1.18 [95% CI, 1.02-1.38]) and less likely to partner with oncology centers (25% vs 33%; ARR, 0.59 [95% CI, 0.44-0.80]). CONCLUSIONS AND

  18. A National Study of Live Hospice Discharges between 2000 and 2012.

    PubMed

    Prsic, Elizabeth; Plotzke, Mike; Christian, Thomas J; Gozalo, Pedro; Teno, Joan M

    2016-09-01

    Live hospice discharges represent a potential vulnerability in the Medicare hospice benefit. Little is known about how live discharges have varied over time. To identify trends in live hospice discharges between 2000 and 2012. Retrospective cohort study of Medicare hospice discharges. In this study, we examined live discharges in the first six months of 2000, 2006, 2008, 2010, and 2012. A live discharge was classified as a burdensome transition if hospice discharge was followed by hospital admission, and then there was a hospice readmission within 2 days of hospital discharge. The adjusted rate of overall live discharges and burdensome transitions was examined with a multivariate mixed-effects logistic model that adjusted for age, gender, race, and hospice primary diagnosis. The model contained an interaction term for year and hospice tax status. The unadjusted overall rate of live discharges increased from 13.7% in 2000 to 18.1% in 2012. For-profit hospice programs had an adjusted live discharge rate of 17.7% in 2000 and 22.7% in 2012. During the same period, the adjusted live discharge rate for nonprofit hospice programs increased from 15.2% to 16.3%. The overall rate of burdensome transitions increased from 2.9% in 2000 to 5.3% in 2012. Similar to the overall rate of live discharge, for-profit hospices had a higher rate of burdensome transitions (6.4%) than nonprofit hospices (4.0%) in 2012. Live hospice discharges and burdensome transitions increased between 2000 and 2012. For-profit hospice programs demonstrated larger increases than nonprofit hospice programs.

  19. 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

  20. 42 CFR 418.309 - Hospice cap amount.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.309 Hospice cap amount. The hospice cap amount... Medicare beneficiaries who elected to receive hospice care from that hospice during the cap period. For... election to receive hospice care, in accordance with § 418.24, from the hospice during the......

  1. 42 CFR 418.309 - Hospice aggregate cap.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.309 Hospice aggregate cap. A hospice...— (1) In the case in which a beneficiary received care from only one hospice, the hospice includes in... included in the calculation of any hospice cap, and who have filed an election to receive hospice......

  2. Just ask: hospice familiarity in Asian and Hispanic adults.

    PubMed

    Pan, Cynthia X; Abraham, Olga; Giron, Fatima; LeMarie, Priscilla; Pollack, Simcha

    2015-05-01

    Previous research documents the under-utilization of hospice services by minority ethnic groups, but less data exist for Asian and Hispanic Americans. It is unclear whether these low utilization rates are a result of attitudinal or information barriers, or both. To examine self-reported familiarity and attitudes toward hospice among Asian and Hispanic groups in ethnically diverse Queens County, NY. We surveyed diverse adults during health fairs, at senior centers, and church programs directed at ethnic populations. Respondents completed surveys in their preferred language: Spanish, Chinese (Mandarin), and Korean. Analysis of variance was used to compare continuous variables among language groups; Fisher's exact test compared categorical variables. A total of 604 community adults were surveyed: 99 Chinese, 349 Korean, 156 Spanish. Respondents were mostly female, average age 53 years. Familiarity with hospice varied significantly among the groups (P < 0.001) and was lower in the Hispanic (16%) and higher in the Chinese (45%) and Korean (56%) groups. Personal experiences with hospice were low (8-16%) in all groups. A majority (75-94%) responded they would share hospice information with loved ones, but the Hispanic group was significantly less likely to do so compared with Chinese and Korean Americans. Between 74 and 95% reported willingness to receive future information about hospice, but the Korean group was significantly less likely to want information. When surveyed in their preferred language, Asian and Hispanic adults reported variable levels of familiarity with hospice services. Most responded positively to receiving future information and would tell friends and family members about hospice. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  3. 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

    ... hospice care to residents of a SNF/NF or ICF/MR. 418.112 Section 418.112 Public Health CENTERS FOR... notifies the hospice if— (i) A significant change in a patient's physical, mental, social, or emotional.../MR to assist in the administration of prescribed therapies included in the plan of care only to the...

  4. Hospice Care for Children With Cancer: Where Do These Children Die?

    PubMed

    Thienprayoon, Rachel; Lee, Simon C; Leonard, David; Winick, Naomi

    2015-07-01

    Hospice is an important provider of end of life care; many children who die of cancer enroll in hospice programs. How frequently such children remain in hospice to die at home, or disenroll from hospice and die in the hospital, has not been described. A child's location of death has important implications for quality of life and parental adaptation. This represents a subanalysis of a retrospective study of 202 consecutive oncology patients who died at a single center between January 1, 2006 and December 31, 2010. Of 95 children who enrolled in hospice, 82 had known location of death. Sixty (73%) died at home or an inpatient hospice unit, 15 (18%) died in the oncology unit, 5 (6%) died in the intensive care unit, and 2 (2%) died in the emergency department. The median length of hospice services was 41 days, twice the national median of 21 days reported in adults. One quarter of children disenrolled from hospice care, ultimately dying in an acute care setting. Further studies are warranted to explore the hospice experience in children, and to address modifiable factors that may impact a family's choice to withdraw from hospice care.

  5. Find a Hospice or Palliative Care Provider

    MedlinePlus

    ... Provider Name: Organization Type: Please select Hospice Multi-Location Hospice Provider Palliative Care Provider or Sitemap Contact Us Privacy Informacion en Español Copyright National Hospice and Palliative ...

  6. Hospice management. Operational, reimbursement, and financial issues.

    PubMed

    Simione, R J; Preston, J F

    1990-11-01

    Of the estimated 1,700 hospices in the United States, approximately half are Medicare-certified. In 1990 alone over 200 hospices have become Medicare-certified. Much of this recent growth can be attributed to both a need for hospice services and the 20% increase in hospice rates legislated by the Omnibus Budget Reconciliation Act of 1989. Medicare certification now presents an opportunity for financial success for hospices, non-participating hospices, and certified home health agencies.

  7. 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.

  8. Same agency, different teams: perspectives from home and inpatient hospice care.

    PubMed

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

    2015-07-01

    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.

  9. Continuing education for hospice staff.

    PubMed

    Conedera, F; Schoessler, M

    1985-06-01

    Hospice nursing is unique because of the philosophy and issues surrounding hospice care. Program planning for hospice staff follows basic principles. The real challenge in developing programs for orientation, continuing, and inservice education is using a format that will truly enable staff to meet the objectives. A lecture, programmed instruction, or video/slide format works well for the "nuts and bolts," but more creativity is needed for the other issues facing the hospice nurse--death, grief, symptom control, stress, team roles, and helping patients with options. Incorporating into the program some of the methods suggested will offer staff the opportunity to become involved in learning and make that learning more meaningful.

  10. Factors Driving Live Discharge From Hospice: Provider Perspectives.

    PubMed

    Dolin, Rachel; Hanson, Laura C; Rosenblum, Sarah F; Stearns, Sally C; Holmes, George M; Silberman, Pam

    2017-06-01

    The proportion of patients disenrolling from hospice before death has increased over the decade with significant variations across hospice types and regions. Such trends have raised concerns about live disenrollment's effect on care quality. Live disenrollment may be driven by factors other than patient preference and may create discontinuities in care, disrupting ongoing patient-provider relationships. Researchers have not explored when and how providers make this decision with patients. The objective of this study was to ascertain provider perspectives on key drivers of live discharge from the Medicare hospice program. We conducted semistructured telephone interviews with 18 individuals representing 14 hospice providers across the country. Transcriptions were coded and analyzed using a template analysis approach. Analysis generated four themes: 1) difficulty estimating patient prognosis, 2) fear of Centers for Medicare & Medicaid Services audits, 3) rising market competition, and 4) challenges with inpatient contracting. Participants emphasized challenges underlying each decision to discharge patients alive, stressing that there often exists a gray line between appropriate and inappropriate discharges. Discussions also focused on scenarios in which financial motivations drive enrollment and disenrollment practices. This study provides significant contributions to existing knowledge about hospice enrollment and disenrollment patterns. Results suggest that live discharge patterns are often susceptible to market and regulatory forces, which may have contributed to the rising national rate. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  11. 42 CFR 418.400 - Individual liability for coinsurance for hospice care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  12. 42 CFR 418.400 - Individual liability for coinsurance for hospice care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  13. 42 CFR 418.400 - Individual liability for coinsurance for hospice care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  14. 42 CFR 418.205 - Special requirements for hospice pre-election evaluation and counseling services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Special requirements for hospice pre-election evaluation and counseling services. 418.205 Section 418.205 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Covered...

  15. 42 CFR 418.205 - Special requirements for hospice pre-election evaluation and counseling services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special requirements for hospice pre-election evaluation and counseling services. 418.205 Section 418.205 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Covered...

  16. 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.

  17. A Military Hospice Model

    DTIC Science & Technology

    1983-05-06

    Dying by Elizabeth Kubler - Ross . Her work has sparked a renewed willingness to be in- volved in the process of dying by assisting with the associated...pp. 516, 293 and 315. 5JCAH Perspectives, November/December, Vol. 2, No. 6, p. 6. 6Elizabeth Kubler - Ross . On Death and Dying. New Y-rk: MacMillan... Kubler - Ross : A Positive Acceptance of Death." American College of Surgeons Bulletin 18 (April 1979); p. 13. 4 1Richard P. Ames, "Unresolved Issues in

  18. Model Learning Center. Final Report.

    ERIC Educational Resources Information Center

    Daviess County School District, Owensboro, KY.

    This handbook describes the model learning resources center in operation at Daviess County (Kentucky) State Vocational-Technical School and details its objectives, materials, and methods of operation. The manual is organized in six sections. The first section describes the learning resources center, and details its philosophy, purpose, objectives,…

  19. 42 CFR 418.309 - Hospice aggregate cap.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Payment for Hospice Care § 418.309 Hospice aggregate... calculation— (1) In the case in which a beneficiary received care from only one hospice, the hospice includes... included in the calculation of any hospice cap, and who have filed an election to receive hospice......

  20. 42 CFR 418.309 - Hospice aggregate cap.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Payment for Hospice Care § 418.309 Hospice aggregate... calculation— (1) In the case in which a beneficiary received care from only one hospice, the hospice includes... included in the calculation of any hospice cap, and who have filed an election to receive hospice......

  1. Lessons learned from hospice care.

    PubMed

    Martin, Caren McHenry

    2013-10-01

    Pharmaceutical care of the hospice patient offers unique challenges in the management of pain and other symptoms. Lessons learned in providing hospice care can be used in the care of nonterminal patients as well to optimize patient-specific care, regardless of care setting or life expectancy.

  2. A descriptive study of California hospice providers' perceptions of public reporting of quality data using the Family Evaluation of Hospice Care Survey.

    PubMed

    Nelson, Marsha; Gale, Randall C; Naierman, Naomi; DeViney, Meredith

    2014-06-01

    The Affordable Care Act requires US hospices to report quality data to the Centers for Medicare and Medicaid Services (CMS) in 2013 with data eventually being made public. There may be some benefit to participating in a voluntary public-reporting program prior to public disclosure by CMS; therefore, we developed and conducted an electronic survey exploring California hospices' perceptions of public reporting. The majority (78.1%) of respondents reported current use of the Family Evaluation of Hospice Care tool and a willingness to consider voluntary participation in a public-reporting program outside of what is being implemented by CMS (58.6%). Tax status of responding hospices was not predictive of a willingness to participate in a statewide public-reporting program of hospice quality in our study.

  3. 75 FR 67905 - National Hospice Month, 2010

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-04

    ... America A Proclamation During National Hospice Month, we recognize the dignity hospice care can provide to... individuals in their final days. Hospice care gives medical services, emotional support, and spiritual... signed into law this year protects and expands hospice services covered under Federal health...

  4. 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

  5. Prison hospice: an unlikely success.

    PubMed

    Craig, E L; Craig, R E

    1999-01-01

    Efforts to introduce hospice and palliative care into American prisons have become fairly widespread, in response to the sharp increase in inmate deaths. The primary impetus originally came from the alarming number of AIDS deaths among prisoners. The new combination therapies have proved very successful in treating AIDS, but are very costly, and many problems must be overcome to ensure their effectiveness in correctional settings. Although the AIDS epidemic seems to be in decline, prisons are experiencing a rise in the number of deaths due to "natural causes." In this article we present a review of the prison hospice scene--the response to this crisis in correctional health care. First, we discuss the challenges facing the introduction of hospice into the correctional setting. Then, we present a brief overview of recent developments and a discussion of some ways hospice components have been adapted for life behind bars. Finally, we indicate some of the prospects for the future. Hospice professionals, armed with thorough professional training and years of experience, often fear that correctional health care providers will only parody superficial aspects of the hospice approach. Continual nudging and nurturing by local and state hospice professionals is required in order to bring about this change in the first place and to sustain it through time. Prison hospice workers need not only initial training, but also ongoing education and personal contact with experienced hospice professionals. While the interest of the big national organizations is necessary, the real action happens when local hospices work with nearby prisons to attend to the needs of dying inmates.

  6. Terminally ill African American elders' access to and use of hospice care.

    PubMed

    Noh, Hyunjin; Schroepfer, Tracy A

    2015-05-01

    The underuse of hospice care by terminally ill African American elders suggests they are suffering when hospice care could offer quality end of life care. Guided by the Behavioral Model for Vulnerable Populations, this study sought understanding of structural barriers faced when seeking access to hospice care and reasons for using it when access is possible. Data was collected through interviews with 28 African American hospice patients. Themes from directed content analysis provide insights into strategies used to overcome access barriers posed by income, health insurance and administrative procedure, as well as the role religion, family, information and health beliefs played in using it. Distributing educational materials and addressing spiritual/religious concerns in choosing hospice care are key in promoting African Americans' use of hospice care.

  7. Timing of Hospice Referral: Assessing Satisfaction While the Patient Receives Hospice Services.

    PubMed

    Adams, Carolyn E; Bader, Julia; Horn, Kathryn V

    2009-02-01

    Generally, satisfaction with timing of hospice referral was measured in mortality follow back surveys of patients who died in hospice. In contrast in this study, investigators assessed timing of the hospice referral in patients/families enrolled in hospice for a minimum of two weeks. About 1/3 of patients/families identified it would have been easier if they started hospice earlier. Barriers to early hospice access were associated primarily with access to the healthcare system.

  8. Hospice assist at home: does the integration of hospice care in primary healthcare support patients to die in their preferred location - A retrospective cross-sectional evaluation study.

    PubMed

    de Graaf, Everlien; Zweers, Daniëlle; Valkenburg, Anna Ch; Uyttewaal, Allegonda; Teunissen, Saskia Ccm

    2016-06-01

    A majority of patients prefer to die at home. Specialist palliative care aims to improve quality of life. Hospice assist at home is a Dutch model of general/specialised palliative care within primary care, collaboratively built by general practitioners and a hospice. The aims of this study are to explore whether hospice assist at home service enables patients at hometo express end-of-life preferences and die in their preferred location. In addition, this study provides insight into symptomburden, stability and early referral. A retrospective cross-sectional evaluation study was performed (December 2014-March 2015), using hospice assist at home patient records and documentation. Primary outcome includes congruence between preferred and actual place of death. Secondary outcomes include symptom burden, (in)stability and early identification. Between June 2012 and December 2014, 130 hospice assist at home patients, living at home with a life expectancy <1 year, were enrolled. Hospice assist at home, a collaboration between general practitioners, district nurses, trained volunteers and a hospice team, facilitates (1) general practitioner-initiated consultation by Nurse Consultant Hospice, (2) fortnightly interdisciplinary consultations and (3) 24/7 hospice backup for patients, caregivers and professionals. A total of 130 patients (62 (48%) men; mean age, 72 years) were enrolled, of whom 107/130 (82%) died and 5 dropped out. Preferred place of death was known for 101/107 (94%) patients of whom 91% patients died at their preferred place of death. Hospice assist at home service supports patients to die in their preferred place of death. Shared responsibility of proactive care in primary care collaboration enabled patients to express preferences. Hospice care should focus on local teamwork, to contribute to shared responsibilities in providing optimal palliative care. © The Author(s) 2016.

  9. Clinical and Socio-Demographic Predictors of Home Hospice Patients Dying at Home: A Retrospective Analysis of Hospice Care Association's Database in Singapore.

    PubMed

    Lee, Yee Song; Akhileswaran, Ramaswamy; Ong, Eng Hock Marcus; Wah, Win; Hui, David; Ng, Sheryl Hui-Xian; Koh, Gerald

    2017-06-01

    Hospice care can be delivered in different settings, but many patients choose to receive it at home because of familiar surroundings. Despite their preferences, not every home hospice patient manages to die at home. To examine the independent factors associated with home hospice patient dying at home. Retrospective analysis of Hospice Care Association's database. Hospice Care Association is the largest home hospice provider in Singapore. The study included all patients who were admitted into home hospice service from January 1, 2004 to December 31, 2013. Cox proportional hazards modeling with time as constant was used to study the relationship between independent variables and home death. A total of 19,721 patients were included in the study. Females (adjusted risk ratio [ARR] 1.09, 95% CI 1.04-1.15), older patients (ARR 1.01, 95% CI 1.00-1.01), shorter duration of home hospice stay (ARR 0.88, 95% CI 0.82-0.94), fewer episodes of hospitalization (ARR 0.81, 95% CI 0.75-0.86), living with caregivers (ARR 1.54, 95% CI 1.05-2.26), doctor (ARR 1.05, 95% CI 1.01-1.08) and nurse (ARR 1.06, 95% CI 1.04-1.08) visits were positive predictors of dying-at-home. Diagnosis of cancer (ARR 0.93, 95% CI 0.86-1.00) was a negative predictor of dying-at-home. Female, older age, living with a caregiver, non-cancer diagnosis, more doctor and nurse visits, shorter duration of home hospice stays, and fewer episodes of acute hospitalizations are predictive of dying-at-home for home hospice patients. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  10. Hospices' enrollment policies may contribute to underuse of hospice care in the United States.

    PubMed

    Aldridge Carlson, Melissa D; Barry, Colleen L; Cherlin, Emily J; McCorkle, Ruth; Bradley, Elizabeth H

    2012-12-01

    Hospice use in the United States is growing, but little is known about barriers that terminally ill patients may face when trying to access hospice care. This article reports the results of the first national survey of the enrollment policies of 591 US hospices. The survey revealed that 78 percent of hospices had at least one enrollment policy that may restrict access to care for patients with potentially high-cost medical care needs, such as chemotherapy or total parenteral nutrition. Smaller hospices, for-profit hospices, and hospices in certain regions of the country consistently reported more limited enrollment policies. We observe that hospice providers' own enrollment decisions may be an important contributor to previously observed underuse of hospice by patients and families. Policy changes that should be considered include increasing the Medicare hospice per diem rate for patients with complex needs, which could enable more hospices to expand enrollment.

  11. [Hospice--an institution of support to the patient].

    PubMed

    Kucharska, Ewa

    2012-01-01

    The paper summarises the past and the present of the palliative care. The author describes the developement in the field from the times of antiquity, through the deep Christian vocation of middle ages to alleviate pain and misery, the eigthteenth century's enlighted ideas until the relatively recent developement of the idea of hospice pioneered in 1967by dr Cicely Saunders in England, and in 1964 by Chrzanowska in Poland. The role of hospice and palliative care at large is summarised, with special focus on emotional, affirmative, instrumental and information-centered support. The paradox of hospice is discussed, which rests on caring for the incurable patient and helping them comfortably to pass the terminal stages of their disease and life, with dignity, without pain, depression, negligence and deprivation. The hospice movement, drawing form Christian tradition, affirms life while accepting the inevitability of death, opposes the idea of euthanasia, educates the society about the issues related to dying, rests on a set of autonomous units the organisation of which is adapted to local needs, and, finally, acts in concordance with other agendas of the healthcare system. The Polish system constituted by palliative care reach-out teams and palliative units and hospices should be strongly supported and adequately founded to supply best care available to the dying and distressed.

  12. Hospice and Palliative Nurses Association

    MedlinePlus

    ... How to Submit an Abstract Writing Educational Objectives Palliative Care APRN Fellowships Chapter Education Grants Individual Education Scholarships Official Journals Journal of Hospice and Palliative Nursing Journal of Palliative Medicine Certification Certification and ...

  13. End of Life (Hospice Care)

    MedlinePlus

    ... reducing pain and addressing physical, psychological, social and spiritual needs. To help families, hospice care also provides ... routine care, such as dressing, bathing and eating. Spiritual counselors. Chaplains, priests, lay ministers or other spiritual ...

  14. 42 CFR 422.320 - Special rules for hospice care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 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 §...

  15. 42 CFR 417.585 - Special rules: Hospice care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Special rules: Hospice care. 417.585 Section 417.585 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE...

  16. 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 417.585 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE...

  17. The impact of a clinical rotation in hospice: medical students' perspectives.

    PubMed

    Jacoby, Liva H; Beehler, Connie J; Balint, John A

    2011-01-01

    Medical educators agree that training in end-of-life care (EOLC) must be an integral part of medical education at all levels. While progress in this area of education has taken place, many gaps still exist. This article describes the self-reported impact of a required one-week hospice rotation for third-year medical students. Students completing their hospice rotation during a one-year period were asked to write an essay describing the most important lessons they learned. Qualitative analyses of the essays revealed 10 core themes and generated a coding schema for detailed analysis. Students' essays reflected knowledge gained, emotional reactions, cognitive insights, and relationship-centered skills. Comments focused on the following themes: benefits and philosophy of hospice; impact on future practice; interdisciplinary team approach; management of pain and suffering; facts about hospice; personal impact; communication with patients and families; dedication and skill of staff; role of families; and value of home care. Students consistently recognized the significance of positive role models. Learning about a new field of medicine helped broaden students' knowledge, skills, and beliefs, and expanded their assumptions about illness and suffering, the role of health care professionals, and the goals of medicine. Reflection and writing brought about self-awareness of the learning process itself. The study demonstrates that a robust clinical EOLC exposure can be effectively incorporated into undergraduate education and that student self-reports constitute a valuable mode of evaluation. Longitudinal assessments of trainees' competencies in EOLC are needed to optimize these educational endeavors.

  18. The lack of effect of market structure on hospice use.

    PubMed

    Iwashyna, Theodore J; Chang, Virginia W; Zhang, James X; Christakis, Nicholas A

    2002-12-01

    To describe the relative importance of health care market structure and county-level demographics in determining rates of hospice use. Medicare claims data for a cohort of elderly patients newly diagnosed with lung cancer, colon cancer, stroke, or heart attack in 1993, followed for up to five years, and linked to Census and Area Resource File data. Variation between markets in rates of hospice use by patients with serious illness was examined after taking into account differences in individual-level data using hierarchical linear models. The relative explanatory power of market-level structure and local demographic variables was compared. The cohort was defined within the Medicare hospital claims data using validated algorithms to detect incident cases of disease with a three-year lookback. Use of hospice was determined by linkage at an individual level to the Standard Analytic Files for Hospice through 1997. Individual-level data was linked to the Area Resource File using county identifiers present in the Medicare claims. There is substantial variation in hospice use across markets. This variation is not explained by differences in the major components of health care infrastructure: the availability of hospital, nursing home, or skilled nursing facilities, nor by the availability of HMOs, doctors, or generalists. Intercounty heterogeneity in hospice use is substantial, and may not be related to the set-up of the medical care system. The important local factors may be local preferences, differences in the particular mix of services provided by local hospices, or differences in community leadership on end of life-issues; many of these differences may be amenable to educational efforts.

  19. 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

  20. 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,…

  1. Unique Challenges of Hospice for Patients with Heart Failure: A Qualitative Study of Hospice Clinicians

    PubMed Central

    Lum, Hillary D.; Jones, Jacqueline; Lahoff, Dana; Allen, Larry A.; Bekelman, David B.; Kutner, Jean S.; Matlock, Daniel D.

    2015-01-01

    Background Patients with heart failure have end-of-life care needs that may benefit from hospice care. The goal of this descriptive study was to understand hospice clinicians’ perspectives on the unique aspects of caring for patients with heart failure to inform approaches to improving end-of-life care. Methods This qualitative study explored experiences, observations and perspectives of hospice clinicians regarding hospice care for patients with heart failure. Thirteen hospice clinicians from a variety of professional disciplines and clinical roles, diverse geographic regions, and varying lengths of time working in hospice participated in semi-structured interviews. Through team-based, iterative qualitative analysis, we identified three major themes. Results Hospice clinicians identified three themes regarding care for patients with heart failure. First, care for patients with heart failure involves clinical complexity and a tailored approach to cardiac medications and advanced cardiac technologies. Second, hospice clinicians describe the difficulty patients with heart failure have in trusting hospice care due to patient optimism, prognostic uncertainty, and reliance on pre-hospice healthcare providers. Third, hospice clinicians described opportunities to improve heart failure-specific hospice care, highlighting the desire for collaboration with referring cardiologists. Conclusions From a hospice clinician perspective, caring for patients with heart failure is unique compared to other hospice populations. This study suggests potential opportunities for hospice clinicians and referring providers who seek to collaborate to improve care for patients with heart failure during the transition to hospice care. PMID:26385036

  2. Hospice Enrollment in Patients With Advanced Heart Failure Decreases Acute Medical Service Utilization.

    PubMed

    Yim, Cindi K; Barrón, Yolanda; Moore, Stanley; Murtaugh, Chris; Lala, Anuradha; Aldridge, Melissa; Goldstein, Nathan; Gelfman, Laura P

    2017-03-01

    Patients with advanced heart failure (HF) enroll in hospice at low rates, and data on their acute medical service utilization after hospice enrollment is limited. We performed a descriptive analysis of Medicare fee-for-service beneficiaries, with at least one home health claim between July 1, 2009, and June 30, 2010, and at least 2 HF hospitalizations between July 1, 2009, and December 31, 2009, who subsequently enrolled in hospice between July 1, 2009, and December 31, 2009. We estimated panel-negative binomial models on a subset of beneficiaries to compare their acute medical service utilization before and after enrollment. Our sample size included 5073 beneficiaries: 55% were female, 45% were ≥85 years of age, 13% were non-white, and the mean comorbidity count was 2.38 (standard deviation 1.22). The median number of days between the second HF hospital discharge and hospice enrollment was 45. The median number of days enrolled in hospice was 15, and 39% of the beneficiaries died within 7 days of enrollment. During the study period, 11% of the beneficiaries disenrolled from hospice at least once. The adjusted mean number of hospital, intensive care unit, and emergency room admissions decreased from 2.56, 0.87, and 1.17 before hospice enrollment to 0.53, 0.19, and 0.76 after hospice enrollment. Home health care Medicare beneficiaries with advanced HF who enrolled in hospice had lower acute medical service utilization after their enrollment. Their pattern of hospice use suggests that earlier referral and improved retention may benefit this population. Further research is necessary to understand hospice referral and palliative care needs of advanced HF patients. © 2017 American Heart Association, Inc.

  3. 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)

  4. Helping You Choose Quality Hospice Care

    MedlinePlus

    ... can also be provided in a hospital or nursing home. Hospice care is a Medicare benefit. The following ... patient’s care? • If the patient lives in a nursing home, how do hospice staff and the nursing home ...

  5. Prison hospice and pastoral care services in California.

    PubMed

    Linder, John F; Knauf, Keith; Enders, Sheila R; Meyers, Frederick J

    2002-12-01

    Hospice at the California Medical Facility (CMF) Vacaville dates back to the mid-1980s, when the acquired immune deficiency syndrome (AIDS) epidemic began to be felt throughout California's Department of Corrections. Vacaville has served for decades as the principal location for delivering health services to California's incarcerated men. Informal hospice-like services were inspired by Elisabeth Kubler-Ross and through inmate and community calls for more humane care for dying inmates. By 1990, efforts to formally establish a hospice were under way. In 1996, a 17-bed, state-licensed hospice began caring for dying inmates. An interdisciplinary team plans and delivers the care, meeting weekly to admit and review patients. The Pastoral Care Services (PCS) inmate volunteer program, with more than 50 trained participants, provides care and comfort to dying patients in hospice and to ill patients on the general medicine service. PCS volunteers perform many duties, including sitting vigil with actively dying inmates. Inmates enrolling in hospice have to forgo further curative therapy, consent to the program in writing, and have a 6-month or less survival prognosis; patients are not required to have a do-not-resuscitate (DNR) order, but are encouraged to consider one. Training for physicians, staff and PCS volunteers is provided by the University of California, Davis faculty of the West Coast Center for Palliative Education. Bereavement services are provided for PCS volunteers, other inmate "family" and staff. Family and friends of the deceased in the free community are followed by phone, mail, and primarily through referral to resources in their local area.

  6. 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…

  7. 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…

  8. 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…

  9. Hospice in assisted living: promoting good quality care at end of life.

    PubMed

    Cartwright, Juliana C; Miller, Lois; Volpin, Miriam

    2009-08-01

    The purpose of this study was to describe good quality care at the end of life (EOL) for hospice-enrolled residents in assisted living facilities (ALFs). A qualitative descriptive design was used to obtain detailed descriptions of EOL care provided by ALF medication aides, caregivers, nurses, and hospice nurses in urban and rural settings. A semistructured interview guide facilitated interviews where 38 participants described specific examples of care that "went well." Findings indicated that the quality and nature of resident-staff and assisted living-hospice staff relationships are critical in promoting good care at EOL for ALF residents on hospice. Length of the resident's stay in the facility and how well staff knew the resident were associated with the quality of the resident-staff relationship. Respectful collaboration, clear communication, use of complementary knowledge and skills of staff, and shared expectations about the care were associated with positive staff relationships. Also important was ALF administrator support for residents' dying in place with hospice services. ALFs choosing to support residents dying in their facility will benefit from developing systems of care that promote resident-staff relationships and optimize communication and collaboration among ALF care providers and with hospice staff. Hospice programs should design their services to support ALF staff as well as patients and families. Now needed are development and testing of models of care by hospice and ALF to support the care needs of ALF residents at EOL.

  10. Conveying empathy to hospice family caregivers: Team responses to caregiver empathic communication

    PubMed Central

    Wittenberg-Lyles, Elaine; Oliver, Debra Parker; Demiris, George; Rankin, Anna; Shaunfield, Sara; Kruse, Robin L.

    2012-01-01

    Objective The goal of this study was to explore empathic communication opportunities presented by family caregivers and responses from interdisciplinary hospice team members. Methods Empathic opportunities and hospice team responses were analyzed from biweekly web-based videoconferences between family caregivers and hospice teams. The authors coded the data using the Empathic Communication Coding System (ECCS) and identified themes within and among the coded data. Results Data analysis identified 270 empathic opportunity-team response sequences. Caregivers expressed statements of emotion and decline most frequently. Two-thirds of the hospice team responses were implicit acknowledgments of caregiver statements and only one-third of the team responses were explicit recognitions of caregiver empathic opportunities. Conclusion Although hospice team members frequently express emotional concerns with family caregivers during one-on-one visits, there is a need for more empathic communication during team meetings that involve caregivers. Practice implications Hospice clinicians should devote more time to discussing emotional issues with patients and their families to enhance patient-centered hospice care. Further consideration should be given to training clinicians to empathize with patients and family caregivers. PMID:22554387

  11. Management of Implantable Defibrillators in Hospice

    PubMed Central

    Goldstein, Nathan; Carlson, Melissa; Livote, Elayne; Kutner, Jean S.

    2010-01-01

    Background Communication about deactivation of ICDs in patients near the end of life is rare. Objectives To determine if hospices are admitting ICD patients, if hospice patients are receiving shocks, and how hospices manage ICDs. Design Cross-sectional survey. Setting Randomly selected hospice facilities Participants 900 hospices were surveyed. A total of 414 hospices responded. Measurements Frequency of admission of ICD patients, frequency of patients receiving shocks, existence of deactivation policies, and frequency of deactivation. Results 97% of hospices admit patients with ICDs. 58% reported that in the last year a patient had been shocked. Only 10% of hospices had a policy which addressed deactivation. On average, 42% (SE 2.9) of patients with ICDs have the shocking function deactivated. A sample deactivation policy is available as a web-only appendix. Limitations The study relied on the knowledge of hospice administrators. Conclusions Hospices are admitting patients with ICDs, and patients are being shocked at the end of life. Assuring that hospices have policies in place to address deactivation may improve the care for patients with these devices. PMID:20194235

  12. 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.

  13. Medicare hospice benefit: Early program experiences

    PubMed Central

    Davis, Feather Ann

    1988-01-01

    In this article, an overview of the Medicare hospice benefit is presented and selected preliminary findings from the Medicare hospice benefit program evaluation are provided. By mid-1987, about one-half of all community home health agency-based hospices were Medicare certified, compared with about one-fifth of all independent/freestanding hospices and one-seventh of hospital and skilled nursing facility-based hospices. Medicare beneficiary election of the hospice benefit increased from about 2,000 beneficiaries in fiscal year 1984 to about 11,000 during fiscal year 1986. Medicare reimbursed hospices an average of $1,798, $2,078 and $2,337 per patient during fiscal years 1984, 1985, and 1986, respectively. PMID:10312635

  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.

  15. 42 CFR 418.30 - Change of the designated hospice.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.30... period, the designation of the particular hospice from which hospice care will be received. (b) The... the hospice from which care has been received and with the newly designated hospice, a statement...

  16. 42 CFR 418.30 - Change of the designated hospice.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.30... period, the designation of the particular hospice from which hospice care will be received. (b) The... the hospice from which care has been received and with the newly designated hospice, a statement...

  17. 42 CFR 418.30 - Change of the designated hospice.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.30... period, the designation of the particular hospice from which hospice care will be received. (b) The... the hospice from which care has been received and with the newly designated hospice, a statement...

  18. Communication Training for Hospice Volunteers.

    ERIC Educational Resources Information Center

    Coffman, Stephen L.; Coffman, Victoria T.

    1993-01-01

    Details communication-related portions of new volunteer training process for Hospice organization. Description covers both theoretical intentions of training and contextual applications. Topics addressed include trusting, listening, talking about death and dying, communicating/interacting effectively, being assertive, taking responsibility,…

  19. 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…

  20. Response Bias in Hospice Evaluation.

    ERIC Educational Resources Information Center

    Hayslip, Bert, Jr.; And Others

    1991-01-01

    Analyzed response bias among 34 recipients of care in hospice. Found nonrespondents to have better bereavement prognoses and tended to care for patients who were younger, male, and in program for shorter time. Nonrespondents were in contact with staff less than were respondents. Data are consistent with earlier research showing significant…

  1. 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…

  2. 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…

  3. 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…

  4. Utilization of hospice and predicted mortality risk among older patients hospitalized with heart failure: findings from GWTG-HF.

    PubMed

    Whellan, David J; Cox, Margueritte; Hernandez, Adrian F; Heidenreich, Paul A; Curtis, Lesley H; Peterson, Eric D; Fonarow, Gregg C

    2012-06-01

    Guidelines recommend hospice care as a treatment option for end-stage heart failure (HF) patients. Little is known regarding utilization of hospice care in a contemporary cohort of patients hospitalized with HF and how this may vary by estimated mortality risk. We analyzed HF patients ≥65 years (n = 58,330) from 214 hospitals participating in the Get With the Guidelines-HF program. Univariate analysis comparing patients discharged to hospice versus other patients was performed. Hospice utilization was evaluated for deciles of estimated 90-day mortality risk using a validated model. Multivariate analysis using admission patient and hospital characteristics was also performed to determine factors associated with hospice discharge. There were 1,442 patients discharged to hospice, and rates of referral varied widely by hospital (interquartile range 0-3.7%) as shown in the univariate analysis. Patients discharged to hospice were significantly older and more often white, had lower left ventricular ejection fraction, higher B-type natriuretic peptide, and lower systolic blood pressure on admission. Utilization rates for each decile of 90-day estimated mortality risk ranged from 0.3% to 8.6%. Multivariable analysis found that factors associated with hospice utilization included increased age, low systolic blood pressure on admission, and increased blood urea nitrogen. Hospice utilization remains low among HF patients, even those with the highest predicted risk of death. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. When do Latinos use hospice services? Studying the utilization of hospice services by Hispanics/Latinos.

    PubMed

    Carrion, Iraida V

    2010-01-01

    This study focuses on the utilization of hospice services within the Latino community including both hospice and non-hospice users. Data were collected from 20 participants using semi-structured interviews. Verbatim transcripts were examined through a combination of ethnographic, open coding, and thematic categorization of the interviewees' responses. The research uncovers cultural factors that contribute to the underutilization of hospice services by this population. The findings indicate that hospice users learned about their terminal diagnosis during a hospital admission from an attending physician. When hospice services were offered, these individuals accepted the services. Conversely, all of the non-hospice users learned about their terminal diagnosis in a medical office setting from their primary physician. When they were offered hospice services, they refused the services.

  6. 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.

  7. The Potential Use of Autopsy for Continuous Quality Improvement in Hospice and Palliative Care

    PubMed Central

    Rokoske, Franziska S.; Schenck, Anna P.; Hanson, Laura C.

    2008-01-01

    Context In 2006, the Centers for Medicare & Medicaid Services (CMS) contracted with The Carolinas Center for Medical Excellence (CCME), the Quality Improvement Organization (QIO) for North and South Carolina, to develop an instrument package and procedures for hospice and palliative care programs to assess and monitor the quality of the care that they provide. As part of our work, we investigated the potential uses of autopsy for continuous quality improvement purposes. Objective Our objective is to understand (1) the potential benefits and uses of autopsy for various constituents, (2) the reasons for the decline in the use of autopsy despite these potential benefits, (3) the practical aspects of autopsy in the hospice setting, and (4) current hospice practices in regard to autopsy. Design To achieve these goals, we reviewed the existing literature and interviewed stakeholders, including hospice and palliative care providers, professional organizations and advocacy groups, quality improvement and measurement experts, and pathologists. Results Important barriers limit the use of autopsy to understand and improve quality of care in hospice, including costs, unintended consequences, and the limited ability to systematically use autopsy information to improve care. Some themes were more predominant among providers, whereas others emerged primarily from interviews with nonproviders. Conclusions On the basis of existing research and stakeholder interviews, autopsy is currently not a feasible mechanism to improve quality of care in hospice. If financial and attitudinal barriers are reduced, a systematic sampling of deaths for autopsy may provide evidence for the value of this information source. PMID:19242595

  8. The "STATE" of home care and hospice.

    PubMed

    Lund, Steve

    2006-04-01

    There is at least one home care and hospice industry association in each of our 50 United States and Puerto Rico. These associations represent tens of thousands of home care and hospice providers. They provide state and local leadership, professional and para-professional training, and other services designed to help home care and hospice providers care for our nation's sick, disabled and elderly. These are their stories.

  9. [Hospice program and palliative medicine].

    PubMed

    Nakagami, Y

    1997-05-01

    Hospice and palliative care have important roles for cancer patients in an incurable state to alleviate their total pain and to achieve the best quality of life. Interdisciplinary team-doctors, nurses, therapists, social workers and so on provide effective support in order to fulfill the varying needs of patients and families. Pain relief as a palliative medicine is most urgently required by seventy percent of patients on admission to our Hospice at the Salvation Army Kiyose Hospital. A case is presented with some comments on pain management. Music therapy is also introduced. This is one of the complementary methods for consolation of the mind and body of patients. Some of them seem to find it beneficial.

  10. Dementia Caregivers and Live Discharge from Hospice: What Happens When Hospice Leaves?

    PubMed

    Wladkowski, Stephanie P

    2017-01-01

    Hospice offers holistic support for individuals living with terminal illness and their caregivers. Some individuals receiving hospice services experience a slower decline in health as than expected, resulting in a 'live discharge' from hospice. A live discharge affects both patient and caregiver(s).The current study (N=24) explored the experiences of caregivers of adults with dementia who experienced a live discharge from hospice. Findings emphasize the comprehensive services covered under the Medicare Hospice benefit and those lost after a live discharge. Implications for social workers supporting caregivers are discussed, including the need to view the patient-caregiver unit during a live discharge.

  11. [An exploratory study of hospice care to patients with advanced cancer].

    PubMed

    Park, H J

    1989-08-31

    True nursing care means total nursing care which includes physical, emotional and spiritual care. The modern nursing care has tendency to focus toward physical care and needs attention toward emotional and spiritual care. The total nursing care is mandatory for patients with terminal cancer and for this purpose, hospice care became emerged. Hospice care originated from the place or shelter for the travellers to Jerusalem in medieval stage. However, the meaning of modern hospice care became changed to total nursing care for dying patients. Modern hospice care has been developed in England, and spreaded to U.S.A. and Canada for the patients with terminal cancer. Nowadays, it became a part of nursing care and the concept of hospice care extended to the palliative care of the cancer patients. Recently, it was introduced to Korea and received attention as model of total nursing care. This study was attempted to assess the efficacy of hospice care. The purpose of this study was to prove a difference in terms of physical, emotional and spiritual aspect between the group who received hospice care and who didn't receive hospice care. The subject for this study were 113 patients with advanced cancer who were hospitalized in the 8 different hospitals. 67 patients received hospice care in 4 different hospitals, and 46 patients didn't receive hospice care in another 4 different hospitals. The method of this study was the questionnaire which was made through the descriptive study. The descriptive study was made by individual contact with 102 patients of advanced cancer for 9 months period. The measurement tool for questionaire was made by author through the descriptive study, and included the personal religious orientation obtained from chung (originated R. Fleck) and 5 emotional stages before dying from Kübler Ross. The content of questionnaire consisted in 67 items which included 11 for general characteristics, 10 for related condition with cancer, 13 for wishes for physical

  12. 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. © The Author(s) 2015.

  13. Home-Based Hospice Care Reduces End-of-Life Expenditure in Taiwan: A Population-Based Study.

    PubMed

    Chen, Li-Fu; Chang, Chun-Ming; Huang, Chih-Yuan

    2015-09-01

    Inpatient hospice care can reduce futile treatment and medical costs. However, the cost trimming effect of home-based hospice care in hospital has yet not been explored. This study evaluates the impact of home-based hospice care on end-of-life expenditure in hospitals with different spending intensity. This is a population-based retrospective study in Taiwan. Cancer decedents were identified in the National Health Insurance Research Database (NHIRD) from 2009 to 2011. They are categorized by hospital spending intensity. A hierarchical linear regression model with a random-intercept model was used to analyze the relationship between end-of-life expenditure (dependent variable) with and without home-based hospice, and both patient-level and hospital-level characteristics. A total of 78,613 cancer decedents were identified in the NHIRD from 2009 to 2011. Of these decedents, 17,638, 43,286, and 17,689 were categorized by hospital spending intensity as high, moderate, and low, respectively. Decedents with home-based hospice care were associated with US$2452 less in expenditure per patient compared with those without home-based hospice care. The majority of savings occurred in the last 3 months of life. These savings with home-based hospice care were consistent in hospitals with different levels of spending intensity. Home-based hospice reduced one-fifth expenditure at the end of life of cancer decedents treated in hospitals with different spending intensity.

  14. Patient safety incidents in home hospice care: the experiences of hospice interdisciplinary team members.

    PubMed

    Smucker, Douglas R; Regan, Saundra; Elder, Nancy C; Gerrety, Erica

    2014-05-01

    Hospice provides a full range of services for patients near the end of life, often in the patient's own home. There are no published studies that describe patient safety incidents in home hospice care. The study objective was to explore the types and characteristics of patient safety incidents in home hospice care from the experiences of hospice interdisciplinary team members. The study design is qualitative and descriptive. From a convenience sample of 17 hospices in 13 states we identified 62 participants including hospice nurses, physicians, social workers, chaplains, and home health aides. We interviewed a separate sample of 19 experienced hospice leaders to assess the credibility of primary results. Semistructured telephone interviews were recorded and transcribed. Four researchers used an editing technique to identify common themes from the interviews. Major themes suggested a definition of patient safety in home hospice that includes concern for unnecessary harm to family caregivers or unnecessary disruption of the natural dying process. The most commonly described categories of patient harm were injuries from falls and inadequate control of symptoms. The most commonly cited contributing factors were related to patients, family caregivers, or the home setting. Few participants recalled incidents or harm related to medical errors by hospice team members. This is the first study to describe patient safety incidents from the experiences of hospice interdisciplinary team members. Compared with patient safety studies from other health care settings, participants recalled few incidents related to errors in evaluation, treatment, or communication by the hospice team.

  15. Patient Safety Incidents in Home Hospice Care: The Experiences of Hospice Interdisciplinary Team Members

    PubMed Central

    Regan, Saundra; Elder, Nancy C.; Gerrety, Erica

    2014-01-01

    Abstract Background: Hospice provides a full range of services for patients near the end of life, often in the patient's own home. There are no published studies that describe patient safety incidents in home hospice care. Objective: The study objective was to explore the types and characteristics of patient safety incidents in home hospice care from the experiences of hospice interdisciplinary team members. Methods: The study design is qualitative and descriptive. From a convenience sample of 17 hospices in 13 states we identified 62 participants including hospice nurses, physicians, social workers, chaplains, and home health aides. We interviewed a separate sample of 19 experienced hospice leaders to assess the credibility of primary results. Semistructured telephone interviews were recorded and transcribed. Four researchers used an editing technique to identify common themes from the interviews. Results: Major themes suggested a definition of patient safety in home hospice that includes concern for unnecessary harm to family caregivers or unnecessary disruption of the natural dying process. The most commonly described categories of patient harm were injuries from falls and inadequate control of symptoms. The most commonly cited contributing factors were related to patients, family caregivers, or the home setting. Few participants recalled incidents or harm related to medical errors by hospice team members. Conclusions: This is the first study to describe patient safety incidents from the experiences of hospice interdisciplinary team members. Compared with patient safety studies from other health care settings, participants recalled few incidents related to errors in evaluation, treatment, or communication by the hospice team. PMID:24576084

  16. Identifying predictors of hospice eligibility in patients with Parkinson disease.

    PubMed

    Goy, Elizabeth R; Bohlig, Amanda; Carter, Julie; Ganzini, Linda

    2015-02-01

    This study aims to improve recognition of hospice eligibility for patients with Parkinson disease (PD) by ascertaining which variables have a higher probability of occurring uniquely in 6 to 12 months before death when compared to 18 to 24 months before death. Participants were 339 patients who died who were diagnosed with PD or Parkinsonism and treated with dopaminergic prescriptions for at least 3 years in northwestern US Veterans Affairs medical centers. A range of indicators were compared across 3 time periods (30-36 months, 24-18 months, and 12-6 months before death) using within-subjects repeated measures design. Results indicate that body mass index less than 18, alone or combined with a shift in prescribing (when benefits of dopaminergic medications no longer outweigh their risk of side effects), may signal appropriate timing for hospice referral.

  17. 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. © 2011 American Society of Law, Medicine & Ethics, Inc.

  18. Model Pseudopotentials for Color Centers

    NASA Astrophysics Data System (ADS)

    Gash, P.; Bartram, R. H.; Gryk, T. J.

    2010-11-01

    The energy-dependent pseudopotentials for electron-excess color centers in ionic crystals adopted by Bartram, Stoneham and Gash (BSG) were determined by a smoothness criterion because the trial wave functions employed are slowly varying on the scale of the ion cores. Energy-independent norm-conserving pseudopotentials were introduced subsequently in the context of molecular-orbital calculations to ensure that the outer parts of valence pseudo-orbitals coincide with those of true valence orbitals. In the present investigation, whole-ion norm-conserving pseudopotentials calculated from numerical wave functions are employed in F-center calculations for comparison with BSG calculations. It is concluded that the smoothness criterion should take precedence in that application.

  19. Financial management of a hospice program.

    PubMed

    Simione, Robert J; Simione, Kathleen A

    2002-07-01

    Agencies interested in starting hospice programs or maximizing the benefits of existing programs need to implement and maintain accurate and effective internal cost accounting systems. Once established, a cost accounting system provides the administrators of the hospice program with information to prepare budget projections, perform break-even analysis, and develop other reports to assist in making sound business decisions to ensure success.

  20. 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…

  1. 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…

  2. 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;…

  3. Missed Opportunity: Hospice Care and the Family.

    PubMed

    Tabler, Jennifer; Utz, Rebecca L; Ellington, Lee; Reblin, Maija; Caserta, Michael; Clayton, Margaret; Lund, Dale

    2015-01-01

    A typical mission statement of hospice services is to provide quality, compassionate care to those with terminal illness and to support families through caregiving and bereavement. This study explored the ways that bereavement needs of caregivers, either predeath or postdeath of their spouse/partner, were addressed using qualitative retrospective phone interviews with 19 caregivers whose spouse/partner was enrolled in hospice care for cancer. Overall, participants expressed high satisfaction with hospice care, most often noting a high satisfaction with the quality of care provided to their spouse/partner. During the predeath phase, caregivers recalled being so focused on their spouse/partner's needs that they rarely spoke with hospice staff about their own personal needs and emotions. Participants said that bereavement counseling occurred primarily after the death of the spouse/partner, in the form of generic pamphlets or phone calls from someone they had not met during prior interactions with hospice staff. These findings suggest that caregivers' high satisfaction with hospice may be more associated with the quality of care provided to the spouse/partner than with bereavement support they received. Our findings illustrated a potential missed opportunity for hospices to address the family-oriented goals that are commonly put forward in hospice mission statements.

  4. Hospice nursing. The concept of palliative care.

    PubMed

    Gurfolino, V; Dumas, L

    1994-09-01

    In this article, some differences are presented between hospice and home care nurses. Issues related to pain control, symptom management, and dehydration are highlighted. Emphasis is placed on the spiritual dimensions of hospice care and the holism implicit in its concept.

  5. 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;…

  6. Racial disparities in receipt of hospice services among nursing home residents.

    PubMed

    Frahm, Kathryn A; Brown, Lisa M; Hyer, Kathryn

    2015-03-01

    This study examined the relationship between race and advance care planning, hospitalization, and death among nursing home residents receiving hospice care. Secondary data analysis using the 2007 Minimum Data Set (MDS) was used to identify documentation of these activities for White, Black, Hispanic, and Asian residents with linear regression models fitted to each dependent variable. Across different types of advance directives, compared to White nursing home residents, Black, Hispanic, and Asian residents who received hospice services were significantly less likely overall to have documented advance directives. All racial groups were also more likely to experience hospitalization while on hospice, regardless of whether they had a documented "do not hospitalize" order. As nursing homes become more diverse, recognizing differences in hospice use and end-of-life planning will continue to increase in importance. © The Author(s) 2013.

  7. Barriers to effective symptom management in hospice.

    PubMed

    Johnson, Daniel C; Kassner, Cordt T; Houser, Janet; Kutner, Jean S

    2005-01-01

    The barriers to effective symptom management in hospice are not well described. We surveyed nurses of hospices affiliated with the Population-based Palliative Care Research Network (PoPCRN) to identify barriers to the effective management of common symptoms in terminally ill patients. 867/1710 (51%) nurses from 67 hospices in 25 U.S. States returned surveys. Of 32 symptoms, nurses reported agitation (45%), pain (40%), and dyspnea (34%) as the 'most difficult to manage.' The most common perceived barriers to effective symptom management were inability of family care providers to implement or maintain recommended treatments (38%), patients or families not wanting recommended treatments (38%), and competing demands from other distressing symptoms (37%). Patterns of barriers varied by symptom. These nurses endorsed multiple barriers contributing to unrelieved symptom distress in patients receiving hospice care. Interventions to improve symptom management in hospice may need to account for these differing barrier patterns.

  8. Making explicit the contention in hospice care.

    PubMed

    Moon, Paul J

    At the core of hospice remains the defining nature of mortals tending to other mortals facing diagnosed terminality. Such situations are pregnant with meanings. As mortals are subjective beings, social engagements become inundated with meaning differences. This alludes to the inescapable occurrence of collisions and conflicts in meaning. It would behoove us to make explicit the contention that exists in hospice care, given that death is the nonnegotiable outcome to be diversely faced by all involved persons whose lived approaches related to death issues may characteristically lack unanimity. Toward elucidating the inherently contentious nature of hospice care, the dynamical influence of external forces that overlie thanatological matters in society and the complex human dynamic in hospice care situations are discussed. Practice suggestions for hospice staff are offered.

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.30 Change of..., the designation of the particular hospice from which hospice care will be received. (b) The change of... from which care has been received and with the newly designated hospice, a statement that includes...

  10. 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,…

  11. 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...

  12. 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...

  13. 42 CFR 417.531 - Hospice care services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Hospice care services. 417.531 Section 417.531... HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.531 Hospice care services. (a) If a... chapter to receive hospice care services, payment for these services is made to the hospice that...

  14. 42 CFR 418.25 - Admission to hospice care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 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...

  15. 42 CFR 418.25 - Admission to hospice care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Admission to hospice care. 418.25 Section 418.25... (CONTINUED) MEDICARE PROGRAM (CONTINUED) 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...

  16. 42 CFR 417.531 - Hospice care services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Hospice care services. 417.531 Section 417.531... HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.531 Hospice care services. (a) If a... chapter to receive hospice care services, payment for these services is made to the hospice that...

  17. 42 CFR 418.30 - Change of the designated hospice.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.30 Change of..., the designation of the particular hospice from which hospice care will be received. (b) The change of... from which care has been received and with the newly designated hospice, a statement that includes...

  18. 42 CFR 418.26 - Discharge from hospice care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Discharge from hospice care. 418.26 Section 418.26... (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.26 Discharge from hospice care. (a) Reasons for discharge. A hospice may discharge a patient if— (1)...

  19. 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... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.26 Discharge from hospice care. (a) Reasons for discharge. A hospice may discharge a patient if— (1) The...

  20. 42 CFR 417.531 - Hospice care services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 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...

  1. 42 CFR 417.531 - Hospice care services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Hospice care services. 417.531 Section 417.531... HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.531 Hospice care services. (a) If a... chapter to receive hospice care services, payment for these services is made to the hospice that...

  2. 42 CFR 418.26 - Discharge from hospice care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Discharge from hospice care. 418.26 Section 418.26... (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.26 Discharge from hospice care. (a) Reasons for discharge. A hospice may discharge a patient if— (1)...

  3. 42 CFR 418.25 - Admission to hospice care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Admission to hospice care. 418.25 Section 418.25... (CONTINUED) MEDICARE PROGRAM (CONTINUED) 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...

  4. 42 CFR 418.25 - Admission to hospice care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Admission to hospice care. 418.25 Section 418.25... (CONTINUED) MEDICARE PROGRAM (CONTINUED) 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...

  5. "I'm not ready for hospice": strategies for timely and effective hospice discussions.

    PubMed

    Casarett, David J; Quill, Timothy E

    2007-03-20

    Hospice programs offer unique benefits for patients who are near the end of life and their families, and growing evidence indicates that hospice can provide high-quality care. Despite these benefits, many patients do not enroll in hospice, and those who enroll generally do so very late in the course of their illness. Some barriers to hospice referral arise from the requirements of hospice eligibility, which will be difficult to eliminate without major changes to hospice organization and financing. However, the challenges of discussing hospice create other barriers that are more easily remedied. The biggest communication barrier is that physicians are often unsure of how to talk with patients clearly and directly about their poor prognosis and limited treatment options (both requirements of hospice referral) without depriving them of hope. This article describes a structured strategy for discussing hospice, based on techniques of effective communication that physicians use in other "bad news" situations. This strategy can make hospice discussions both more compassionate and more effective.

  6. 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…

  7. End-of-Life Care Intensity and Hospice Use: A Regional-level Analysis.

    PubMed

    Wang, Shi-Yi; Aldridge, Melissa D; Gross, Cary P; Canavan, Maureen; Cherlin, Emily; Johnson-Hurzeler, Rosemary; Bradley, Elizabeth

    2016-07-01

    Despite increased hospice use over the last decade, end-of-life care intensity continues to increase. To understand this puzzle, we sought to examine regional variation in intensive end-of-life care and determine its associations with hospice use patterns. Using Medicare claims for decedents aged 66 years and above in 2011, we assessed end-of-life care intensity in the last 6 months of life across hospital referral regions (HRRs) as measured by proportion of decedents per HRR experiencing hospitalization, emergency department use, intensive care unit (ICU) admission, and number of days spent in hospital (hospital-days) and ICU (ICU-days). Using hierarchical generalized linear models and adjusting for patient characteristics, we examined whether these measures were associated with overall hospice use, very short (≤7 d), medium (8-179 d), or very long (≥180 d) hospice enrollment, focusing on very short stay. End-of-life care intensity and hospice use patterns varied substantially across HRRs. Regional-level end-of-life care intensity was positively correlated with very short hospice enrollment. Comparing HRRs in the highest versus the lowest quintiles of intensity in end-of-life care, regions with more intensive care had higher rates of very short hospice enrollment, with adjusted odds ratios (AOR) 1.14 [99% confidence interval (CI), 1.04-1.25] for hospitalization; AOR, 1.23 (CI, 1.12-1.36) for emergency department use; AOR, 1.25 (CI, 1.14-1.38) for ICU admission; AOR, 1.10 (CI, 1.00-1.21) for hospital-days; and AOR, 1.20 (CI, 1.08-1.32) for ICU-days. At the regional level, increased end-of-life care intensity was consistently associated with very short hospice use.

  8. Children with intellectual disability and hospice utilization.

    PubMed

    Lindley, Lisa C; Colman, Mari Beth; Meadows, John T

    2017-02-01

    Over 42,000 children die each year in the United States, including those with intellectual disability (ID). Survival is often reduced when children with intellectual disability also suffer from significant motor dysfunction, progressive congenital conditions, and comorbidities. Yet, little is known about hospice care for children with intellectual disability. The purpose of this study was to explore the relationship between intellectual disability and hospice utilization. Additionally, we explored whether intellectual disability combined with motor dysfunction, progressive congenital conditions, and comorbidities influenced pediatric hospice utilization. Using a retrospective cohort design and data from the 2009 to 2010 California Medicaid claims files, we conducted a multivariate analysis of hospice utilization. This study shows that intellectual disability was negatively related to hospice enrollment and length of stay. We also found that when children had both intellectual disability and comorbidities, there was a positive association with enrolling in hospice care. A number of clinical implications can be drawn from the study findings that hospice and palliative care nurses use to improve their clinical practice of caring for children with ID and their families at end of life.

  9. Hospitalization of hospice patients with cancer.

    PubMed

    Cintron, Alexie; Hamel, Mary B; Davis, Roger B; Burns, Risa B; Phillips, Russell S; McCarthy, Ellen P

    2003-10-01

    To identify factors associated with hospitalization of elderly hospice patients with cancer and to describe their hospital experiences. Retrospective analysis of the last year of life. Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Medicare beneficiaries dying of lung or colorectal cancer between 1988 and 1998 who enrolled in hospice. Hospitalization after hospice entry. For hospitalized patients, we describe admission diagnoses, aggressiveness of care, and in-hospital death. Of the 23608 patients, 1423 (6.0%) were hospitalized after hospice enrollment. Hospitalization declined over time by 7.0% per year of hospice enrollment. Factors associated with higher hospitalization rates were younger age, male gender, black race/ethnicity, local cancer stage at diagnosis, and hospice enrollment within 4 months of cancer diagnosis. The most common reasons for hospital admission were lung cancer, metastatic disease, bone fracture, pneumonia, and volume depletion. Of the 1423 patients hospitalized, 34.6% received aggressive care and 35.8% died in the hospital. The rates of hospitalization for elderly hospice patients with lung or colorectal cancer appear to be declining. However, patients who are hospitalized undergo aggressive care and often die in the hospital rather than at home. This aggressive care may be consistent with changes in patients' care preferences, but could also reflect the current culture of acute care hospitals, which focuses on curative treatment and is ill-equipped to provide palliative care.

  10. 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.

  11. 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.

  12. Knowledge About Hospice: Exploring Misconceptions, Attitudes, and Preferences for Care.

    PubMed

    Cagle, John G; Van Dussen, Daniel J; Culler, Krystal L; Carrion, Iraida; Hong, Seokho; Guralnik, Jack; Zimmerman, Sheryl

    2016-02-01

    Poor knowledge and misperceptions about hospice are believed to be common, but there is scant evidence about the public's understanding of hospice. To examine hospice knowledge among geographically diverse adults; and describe linkages between knowledge, attitudes and beliefs about hospice care, and demographics. A small cross-sectional telephone survey of adults living in the contiguous US was conducted using randomly selected numbers (cell phone and landline) and over-sampling of minorities. Measures assessed knowledge (23-item test), attitudes (8-item scale), experiences and preferences related to hospice. 123 participants completed surveys (response rate 46%). 106 (86%) had heard about hospice, 65 (54%) of whom had a personal experience with hospice. Participants had an average hospice knowledge test score of 18 (SD = 3.4) indicating moderate knowledge of hospice. A majority of respondents (62%) did not know that hospice cannot provide concurrent cure-oriented care. Misperceptions about eligibility, coverage of hospice, the provision of hospice in nursing homes or to persons who live alone were not uncommon (missed by >20%). Greater knowledge of hospice was associated with more favorable attitudes about the hospice philosophy of care (r = .22, p = .023) and a greater preference for hospice (p = .049). Respondents who were more educated, worked in the medical field, were non-Hispanic White, and had direct experience with hospice were also more likely to be more knowledgeable about hospice. Despite relatively high hospice awareness and favorability, myths and misperceptions about hospice still abound--and may drive ethnic disparities in end-of-life care. Educational interventions and future study are needed. © The Author(s) 2014.

  13. Family caregiver participation in hospice interdisciplinary team meetings: how does it affect the nature and content of communication?

    PubMed

    Wittenberg-Lyles, Elaine; Oliver, Debra Parker; Kruse, Robin L; Demiris, George; Gage, L Ashley; Wagner, Ken

    2013-01-01

    Collaboration between family caregivers and health care providers is necessary to ensure patient-centered care, especially for hospice patients. During hospice care, interdisciplinary team members meet biweekly to collaborate and develop holistic care plans that address the physical, spiritual, psychological, and social needs of patients and families. The purpose of this study was to explore team communication when video-conferencing is used to facilitate the family caregiver's participation in a hospice team meeting. Video-recorded team meetings with and without family caregiver participation were analyzed for communication patterns using the Roter Interaction Analysis System. Standard meetings that did not include caregivers were shorter in duration and task-focused, with little participation from social workers and chaplains. Meetings that included caregivers revealed an emphasis on biomedical education and relationship-building between participants, little psychosocial counseling, and increased socioemotional talk from social workers and chaplains. Implications for family participation in hospice team meetings are highlighted.

  14. The School Media Center: A Conceptual Model.

    ERIC Educational Resources Information Center

    Hodson, Yvonne D.

    1979-01-01

    Describes a model for a school media center which will serve as a strategic learning facility. The model is based upon research in both media and education dealing with behavioristic psychology, personality theory, cognitive psychology, and theories of learning as information processing. (Author/FM)

  15. 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

  16. Can Faith and Hospice Coexist: Is the African American Church the Key to Increased Hospice Utilization for African Americans?

    PubMed

    Townsend, Apollo; March, Alice L; Kimball, Jan

    2017-01-01

    African Americans are twice as likely as Caucasian Americans to choose aggressive hospital treatment when death is imminent. Repeat hospitalizations are traumatic for patients and drain patient and health system resources. Hospice care is a specialized alternative that vastly improves patient quality of life at end-of-life. This study was conducted to determine if hospices partnering with African American churches to disseminate hospice education materials could increase utilization of hospice services by African Americans. Members of two African American churches (N = 34) participated in focus group discussions to elicit beliefs about hospice care. Focus group transcripts were coded and comments were grouped according to theme. Six themes were identified. Lack of knowledge about hospice services and spiritual beliefs emerged as the top two contributing factors for underutilization of hospice services. Study findings support partnerships between hospices and African American churches to provide hospice education to the African American community. © The Author(s) 2015.

  17. A salute to the nation's first hospice.

    PubMed

    Halamandaris, Val J

    2011-09-01

    There is great honor in being the first hospice in America. This distinction belongs to The Connecticut Hospice (TCH) of Branford, Connecticut. This commendable organization was born in 1974, only two years after Elisabeth Kübler-Ross, M.D. testified before the U.S. Senate Committee on Aging at the first Congressional hearings on the previously taboo subject of death and dying in America. I had the honor of helping to produce those hearings.

  18. 76 FR 44010 - Medicare Program; Hospice Wage Index for Fiscal Year 2012; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-22

    ... Index for Fiscal Year 2012; Correction AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS... appeared in the notice of CMS ruling published in the Federal Register on May 9, 2011 entitled ``Hospice Wage Index for Fiscal Year 2012''. DATES: Effective Date: This document is effective on May 9, 2011...

  19. 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…

  20. 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…

  1. Enhancing end-of-life care with dignity: characterizing hospice nursing in Romania.

    PubMed

    Vosit-Steller, Julie; White, Patricia; Barron, Anne-Marie; Gerzevitz, Diane; Morse, Allison

    2010-09-01

    The purpose of this research was to characterize the nursing actions practiced by Romanian nurses affiliated with Hospices of Hope that promote dignified dying and explore needs to promote a more dignified death. A survey method used the International Classification for Nursing Practice dignified dying survey. A convenience sample of 43 hospice nurses responded. Descriptive statistics, t-tests and content analysis were used to analyze the data. Characteristics that promoted dignified dying included the use of a formal, iterative process of assessment, interventions that supported pain and symptom management, and spiritual comfort at the end of life. Participants described family-centered hospice care that integrated Christian orthodox tradition that transformed patients as death approached. Dignity for terminally ill Romanian will be enhanced as the nurses implement these interventions. Awareness of cultural and spiritual differences concerning end of life will facilitate dialogue among nurse scientists.

  2. Exploring the association of hospice care on patient experience and outcomes of care.

    PubMed

    Kleinpell, Ruth; Vasilevskis, Eduard E; Fogg, Louis; Ely, E Wesley

    2016-08-16

    To examine the association of the use of hospice care on patient experience and outcomes of care. Promoting high-value, safe and effective care is an international healthcare imperative. However, the extent to which hospice care may improve the value of care is not well characterised. A secondary analysis of variations in care was conducted using the Dartmouth Atlas Report, matched to the American Hospital Association Annual Survey Database to abstract organisational characteristics for 236 US hospitals to examine the relationship between hospice usage and a number of variables that represent care value, including hospital care intensity index, hospital deaths, intensive care unit (ICU) deaths, patient satisfaction and a number of patient quality indicators. Structural equation modelling was used to demonstrate the effect of hospice use on patient experience, clinical and efficiency outcomes. Hospice admissions in the last 6 months of life were correlated with a number of variables, including increases in patient satisfaction ratings (r=0.448, p=0.01) and better pain control (r=0.491, p=0.01), and reductions in hospital days (r=-0.517, p=0.01), fewer hospital deaths (r=-0.842, p=0.01) and fewer deaths occurring with an ICU admission during hospitalisation (r=-0.358, p=0.01). The structural equation model identified that use of hospice care was inversely related to hospital mortality (-0.885) and ICU mortality (-0.457). The results of this investigation demonstrate that greater use of hospice care during the last 6 months of life is associated with improved patient experience, including satisfaction and pain control, as well as clinical outcomes of care, including decreased ICU and hospital mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  3. [Aging problem in the home hospice care].

    PubMed

    Watanabe, Go; Yamagiwa, Tetsuya; Nakayama, Shinya; Ito, Satoko; Fukuda, Akiko; Shiotani, Tomohiro; Yamaoka, Yoshio

    2012-12-01

    Home hospice care is not merely an extension of hospital-based medical care administered at the hospital, but refers to hospice care for patients with life-threatening diseases that can only be given at their homes. The rapid growth of the elderly population in Japan has led to not only the need for home hospice care, but also social problems such as living alone, living with only one elderly family member, and problems that are particularly acute in cancer patients with dementia. We analyzed data for 262 patients for whom home hospice care was provided by our clinic. Overall, elderly persons with dementia tended to request admission before death, but most elderly persons living alone preferred home hospice care. We found that 58% of the patients living with only one elderly family member requested admission before death, which was lower than the rate of the study group as a whole. We further performed an in-depth analysis of the current situation in order to improve home hospice care of terminally ill patients in Japan, focusing on problems related to the aging population.

  4. 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…

  5. Comparing pediatric deaths with and without hospice support.

    PubMed

    Dickens, David S

    2010-05-01

    Although pediatric hospice care is commonly accepted as a beneficial intervention, the incremental advantage over end-of-life care delivered without engaging hospice remains unknown. The primary objective of this study was to describe differences in pediatric end-of-life care when delivered with and without hospice support, as perceived by the medical provider. A retrospective survey of medical providers was conducted in 2005 over a 2-month period at a single institution, the Helen DeVos Children's Hospital (HDVCH). Medical providers with self-determined experience in pediatric end-of-life care were asked to separately provide positive and negative comments about their experience with hospice. Additionally they were asked to describe differences between children under their supervision who died with and without hospice care. Medical provider comments and comparisons of experiences in caring for children dying with and without hospice involvement are described. Out of 157 responders, 43 reported positive comments about the hospice intervention. Non-medical support and location of death were the most frequently cited benefits. Nineteen responders provided negative comments about hospice; all involving feelings of lost hope, intrusion, or distrust. When asked to directly compare deaths with and without hospice support, 44 of 51 (86%) responders favored hospice. The most cited reason for preferring hospice involvement was better provision of non-medical services. The majority of pediatric providers in this survey observed an advantage to utilizing hospice care for dying children as compared to providing end-of-life care without hospice involvement.

  6. Center for Advanced Modeling and Simulation Intern

    ScienceCinema

    Gertman, Vanessa

    2016-07-12

    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.

  7. 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.

  8. 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…

  9. 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…

  10. Cultural competency and diversity among hospice palliative care volunteers.

    PubMed

    Jovanovic, Maja

    2012-05-01

    This case study examines the current state of cultural competence in hospice and palliative care in the Greater Toronto Area (GTA). Because of changing demographic trends and ethnic minorities underutilizing hospice palliative care services, this research examined the current state of culturally competent care in a hospice setting, and the challenges to providing culturally competent care in a hospice in the GTA. A case study was conducted with a hospice and included in-depth interviews with 14 hospice volunteers. The findings reveal that volunteers encountered cultural clashes when their level of cultural competency was weak. Second, volunteers revealed there was a lack of adequate cultural competency training with their hospice, and finally, there was a lack of ethnic, cultural, and linguistic diversity among the hospice volunteers.

  11. Do Blacks, Hispanics Get Low Quality Hospice Care?

    MedlinePlus

    ... fullstory_167030.html Do Blacks, Hispanics Get Low Quality Hospice Care? Caregiver survey finds disparities between minority ... 2017 WEDNESDAY, July 5, 2017 (HealthDay News) -- Hospice quality varies, with blacks and Hispanics often getting less ...

  12. A study of the motivations of British hospice volunteers.

    PubMed

    Claxton-Oldfield, Stephen; Claxton-Oldfield, Jane; Paulovic, Stefan; Wasylkiw, Louise

    2013-09-01

    In all, 162 British hospice volunteers completed the Inventory of Motivations for Hospice Palliative Care Volunteerism (IMHPCV) of Claxton-Oldfield, Wasylkiw, Mark, and Claxton-Oldfield.(1) The IMHPCV taps into 5 different categories of motives for becoming a hospice palliative care volunteer: altruism, civic responsibility, leisure, self-promotion, and personal gain. Altruistic motives were the most influential reasons for choosing to join hospice; personal gain motives were the least influential reasons for becoming a hospice volunteer. Altruistic motives were found to be a significant predictor of volunteers' length of service to the hospice. Compared to previously collected data from a sample of Canadian hospice palliative care volunteers,(1) the current study's sample of British hospice volunteers scored significantly different on 2 of the 5 categories of motives on the IMHPCV.

  13. Geographic Access to Hospice in the United States

    PubMed Central

    Bradley, Elizabeth H.; Du, Qingling; Morrison, R. Sean

    2010-01-01

    Abstract Background Despite a 41% increase in the number of hospices since 2000, more than 60% of Americans die without hospice care. Given that hospice care is predominantly home based, proximity to a hospice is important in ensuring access to hospice services. We estimated the proportion of the population living in communities within 30 and 60 minutes driving time of a hospice. Methods We conducted a cross-sectional study of geographic access to U.S. hospices using the 2008 Medicare Provider of Services data, U.S. Census data, and ArcGIS software. We used multivariate logistic regression to identify gaps in hospice availability by community characteristics. Results As of 2008, 88% of the population lived in communities within 30 minutes and 98% lived in communities within 60 minutes of a hospice. Mean time to the nearest hospice was 15 minutes and the range was 0 to 403 minutes. Community characteristics independently associated with greater geographic access to hospice included higher population density, higher median income, higher educational attainment, higher percentage of black residents, and the state not having a Certificate of Need policy. The percentage of each state's population living in communities more than 30 minutes from a hospice ranged from 0% to 48%. Conclusions Recent growth in the hospice industry has resulted in widespread geographic access to hospice care in the United States, although state and community level variation exists. Future research regarding variation and disparities in hospice use should focus on barriers other than geographic proximity to a hospice. PMID:20979524

  14. Medicare Program; FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements. Final rule.

    PubMed

    2017-08-04

    This final rule will update the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2018. Additionally, this rule includes new quality measures and provides an update on the hospice quality reporting program.

  15. Demystifying the role of nurse practitioners in hospice: nurse practitioners as an integral part of the hospice plan of care.

    PubMed

    Kennedy, Jennifer

    2012-01-01

    Beginning January 1, 2011, as a result of the Patient Protection and Affordable Care Act healthcare-reform law that was signed in March 2010, Medicare requires that all patients entering their third or later hospice benefit period must have a face-to-face encounter with a hospice physician or nurse practitioner (NP) to validate hospice eligibility. Medicare has allowed NPs to function as a patient's hospice attending physician since 2003, but they may not certify or recertify a patient's terminal illness or function in the role of the hospice physician in the hospice interdisciplinary team. The allowance of Medicare for the NP to complete the hospice face-to-face encounter allows a greater role for a NP in the realm of hospice care.

  16. 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…

  17. 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...

  18. 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;…

  19. 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,…

  20. 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…

  1. 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 Special rules for hospice care. (a) Information. An MA organization that has a contract under subpart K of this part must inform each Medicare enrollee eligible to select hospice care under §...

  2. 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,…

  3. 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...

  4. 42 CFR 418.24 - Election of hospice care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... palliative rather than curative nature of hospice care, as it relates to the individual's terminal illness... 42 Public Health 3 2014-10-01 2014-10-01 false Election of hospice care. 418.24 Section 418.24... (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits §...

  5. 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...

  6. 42 CFR 418.24 - Election of hospice care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 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...

  7. 42 CFR 422.320 - Special rules for hospice care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Special rules for hospice care. 422.320 Section 422... Organizations § 422.320 Special rules for hospice care. (a) Information. An MA organization that has a contract under subpart K of this part must inform each Medicare enrollee eligible to select hospice care...

  8. 42 CFR 422.320 - Special rules for hospice care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Special rules for hospice care. 422.320 Section 422... Organizations § 422.320 Special rules for hospice care. (a) Information. An MA organization that has a contract under subpart K of this part must inform each Medicare enrollee eligible to select hospice care...

  9. 42 CFR 417.585 - Special rules: Hospice care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Special rules: Hospice care. 417.585 Section 417... HEALTH CARE 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 §...

  10. 42 CFR 417.585 - Special rules: Hospice care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Special rules: Hospice care. 417.585 Section 417... HEALTH CARE 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 §...

  11. 42 CFR 422.320 - Special rules for hospice care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Special rules for hospice care. 422.320 Section 422... Organizations § 422.320 Special rules for hospice care. (a) Information. An MA organization that has a contract under subpart K of this part must inform each Medicare enrollee eligible to select hospice care...

  12. 42 CFR 417.585 - Special rules: Hospice care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Special rules: Hospice care. 417.585 Section 417... HEALTH CARE 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 §...

  13. The Sacred Circle: a conceptual framework for spiritual care in hospice.

    PubMed

    Paton, L

    1996-01-01

    Hospice care has consistently recognized the need to integrate spiritual care into holistic plans of care for dying patients and their families. Designing and implementing spiritual care interventions can be potentially difficult for hospice practitioners who have not had specific training in theology or pastoral care. Matthew Fox, a theologian, has developed a model of spiritual development that utilizes an ecumenical, ethical framework that can be directly applied to the care of hospice patients and families. This model employs a Sacred Circle approach that begins with an emphasis upon the sense of awe and wonder (the Via Positiva), moves into the next cycle by recognizing problems and negative emotions (the Via Negativa), that then flows into the creative solutions to problems (the Via Creativa), which finally transforms the problem into a new level of understanding (the Via Transformativa).

  14. Organizational and environmental correlates of the adoption of a focus strategy in U.S. hospices.

    PubMed

    Apenteng, Bettye A; Nayar, Preethy; Yu, Fang; Adams, John; Opoku, Samuel T

    2015-01-01

    The hospice industry has experienced rapid growth in the last decade and has become a prominent component of the U.S. health care delivery system. In recent decades, the number of hospices serving nursing facility residents has increased. However, there is paucity of research on the organizational and environmental determinants of this strategic behavior. The aim of this study was to empirically identify the factors associated with the adoption of a nursing facility focus strategy in U.S. hospices. A nursing facility focus strategy was defined in this study as a strategic choice to target the provision of hospice services to skilled nursing facility or nursing home residents. This study employed a longitudinal study design with lagged independent variables in answering its research questions. Data for the study's dependent variables are obtained for the years 2005-2008, whereas data for the independent variables are obtained for the years 2004-2007, representing a 1-year lag. Mixed effects regression models were used in the multivariate regression analyses. Using a resource dependence framework, the findings from this study indicate that organizational size, community wealth, competition, and ownership type are important predictors of the adoption of a nursing facility focus strategy. Hospices may be adopting a nursing facility focus strategy in response to increasing competition. The decision to focus the provision of care to nursing facility residents may be driven by the need to secure stability in referrals. Further empirical exploration of the performance implications of adopting a nursing facility focus strategy is warranted.

  15. What explains racial differences in the use of advance directives and attitudes toward hospice care?

    PubMed

    Johnson, Kimberly S; Kuchibhatla, Maragatha; Tulsky, James A

    2008-10-01

    Cultural beliefs and values are thought to account for differences between African Americans and whites in the use of advance directives and beliefs about hospice care, but few data clarify which beliefs and values explain these differences. Two hundred five adults aged 65 and older who received primary care in the Duke University Health System were surveyed. The survey included five scales: Hospice Beliefs and Attitudes, Preferences for Care, Spirituality, Healthcare System Distrust, and Beliefs About Dying and Advance Care Planning. African Americans were less likely than white subjects to have completed an advance directive (35.5% vs 67.4%, P<.001) and had less favorable beliefs about hospice care (Hospice Beliefs and Attitudes Scale score, P<.001). African Americans were more likely to express discomfort discussing death, want aggressive care at the end of life, have spiritual beliefs that conflict with the goals of palliative care, and distrust the healthcare system. In multivariate analyses, none of these factors alone completely explained racial differences in possession of an advance directive or beliefs about hospice care, but when all of these factors were combined, race was no longer a significant predictor of either of the two outcomes. These findings suggest that ethnicity is a marker of common cultural beliefs and values that, in combination, influence decision-making at the end of life. This study has implications for the design of healthcare delivery models and programs that provide culturally sensitive end-of-life care to a growing population of ethnically diverse older adults.

  16. Rethinking Family Caregiving: Tailoring Cognitive–Behavioral Therapies to the Hospice Experience

    PubMed Central

    Washington, Karla T.; Wittenberg-Lyles, Elaine; Parker Oliver, Debra; Baldwin, Paula K.; Tappana, Jessica; Wright, Jesse H.; Demiris, George

    2014-01-01

    Hospice family caregivers experience significantly higher rates of psychological distress than demographically similar noncaregivers. Interventions based on cognitive–behavioral therapy have been shown to reduce psychological distress in the general population by providing tools to modify thinking patterns that directly affect emotions and behavior. Such interventions might reasonably be incorporated into hospice social work; however, numerous contextual factors must be taken into account to ensure that any interventions are appropriate to the unique needs of clients. The purpose of the study discussed in this article was to contextualize one aspect of the cognitive–behavioral model based on firsthand accounts of hospice family caregivers. Following a modified grounded theory approach, researchers engaged in a secondary analysis of data from a larger study provided in a subsample of 90 audio-recorded conversations between hospice family caregivers and interventionists. Findings indicated that distressed caregivers engaged in five dominant thinking patterns: (1) “should” statements, (2) catastrophizing or minimizing, (3) personalizing, (4) absolute thinking, and (5) making assumptions. Implementing cognitive–behavioral therapies based on identified caregiver thinking patterns will allow hospice social workers to empower caregivers to cope more effectively with the numerous stressors they encounter while caring for a dying loved one. PMID:25369725

  17. The hospice: Humane care for the dying.

    PubMed

    Franco, V W

    1983-09-01

    The hospice movement arose as a reaction to the dehumanizing atmosphere of acute-care hospitals, where excessive utilization of life support equipment deprived dying patients of a meaningful vision of their destiny. Respecting the spiritual quest of the terminally ill for wholeness and dignity, the hospice concept prescribes the rendering of compassionate and pastoral care by a benevolent community of family, health care staff, friends, and clergy. Approximately 800 hospice programs are currently evolving in the United States. St. Mary's (formerly "Hillhaven") Hospice in Tucson, Arizona, offers the most comprehensive program of services, including home care, inpatient care, and artistic media through which the dying express their creativity. Numerous demonstration projects funded by several government agencies, principally the Health Care Financing Administration (HCFA), are expected to result in the legislative actions eliminating barriers to reimbursement of the cost of hospice services by Medicare, Medicaid, and other third-party payers. Existential analysis reveals the value of religion and spiritual support in enabling the dying to banish anxiety and muster the hope requisite for fully appreciating the authentic meaning of their destiny.

  18. The hospice: Humane care for the dying.

    PubMed

    Franco, V W

    1985-03-01

    The hospice movement arose as a reaction to the dehumanizing atmosphere of acute-care hospitals, where excessive utilization of life support equipment deprived dying patients of a meaningful vision of their destiny. Respecting the spiritual quest of the terminally ill for wholeness and dignity, the hospice concept prescribes the rendering of compassionate and pastoral care by a benevolent community of family, health care staff, friends, and clergy. Approximately 800 hospice programs are currently evolving in the United States. St. Mary's (formerly "Hillhaven") Hospice in Tucson, Arizona, offers the most comprehensive program of services, including home care, inpatient care, and artistic media through which the dying express their creativity. Numerous demonstration projects funded by several government agencies, principally the Health Care Financing Administration (HCFA), are expected to result in legislative actions eliminating barriers to reimbursement of the cost of hospice services by Medicare, Medicaid, and other third-party payers. Existential analysis reveals the value of religion and spiritual support in enabling the dying to banish anxiety and muster the hope requisite for fully appreciating the authentic meaning of their destiny.

  19. Spreading the word ... hospice information systems.

    PubMed

    Jackson, Avril; Hodson, Melanie; Brady, Denise; Pahl, Nick

    The rapid spread of Saunders' thinking across the world has been facilitated by the Hospice Information service and library at St Christopher's Hospice which she helped to create and further enhanced by Help the Hospices. We have set this article in the context of the Web and other information systems as they are developing today. "Connecting people" and "collecting people's experiences" were terms often used by Cicely Saunders when she described the work of Hospice Information, a service that has in some measure contributed to the rapid spread of her thinking across the world and which is currently in close contact with palliative care workers in over 120 countries. Connecting--or networking--putting people and organizations in touch with each other for mutual benefit and collecting and disseminating people's experiences are central to our work as a U.K. and international resource on hospice and palliative care for professionals and the public. Add to these the crucial role of information provision and advocacy for patients, carers, and health professionals alike and we hope that you may begin to appreciate how our respective organizations have contributed to the spread of Cicely Saunders' vision.

  20. Stress Variances Among Informal Hospice Caregivers

    PubMed Central

    Wittenberg-Lyles, Elaine; Demiris, George; Oliver, Debra Parker; Washington, Karla; Burt, Stephanie; Shaunfield, Sara

    2013-01-01

    Care interventions are not routinely provided for hospice caregivers, despite widespread documentation of the burden and toll of the caregiving experience. Assessing caregivers for team interventions (ACT) proposes that holistic patient and family care includes ongoing caregiver needs assessment of primary, secondary, and intrapsychic stressors. In this study, our goal was to describe the variance in stressors for caregivers to establish evidence for the ACT theoretical framework. We used secondary interview data from a randomized controlled trial to analyze hospice caregiver discussions about concerns. We found variances in stress types, suggesting that caregiver interventions should range from knowledge and skill building to cognitive-behavioral interventions that aid in coping. Family members who assume the role of primary caregiver for a dying loved one need to be routinely assessed by hospice providers for customized interventions. PMID:22673093

  1. Advancing Hospice and Palliative Care Social Work Leadership in Interprofessional Education and Practice.

    PubMed

    Blacker, Susan; Head, Barbara A; Jones, Barbara L; Remke, Stacy S; Supiano, Katherine

    2016-01-01

    The importance of interprofessional collaboration in achieving high quality outcomes, improving patient quality of life, and decreasing costs has been growing significantly in health care. Palliative care has been viewed as an exemplary model of interprofessional care delivery, yet best practices in both interprofessional education (IPE) and interprofessional practice (IPP) in the field are still developing. So, too, is the leadership of hospice and palliative care social workers within IPE and IPP. Generating evidence regarding best practices that can prepare social work professionals for collaborative practice is essential. Lessons learned from practice experiences of social workers working in hospice and palliative care can inform educational efforts of all professionals. The emergence of interprofessional education and competencies is a development that is relevant to social work practice in this field. Opportunities for hospice and palliative social workers to demonstrate leadership in IPE and IPP are presented in this article.

  2. Got volunteers? Association of hospice use of volunteers with bereaved family members' overall rating of the quality of end-of-life care.

    PubMed

    Block, Eve M; Casarett, David J; Spence, Carol; Gozalo, Pedro; Connor, Stephen R; Teno, Joan M

    2010-03-01

    Volunteers are a key component of hospice, and they are required by Medicare conditions of participation in the United States. Yet, little is known about the impact of volunteers in hospice. The goal of this study was to characterize whether bereaved family members in hospice programs with increased use of volunteer hours per patient day report higher overall satisfaction with hospice services. A secondary analysis of the 2006 Family Evaluation of Hospice Care data repository with hospice organization data regarding the number of volunteer hours in direct patient care and the total number of patient days served. A multivariate model examined the association of institutional rate of bereaved family members stating end-of-life care was excellent with that of hospices' rate of volunteer hours per patient day, controlling for other organizational characteristics. Three hundred five hospice programs (67% freestanding and 20.7% for profit) submitted 57,353 surveys in 2006 (54.2% female decedents and 47.4% with cancer). Hospice programs reported on average 0.71 hours per patient week (25th percentile: 0.245 hours per patient week; 75th percentile: 0.91 volunteer hours per patient week; and 99 th percentile: 3.3 hours per patient week). Those hospice programs in the highest quartile of volunteer usage had higher overall satisfaction compared with those in the lowest-quartile usage of volunteers (75.8% reported excellent overall quality of care compared with 67.8% reporting excellent in the lowest quartile. After adjustment for hospice program characteristics, hospice programs in the highest quartile had highest overall rating of the quality of care (coefficient=0.06, 95% confidence interval=0.04, 0.09). In this cross-sectional study, hospice programs with higher use of volunteers per patient day were associated with bereaved family member reports that the hospice program quality of care was excellent. (c) 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc

  3. Job satisfaction among hospice interdisciplinary team members.

    PubMed

    DeLoach, Roenia

    2003-01-01

    The purpose of this study was to investigate job satisfaction among hospice interdisciplinary team (IDT) members. Interdisciplinary team members (N = 76) from several hospices in Ohio participated in the study. Pearson product-moment correlations (p < .05) revealed that there were significant relationships between job satisfaction and autonomy, role ambiguity, role conflict, supervisory support, task significance, routinization, positive affectivity, negative affectivity, and team functioning. Multiple regression analysis (p < .05) revealed that supervisory support, positive affectivity, role ambiguity, autonomy, and routinization were significant predictors of job satisfaction.

  4. Support needs of informal hospice caregivers: a qualitative study.

    PubMed

    Kutner, Jean; Kilbourn, Kristin M; Costenaro, Allison; Lee, Courtney A; Nowels, Carolyn; Vancura, Jenny L; Anderson, Derek; Keech, Tarah Ellis

    2009-12-01

    Informal caregivers of hospice patients experience multiple stressors that can negatively impact physical, psychological, and emotional health. The goal of this qualitative study was to understand caregivers' needs to inform the feasibility, structure, and content of a telephone-based counseling intervention. Focus groups and interviews with 36 former hospice caregivers and 11 hospice staff from 6 hospices were conducted. Interviews and focus groups were audio-recorded, transcribed, and analyzed using a constant comparative approach. Key content areas included coping, emotional support, self-care, logistical issues, and bereavement. Respondents supported telephone-based counseling, appreciating its relative anonymity and convenience. It was recommended that calls be initiated by the counselor, on a weekly basis, and that one counselor be assigned to each caregiver. Hospice staff emphasized the need to coordinate telephone counseling with hospice care, scheduling around and communicating with hospice staff. Most caregivers indicated that they would participate in telephone-based counseling were it available; hospice staff thought that half of caregivers would participate. A pervasive theme was that "there can never be enough support for a caregiver." Informal caregivers of hospice patients have support needs that are amenable to telephone-based counseling designed to be complementary to existing hospice services. Based on these qualitative findings, we are pilot-testing a telephone-based cognitive-behavioral stress management program for informal caregivers of hospice patients.

  5. Availability of Heart Failure Medications in Hospice Care.

    PubMed

    Lum, Hillary D; Horney, Carolyn; Koets, David; Kutner, Jean S; Matlock, Daniel D

    2016-12-01

    Availability of cardiac medications in hospice for acute symptom management of heart failure is unknown. This study explored hospice approaches to cardiac medications for patients with heart failure. Descriptive study using a quantitative survey of 46 US hospice agencies and clinician interviews. Of 31 hospices that provided standard home medication kits for acute symptom management, only 1 provided medication with cardiac indications (oral furosemide). Only 22% of the hospice agencies had a specific cardiac medication kit. Just over half (57%) of the agencies could provide intravenous inotropic therapy, often in multiple hospice settings. Clinicians described an individualized approach to cardiac medications for patients with heart failure. This study highlights opportunities for practice guidelines that inform medical therapy for hospice patients with heart failure. © The Author(s) 2015.

  6. 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.

  7. Hospice-assisted death? A study of Oregon hospices on death with dignity.

    PubMed

    Campbell, Courtney S; Cox, Jessica C

    2012-05-01

    Nearly 90% of terminally ill patients who have used Oregon's distinctive death with dignity law to receive a medication to end their lives are enrolled in hospice care programs. In 2009-2010, we conducted a study of the policies developed by Oregon hospices to address patient inquiries and requests for death with dignity. The study examined the stated hospice values and positions and identified the boundaries to participation drawn by the hospice programs to protect personal and programmatic integrity. The boundaries were drawn around 6 key caregiving considerations: (1) language regarding physician-assisted death (PAD); (2) informed decision making by patients; (3) collaboration with physicians; (4) provision of lethal medication; (5) assistance in the patient's act of taking the medication; and (6) staff presence at the time of medication ingestion.

  8. Characteristics of Prison Hospice Patients: Medical History, Hospice Care, and End-of-Life Symptom Prevalence.

    PubMed

    Cloyes, Kristin G; Berry, Patricia H; Martz, Kim; Supiano, Katherine

    2015-07-01

    Increasing numbers of prisoners in the United States are dying from age-related and chronic illnesses while incarcerated. This study is among the first to document characteristics of a population of prison hospice patients. Retrospective review of medical records for all patients admitted to the Louisiana State Penitentiary prison hospice program between January 1, 2004, and May 31, 2012 (N = 79) examined demographics, medical history, hospice diagnosis, length of stay, and end-of-life symptom prevalence on admission and during final 72 hours before death. Resulting data were contrasted with community-based end-of-life care study data, demonstrating a unique clinical profile of this group. As prisons consider adopting programs to meet the growing need for inmate end-of-life care, more research concerning the particular characteristics and unique needs of prison hospice patients will inform these efforts.

  9. 42 CFR 418.308 - Limitation on the amount of hospice payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.308 Limitation... total Medicare payment to a hospice for care furnished during a cap period is limited by the hospice cap... 42 Public Health 3 2010-10-01 2010-10-01 false Limitation on the amount of hospice payments....

  10. 42 CFR 418.308 - Limitation on the amount of hospice payments.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Payment for Hospice Care § 418.308... total Medicare payment to a hospice for care furnished during a cap period is limited by the hospice cap... 42 Public Health 3 2014-10-01 2014-10-01 false Limitation on the amount of hospice payments....

  11. 42 CFR 418.308 - Limitation on the amount of hospice payments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.308 Limitation... total Medicare payment to a hospice for care furnished during a cap period is limited by the hospice cap... 42 Public Health 3 2011-10-01 2011-10-01 false Limitation on the amount of hospice payments....

  12. 42 CFR 418.308 - Limitation on the amount of hospice payments.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Payment for Hospice Care § 418.308... total Medicare payment to a hospice for care furnished during a cap period is limited by the hospice cap... 42 Public Health 3 2013-10-01 2013-10-01 false Limitation on the amount of hospice payments....

  13. 42 CFR 418.308 - Limitation on the amount of hospice payments.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Payment for Hospice Care § 418.308... total Medicare payment to a hospice for care furnished during a cap period is limited by the hospice cap... 42 Public Health 3 2012-10-01 2012-10-01 false Limitation on the amount of hospice payments....

  14. Collaborative practice model: Madigan Army Medical Center.

    PubMed

    Nielsen, Peter E; Munroe, Michelle; Foglia, Lisa; Piecek, Roxanne I; Backman, Mary Paul; Cypher, Rebecca; Smith, Denise C

    2012-09-01

    In 2007, Madigan Army Medical Center implemented a new maternity care delivery model, integrating obstetricians and certified nurse-midwives (CNMs) in a collaborative practice. The change was driven by multiple factors, including patient preference, changes in the resident workweek, and low provider satisfaction. This article describes the elements of successful collaboration, including the structure, effective teamwork principles, role of the CNM in resident education, and preliminary data on mode of delivery, the number of CNM-supervised resident births, and procedures, such as episiotomy and epidural use.

  15. 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)

  16. National Hospice and Palliative Care Organization

    MedlinePlus

    ... MDP Courses/Modules Calendar of Events Palliative Care Pediatric Hospice and Palliative Care Palliative Care Membership - Join Facebook Twitter LinkedIn YouTube Pinterest RSS ehospice moments my.nhpco 2 new Episodes-Election Recap and Intensives Review Plan ahead, order your 2017 Webinar package ...

  17. 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…

  18. 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)

  19. 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…

  20. 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…

  1. 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.…

  2. 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.

  3. Iowa Flood Center Model Performance Evaluation

    NASA Astrophysics Data System (ADS)

    Quintero, F.; Krajewski, W. F.; Mantilla, R.; Seo, B. C.

    2016-12-01

    We evaluated the performance of a hydrologic model which produces real-time flow forecasts. The model was developed by the Iowa Flood Center (IFC) and it is implemented operationally to produce streamflow forecast for the communities of the state of Iowa in the United States. The model parameters are calibration-free. It has a parsimonious structure that reproduces the more significant processes involved in the transformation from rainfall to runoff. The operational model uses a rainfall forcing produced by IFC, derived from the combination of rainfall fields of seven NEXRAD radars. This rainfall forcing does not include bias adjustment from rain gauges, due to the non-existence of a raingage network that enable the correction in real-time. Therefore, the model was also evaluated using the bias-adjusted rainfall product Stage IV. We used six years of IFC rainfall and Stage IV to evaluate the performance of the hydrologic model and the sensitivity of the flow simulations to the model input. The model was not calibrated to any particular rainfall product. The distributed structure of the model allows obtaining results at any channel of the drainage network. We produced simulated hydrographs at about 140 locations with different sub-basin spatial scales, where USGS streamflow observations are available. We compared flow simulations to observations and obtained several metrics of error including Nash Sutcliffe efficiency, normalized root mean square error, volume error and time to peak error. We also evaluated the number of occurrences of hits and false alarms of discharge forecasts exceeding flood stage.

  4. Space Weather Modeling at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Hesse M.

    2005-01-01

    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 dose 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, as well as distributed computing facilities provided by the US Air Force. CCMC also provides, to the research community, access to state-of-the-art space research models. In this paper we will provide updates on CCMC status, on current plans, research and development accomplishments and goals, and on 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.

  5. 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.

  6. Space Weather Modeling at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Hesse M.

    2005-01-01

    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 dose 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, as well as distributed computing facilities provided by the US Air Force. CCMC also provides, to the research community, access to state-of-the-art space research models. In this paper we will provide updates on CCMC status, on current plans, research and development accomplishments and goals, and on 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.

  7. 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.

  8. Validation of the Quality of Dying (QOD)-Hospice Scale

    PubMed Central

    Cagle, John G.; Munn, Jean C.; Hong, Seokho; Clifford, Maggie; Zimmerman, Sheryl

    2014-01-01

    Context Measuring the quality of the dying experience is important for hospice providers. However, few instruments exist that assess the quality of one’s dying; and those that do, have not been well validated in hospice. Objectives This study tested the properties of the Quality of Death-Hospice Scale (QOD-Hospice) to provide preliminary validation data on internal consistency, inter-rater reliability, convergent validity and factorability in a hospice setting. Additionally, results of the factor analysis were used to create a brief version of the measure. Methods Bereaved informal caregivers who had provided care for a hospice patient were recruited from a large non-profit hospice. Participants completed post-death surveys, which included the QOD-Hospice and other study measures. Convergent validity was tested by exploring hypothesized associations with related instruments measuring: negative emotional states (Depression Anxiety Stress Scale-21); emotional grief (Texas Revised Inventory of Grief-2); social support (Lubben Social Network Scale-6); and a single item measure of satisfaction with hospice care. Results Seventy caregivers participated in the survey (40 primary caregivers, 30 secondary caregivers), most of whom were female (67%) and white (81%). The QOD-Hospice produced an alpha of 0.86, an intraclass correlation of 0.49 between caregivers of the same decedent, and was correlated with all measures testing convergent validity (P<0.05; in the hypothesized direction) and most, but not all, subscales. An exploratory factor analysis elicited two factors, Preparation (seven items) and Security (six items), which were combined to create a 13-item version of the scale, the QOD-Hospice-SF. Conclusion Although further testing of the QOD-Hospice measures is needed, preliminary evidence suggests the instruments are reliable and valid for use in hospice. PMID:25057986

  9. Factors associated with the provision of hospice care for children.

    PubMed

    Lindley, Lisa C; Mark, Barbara A; Daniel Lee, Shoou-Yih; Domino, Marisa; Song, Mi-Kyung; Jacobson Vann, Julie

    2013-04-01

    Children at the end of life often lack access to hospice care at home or in a dedicated facility. The factors that may influence whether or not hospices provide pediatric care are relatively unknown. The purpose of this study was to understand the institutional and resource factors associated with provision of pediatric hospice care. This study used a retrospective, longitudinal design. The main data source was the 2002 to 2008 California State Hospice Utilization Data Files. The sample size was 311 hospices or 1368 hospice observations over seven years. Drawing on institutional and resource dependence theory, this study used generalized estimating equations to examine the institutional and resource factors associated with provision of pediatric hospice care. Interaction terms were included to assess the moderating effect of resource factors on the relationship between institutional factors and provision of care. Membership in professional groups increased the probability (19%) of offering hospice services for children. Small- (-22%) and medium-sized (-11%) hospices were less likely to provide care for children. The probability of providing pediatric hospice care diminished (-23%) when competition increased in the prior year. Additionally, small size attenuated the accreditation-provision relationship and medium size magnified the membership-provision relationship. Professional membership may promote conformity to industry standards of pediatric care and remove the unknowns of providing hospice care for children. Hospices, especially medium-sized hospices, interested in developing or expanding care for children may benefit by identifying a pediatric champion to join a professional group. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  10. 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

  11. Models of the ISM in Galaxy Centers

    NASA Astrophysics Data System (ADS)

    Meijerink, Rowin

    2006-11-01

    Part I: M51 is observed at a wavelength of 850 mum, where most radiation is emitted by dust. We find prominent spiral arms and an underlying exponential disk. The properties of the disk and the arms are studied. Part II and III: Gas in Galaxy Centers is exposed to intense radiation from a starburst region, an Active Galactic Nucleus (AGN), or both. The OB stars in starforming regions mostly radiate in the far-ultraviolet (FUV) and accreting black holes mostly in the X-ray regime. FUV and X-ray photons lead to a totally different chemical composition of gas clouds. Therefore, molecules such as H2, CO, HCN and HCO+ emit different line intensities. In the thesis, we model the line emission of the molecules in these gas clouds with Photon Dominated Regions models (FUV: PDR) and X-ray Dominated Region models (X-rays: XDR). These models are applied to nearby active galaxies such as NGC 253 and NGC 1068.

  12. Caregiver Activation and Home Hospice Nurse Communication in Advanced Cancer Care.

    PubMed

    Dingley, Catherine E; Clayton, Margaret; Lai, Djin; Doyon, Katherine; Reblin, Maija; Ellington, Lee

    Activated patients have the skills, knowledge, and confidence to manage their care, resulting in positive outcomes such as lower hospital readmission and fewer adverse consequences due to poor communication with providers. Despite extensive evidence on patient activation, little is known about activation in the home hospice setting, when family caregivers assume more responsibility in care management. We examined caregiver and nurse communication behaviors associated with caregiver activation during home hospice visits of patients with advanced cancer using a prospective observational design. We adapted Street's Activation Verbal Coding tool to caregiver communication and used qualitative thematic analysis to develop codes for nurse communications that preceded and followed each activation statement in 60 audio-recorded home hospice visits. Caregiver communication that reflected activation included demonstrating knowledge regarding the patient/care, describing care strategies, expressing opinions regarding care, requesting explanations of care, expressing concern about the patient, and redirecting the conversation toward the patient. Nurses responded by providing education, reassessing the patient/care environment, validating communications, clarifying care issues, updating/revising care, and making recommendations for future care. Nurses prompted caregiver activation through focused care-specific questions, open-ended questions/statements, and personal questions. Few studies have investigated nurse/caregiver communication in home hospice, and, to our knowledge, no other studies focused on caregiver activation. The current study provides a foundation to develop a framework of caregiver activation through enhanced communication with nurses. Activated caregivers may facilitate patient-centered care through communication with nurses in home hospice, thus resulting in enhanced outcomes for patients with advanced cancer.

  13. Application of the VALUE communication principles in ACTIVE hospice team meetings.

    PubMed

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

    2013-01-01

    The ACTIVE (Assessing Caregivers for Team Intervention through Video Encounters) intervention uses technology to enable family caregivers to participate in hospice interdisciplinary team (IDT) meetings from geographically remote locations. Previous research has suggested that effective communication is critical to the success of these meetings. The purpose of this study was to explore communication in ACTIVE IDT meetings involving family caregivers and to assess the degree to which hospice teams use specific communication principles (summarized in the mnemonic VALUE: value, acknowledge, listen, understand, and elicit), which have been supported in previous research in intensive care settings. Researchers analyzed team-family communication during 84 video- and/or audio-recorded care plan discussions that took place during ACTIVE team meetings, using a template approach to text analysis to determine the extent and quality of VALUE principles. The total content analyzed was 9 hours, 28 minutes in length. Hospice clinicians routinely employed the VALUE communication principles in communication during ACTIVE IDT meetings with family caregivers, but the quality of this communication was frequently rated moderate or poor. The majority of such communication was task-focused. Less often, communication centered on emotional concerns and efforts to gain a more holistic understanding of patients and families. This analysis suggests an opportunity for improving support for family members during ACTIVE IDT meetings. Members of hospice IDTs should remain aware of the opportunity for additional attention to the emotional realities of the hospice experience for family caregivers and could improve support for family caregivers during IDT meetings by ensuring that messages used to exemplify VALUE principles during team-family communication are of a high quality.

  14. Application of the VALUE Communication Principles in ACTIVE Hospice Team Meetings

    PubMed Central

    Wittenberg-Lyles, Elaine; Parker Oliver, Debra; Demiris, George; Shaunfield, Sara; Crumb, Edith

    2013-01-01

    Abstract Background The ACTIVE (Assessing Caregivers for Team Intervention through Video Encounters) intervention uses technology to enable family caregivers to participate in hospice interdisciplinary team (IDT) meetings from geographically remote locations. Previous research has suggested that effective communication is critical to the success of these meetings. The purpose of this study was to explore communication in ACTIVE IDT meetings involving family caregivers and to assess the degree to which hospice teams use specific communication principles (summarized in the mnemonic VALUE: value, acknowledge, listen, understand, and elicit), which have been supported in previous research in intensive care settings. Methods Researchers analyzed team-family communication during 84 video- and/or audio-recorded care plan discussions that took place during ACTIVE team meetings, using a template approach to text analysis to determine the extent and quality of VALUE principles. The total content analyzed was 9 hours, 28 minutes in length. Results Hospice clinicians routinely employed the VALUE communication principles in communication during ACTIVE IDT meetings with family caregivers, but the quality of this communication was frequently rated moderate or poor. The majority of such communication was task-focused. Less often, communication centered on emotional concerns and efforts to gain a more holistic understanding of patients and families. Conclusions This analysis suggests an opportunity for improving support for family members during ACTIVE IDT meetings. Members of hospice IDTs should remain aware of the opportunity for additional attention to the emotional realities of the hospice experience for family caregivers and could improve support for family caregivers during IDT meetings by ensuring that messages used to exemplify VALUE principles during team-family communication are of a high quality. PMID:23036014

  15. Future Models for Federally Funded Research and Development Center Contracts

    DTIC Science & Technology

    2016-10-20

    Future Models for Federally Funded Research and Development Center Contracts Approved by the DBB 20 October 2016 Presentation on: Task Group...Development Center (FFRDC) contracts . Specifically, the DBB should;  Review existing governance models, compare management activities to those of the...Center (FFRDC) contracts . Specifically, the DBB should; − Review existing governance models, compare management activities to those of the private

  16. Home care for children with multiple complex chronic conditions at the end of life: The choice of hospice versus home health.

    PubMed

    Lindley, Lisa C; Mixer, Sandra J; Mack, Jennifer W

    2016-01-01

    Families desire to bring their children home at end of life, and this creates a variety of unique care needs at home. This study analyzed the child and family factors associated with hospice versus home health care use in the last year of life among children with multiple complex chronic conditions. Using the Andersen Behavioral Healthcare Utilization Model, the predisposing, enabling, and need factors of the child and family were shown to be significant predictors of hospice and home health care use. Hospice and home health care have advantages, and families may wish to use the service that best fits their needs.

  17. The fundamentals of hospice compliance what is it and what are the implications for the future? An overview for hospice clinicians part 2: Hospice risk areas.

    PubMed

    Balfour, Susan

    2012-05-01

    This article, Part 2 of a 2-part series, continues the examination of the Medicare compliance climate and its impact on hospice providers. This 2nd part focuses on hospice-specific compliance risk areas and specific risk-reduction strategies. The case example from Part 1 is continued.

  18. Oncology social workers' attitudes toward hospice care and referral behavior.

    PubMed

    Becker, Janet E

    2004-02-01

    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, yet the average proportion of terminally ill patients whom they referred to hospice was only 49.5 percent. The worker's HPS score was related significantly, although weakly, to the likelihood of referral. A follow-up study was undertaken to determine the reasons for the discrepancy between the workers' self-reported favorable attitudes toward hospice and their relatively low rate of patient referral. The factor identified most frequently was resistance from families because of the requirement that hospice patients discontinue active treatment.

  19. 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

  20. Questions & answers about hospice: a guide for Missouri's physicians.

    PubMed

    Zweig, Steven

    2002-01-01

    Hospice provides multidisciplinary care to dying patients with and without cancer. Most adults would prefer to be cared for in their home or that of a family member. This guide provides answers to the questions most commonly asked of physicians. Its goal is to facilitate a better understanding of what hospice does, who is eligible, physician roles, and how physicians can use hospice to help their patients.

  1. Do-Not-Resuscitate Orders and/or Hospice Care, Psychological Health, and Quality of Life among Children/Adolescents with Acquired Immune Deficiency Syndrome

    PubMed Central

    Lyon, Maureen E.; Williams, Paige L.; Woods, Elizabeth R.; Hutton, Nancy; Butler, Anne M.; Sibinga, Erica; Brady, Michael T.; Oleske, James M.

    2009-01-01

    Objective The frequency of do-not-resuscitate (DNR) orders and hospice enrollment in children/adolescents living with acquired immune deficiency syndrome (AIDS) and followed in Pediatric AIDS Clinical Trials Group (PACTG) Study 219C was examined, and evaluated for any association with racial disparities or enhanced quality of life (QOL), particularly psychological adjustment. Methods A cross-sectional analysis of children with AIDS enrolled in this prospective multicenter observational study between 2000 and 2005 was conducted to evaluate the incidence of DNR/hospice overall and by calendar time. Linear regression models were used to compare caregivers' reported QOL scores within 6 domains between those with and without DNR/hospice care, adjusting for confounders. Results Seven hundred twenty-six (726) children with AIDS had a mean age of 12.9 years (standard deviation [SD] = 4.5), 51% were male, 60% black, 25% Hispanic. Twenty-one (2.9%) had either a DNR order (n = 16), hospice enrollment (n = 7), or both (n = 2). Of 41 children who died, 80% had no DNR/hospice care. Increased odds of DNR/hospice were observed for those with CD4% less than 15%, no current antiretroviral use, and prior hospitalization. No differences by race were detected. Adjusted mean QOL scores were significantly lower for those with DNR/hospice enrollment than those without across all domains except for psychological status and health care utilization. Poorer psychological status correlated with higher symptom distress, but not with DNR/hospice enrollment after adjusting for symptoms. Conclusions Children who died of AIDS rarely had DNR/hospice enrollment. National guidelines recommend that quality palliative care be integrated routinely with HIV care. Further research is needed to explore the barriers to palliative care and advance care planning in this population. PMID:18363489

  2. Acknowledged Dependence and the Virtues of Perinatal Hospice

    PubMed Central

    Cobb, Aaron D.

    2016-01-01

    Prenatal screening can lead to the detection and diagnosis of significantly life-limiting conditions affecting the unborn child. Recognizing the difficulties facing parents who decide to continue the pregnancy, some have proposed perinatal hospice as a new modality of care. Although the medical literature has begun to devote significant attention to these practices, systematic philosophical reflection on perinatal hospice has been relatively limited. Drawing on Alasdair MacIntyre’s account of the virtues of acknowledged dependence, I contend that perinatal hospice manifests and facilitates virtues essential to living well with human dependency and vulnerability. For this reason, perinatal hospice deserves broad support within society. PMID:26661051

  3. Acknowledged Dependence and the Virtues of Perinatal Hospice.

    PubMed

    Cobb, Aaron D

    2016-02-01

    Prenatal screening can lead to the detection and diagnosis of significantly life-limiting conditions affecting the unborn child. Recognizing the difficulties facing parents who decide to continue the pregnancy, some have proposed perinatal hospice as a new modality of care. Although the medical literature has begun to devote significant attention to these practices, systematic philosophical reflection on perinatal hospice has been relatively limited. Drawing on Alasdair MacIntyre's account of the virtues of acknowledged dependence, I contend that perinatal hospice manifests and facilitates virtues essential to living well with human dependency and vulnerability. For this reason, perinatal hospice deserves broad support within society.

  4. Physician Characteristics Strongly Predict Patient Enrollment In Hospice.

    PubMed

    Obermeyer, Ziad; Powers, Brian W; Makar, Maggie; Keating, Nancy L; Cutler, David M

    2015-06-01

    Individual physicians are widely believed to play a large role in patients' decisions about end-of-life care, but little empirical evidence supports this view. We developed a novel method for measuring the relationship between physician characteristics and hospice enrollment, in a nationally representative sample of Medicare patients. We focused on patients who died with a diagnosis of poor-prognosis cancer in the period 2006-11, for whom palliative treatment and hospice would be considered the standard of care. We found that the proportion of a physician's patients who were enrolled in hospice was a strong predictor of whether or not that physician's other patients would enroll in hospice. The magnitude of this association was larger than that of other known predictors of hospice enrollment that we examined, including patients' medical comorbidity, age, race, and sex. Patients cared for by medical oncologists and those cared for in not-for-profit hospitals were significantly more likely than other patients to enroll in hospice. These findings suggest that physician characteristics are among the strongest predictors of whether a patient receives hospice care-which mounting evidence indicates can improve care quality and reduce costs. Interventions geared toward physicians, both by specialty and by previous history of patients' hospice enrollment, may help optimize appropriate hospice use.

  5. Motivations, Death Anxiety, and Empathy in Hospice Volunteers in France.

    PubMed

    Garbay, Meriem; Gay, Marie-Claire; Claxton-Oldfield, Stephen

    2015-08-01

    This study examined the motivations for volunteering of hospice volunteers in France. In addition, their levels of death anxiety and empathy were measured and compared with those of French non-hospice volunteers and non-volunteers. Three questionnaires-the Inventory of Motivations for Hospice Palliative Care Volunteerism (IMHPCV), the Templer/McMordie Death Anxiety Scale, and the Interpersonal Reactivity Index-were sent via an Internet link to 2 hospice volunteer associations and to non-hospice volunteers and non-volunteers (only the hospice volunteers received the IMHPCV). Altruistic motives had the most influence on the respondents' decision to become a hospice volunteer. French hospice volunteers scored significantly lower on 3 categories of motives on the IMHPCV compared to a sample of Canadian hospice palliative care volunteers (study 2), suggesting that cultural differences may be involved. No significant differences were found in levels of death anxiety or empathy between the 3 groups of respondents of the study. © The Author(s) 2014.

  6. Correlates and Predictors of Conflict at the End of Life Among Families Enrolled in Hospice.

    PubMed

    Kramer, Betty J; Boelk, Amy Z

    2015-08-01

    Despite the palliative care mandate to view family as the unit of care, and the high prevalence and detrimental consequences of conflict at the end of life, little research has been conducted with hospice families to understand what contributes to family conflict. Using a recently generated explanatory matrix of family conflict at the end of life, this study sought to identify the correlates and predictors of family conflict. As part of a larger mixed methods cross-sectional study, a 100-item survey was administered to 161 hospice family caregivers enrolled in a Medicare/Medicaid certified non-profit hospice organization located in the Midwest U.S. Although overall levels of conflict were relatively low, 57% of hospice caregivers reported experiencing some family conflict at the end of life. Contextual variables associated with family conflict included a history of family conflict, female gender, younger caregiver age, presence of children in the home, and less advance care planning discussions. Significant main effects in the prediction of family conflict in the final hierarchical multiple regression model included prior family conflict, caregiver age, caregiver gender, advance care planning discussions, family "coming out of the woodwork," communication constraints, and family members asserting control. The model explained 59% of the variance in family conflict. Results support the multidimensional theoretical model of family conflict specifying the importance of the family context, key conditions that set the stage for conflict, and essential contributing factors. Implications for routine assessment and screening to identify families at risk and recommendations for future research are highlighted. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  7. Communication among cancer patients, caregivers, and hospice nurses: Content, process and change over time.

    PubMed

    Ellington, Lee; Clayton, Margaret F; Reblin, Maija; Donaldson, Gary; Latimer, Seth

    2017-09-22

    First, to describe communication of home hospice nurse visits to cancer patient-caregiver dyads. Second, to assess change in communication related to domains of care over the course of visits. Multi-site prospective observational longitudinal study of audio-recorded home hospice visits (N=537 visits; 101 patient-caregiver dyads; 58 nurses). Communication was coded using the Roter Interaction Analysis System to describe content and process. Conversation representing three care domains (physical, psychosocial/daily life, and emotional) was calculated from RIAS categories across speakers and analyzed to assess change in communication over time. On average, nurses spoke 54% of total utterances, caregivers 29%, and patients 17%. For all participants, the predominant conversational focus was on physical care. Linear mixed effects models indicated that combined participant emotional talk showed a small systematic decrease over time; however, the results for all domains indicated variability unexplained by time or speaker effects. Home hospice conversations are predominantly focused on physical care. Systematic change in communication versus responsiveness to the dynamic effects of patient death and family response over time are discussed. Communication strategies already in use by hospice nurses could be leveraged and expanded upon to better facilitate family competence and confidence. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Euthanasia from the perspective of hospice care.

    PubMed

    Gillett, G

    1994-01-01

    The hospice believes in the concept of a gentle and harmonious death. In most hospice settings there is also a rejection of active euthanasia. This set of two apparently conflicting principles can be defended on the basis of two arguments. The first is that doctors should not foster the intent to kill as part of their moral and clinical character. This allows proper sensitivity to the complex and difficult situation that arises in many of the most difficult terminal care situations. The second argument turns on the seduction of technological solutions to human problems and the slippery slope that may arise in the presence of a quick and convenient way of dealing with problems of death and dying.

  9. Interdisciplinary collaboration in hospice team meetings.

    PubMed

    Wittenberg-Lyles, Elaine; Parker Oliver, Debra; Demiris, George; Regehr, Kelly

    2010-05-01

    Hospice and palliative care teams provide interdisciplinary care to seriously-ill and terminally-ill patients and their families. Care teams are comprised of medical and non-medical disciplines and include volunteers and lay workers in healthcare. The authors explored the perception of collaboration among hospice team members and actual collaborative communication practices in team meetings. The data set consisted of videotaped team meetings, some of which included caregiver participation, and team member completion of a survey. Findings revealed that the team's reflection on process was most likely to occur in team meetings, however least likely to occur when caregivers were present. Although team members had a high perception of interdependence and flexibility of roles, this was less likely to be enacted in team meetings with and without the presence of caregivers. Caregiver participation in team meetings had a positive impact on collaborative communication and the potential benefit of caregiver inclusion in team meetings is explored.

  10. Hospice, She Yelped: Examining the Quantity and Quality of Decision Support Available to Patient and Families Considering Hospice.

    PubMed

    Finnigan-Fox, Grace; Matlock, Dan D; Tate, Channing E; Knoepke, Christopher E; Allen, Larry A

    2017-08-14

    Whether to engage hospice is one of the most difficult medical decisions patients and families make. Meanwhile, misperceptions about hospice persist. Within this context, the breadth and depth of patient decision support materials for hospice is unknown. Identify available patient decision aids (PtDAs) relating information about hospice care and compare that information to the informational needs expressed by real-world healthcare consumers. First, the research team conducted an environmental scan of available PtDAs that included hospice as a treatment option and met 6 basic criteria defined by the International Patient Decision Aid Standards (IPDAS). Second, laypersons conducted an organic web search for information regarding hospice, followed by a semi-structured interview eliciting perceptions of the available information. The setting was the University of Colorado Health Care System. Participants included 20 laypersons aged 18 or older. The environmental scan identified 7 PtDAs that included hospice. No PtDAs were designed primarily around hospice; rather, hospice was referenced under the umbrella of another treatment option. The layperson search identified information distinct from the scan; no participant accessed any of the above 7 PtDAs. Many participants found the available online material confusing and biased, while failing to provide clear information on cost and lacking desired patient and caregiver testimonials. We found no formal PtDA designed primarily to help patients/families contemplating hospice. Furthermore, accessible online information about hospice does not appear to meet patient and caregiver decisional needs. These findings support the development and dissemination of high-quality decision support materials for hospice. Copyright © 2017. Published by Elsevier Inc.

  11. 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

  12. 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.

  13. Trauma-Informed Hospice and Palliative Care.

    PubMed

    Ganzel, Barbara L

    2016-12-07

    This review highlights the need to integrate trauma-informed practices into hospice and palliative care. The pervasiveness of psychological trauma exposure has been established in the general population and among the elderly adults. Moreover, there is emerging evidence for multiple additional opportunities for exposure to psychological trauma at or near the end of life. For example, many people experience intensive medical interventions prior to their admission to hospice and/or palliative care, and there is increasing recognition that these interventions may be traumatic. These and related opportunities for trauma exposure may combine synergistically at the end of life, particularly in the presence of pain, anxiety, delirium, dementia, or ordinary old age. This, in turn, can negatively affect patient mental health, well-being, behavior, and reported experience of pain. This review closes with suggestions for future research and a call for universal assessment of psychological trauma history and symptoms in hospice and palliative care patients, along with the development of palliative trauma intervention strategies appropriate to these populations. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. Generic magnetohydrodynamic model at the Community Coordinated Modeling Center

    NASA Astrophysics Data System (ADS)

    Honkonen, I. J.; Rastaetter, L.; Glocer, A.

    2016-12-01

    The Community Coordinated Modeling Center (CCMC) at NASA Goddard Space Flight Center is a multi-agency partnership to enable, support and perform research and development for next-generation space science and space weather models. CCMC currently hosts nearly 100 numerical models and a cornerstone of this activity is the Runs on Request (RoR) system which allows anyone to request a model run and analyse/visualize the results via a web browser. CCMC is also active in the education community by organizing student research contests, heliophysics summer schools, and space weather forecaster training for students, government and industry representatives. Recently a generic magnetohydrodynamic (MHD) model was added to the CCMC RoR system which allows the study of a variety of fluid and plasma phenomena in one, two and three dimensions using a dynamic point-and-click web interface. For example students can experiment with the physics of fundamental wave modes of hydrodynamic and MHD theory, behavior of discontinuities and shocks as well as instabilities such as Kelvin-Helmholtz.Students can also use the model to experiments with numerical effects of models, i.e. how the process of discretizing a system of equations and solving them on a computer changes the solution. This can provide valuable background understanding e.g. for space weather forecasters on the effects of model resolution, numerical resistivity, etc. on the prediction.

  15. Predictors of Transition to Hospice Care Among Hospitalized Older Adults With a Diagnosis of Dementia in Texas: A Population-Based Study.

    PubMed

    Oud, Lavi

    2017-01-01

    Decedent older adults with dementia are increasingly less likely to die in a hospital, though escalation of care to a hospital setting, often including critical care, remains common. Although hospice is increasingly reported as the site of death in these patients, the factors associated with transition to hospice care during end-of-life (EOL) hospitalizations of older adults with dementia and the extent of preceding escalation of care to an intensive care unit (ICU) setting among those discharged to hospice have not been examined. We identified hospitalizations aged ≥ 65 years with a diagnosis of dementia in Texas between 2001 and 2010. Potential factors associated with discharge to hospice were evaluated using multivariate logistic regression modeling, and occurrence of hospice discharge preceded by ICU admission was examined. There were 889,008 elderly hospitalizations with a diagnosis of dementia during study period, with 40,669 (4.6%) discharged to hospice. Discharges to hospice increased from 908 (1.5%) to 7,398 (6.3%) between 2001 and 2010 and involved prior admission to ICU in 45.2% by 2010. Non-dementia comorbidities were generally associated with increased odds of hospice discharge, as were development of organ failure, the number of failing organs, or use of mechanical ventilation. However, discharge to hospice was less likely among non-white minorities (lowest among blacks: adjusted odds ratio (aOR): 0.67; 95% confidence interval (CI): 0.65 - 0.70) and those with non-commercial primary insurance or the uninsured (lowest among those with Medicaid: aOR (95% CI): 0.41 (0.37 - 0.46)). This study identified potentially modifiable factors associated with disparities in transition to hospice care during EOL hospitalizations of older adults with dementia, which persisted across comorbidity and severity of illness measures. The prevalent discharge to hospice involving prior critical care suggests that key discussions about goals-of-care likely took place

  16. Predictors of Transition to Hospice Care Among Hospitalized Older Adults With a Diagnosis of Dementia in Texas: A Population-Based Study

    PubMed Central

    Oud, Lavi

    2017-01-01

    Background Decedent older adults with dementia are increasingly less likely to die in a hospital, though escalation of care to a hospital setting, often including critical care, remains common. Although hospice is increasingly reported as the site of death in these patients, the factors associated with transition to hospice care during end-of-life (EOL) hospitalizations of older adults with dementia and the extent of preceding escalation of care to an intensive care unit (ICU) setting among those discharged to hospice have not been examined. Methods We identified hospitalizations aged ≥ 65 years with a diagnosis of dementia in Texas between 2001 and 2010. Potential factors associated with discharge to hospice were evaluated using multivariate logistic regression modeling, and occurrence of hospice discharge preceded by ICU admission was examined. Results There were 889,008 elderly hospitalizations with a diagnosis of dementia during study period, with 40,669 (4.6%) discharged to hospice. Discharges to hospice increased from 908 (1.5%) to 7,398 (6.3%) between 2001 and 2010 and involved prior admission to ICU in 45.2% by 2010. Non-dementia comorbidities were generally associated with increased odds of hospice discharge, as were development of organ failure, the number of failing organs, or use of mechanical ventilation. However, discharge to hospice was less likely among non-white minorities (lowest among blacks: adjusted odds ratio (aOR): 0.67; 95% confidence interval (CI): 0.65 - 0.70) and those with non-commercial primary insurance or the uninsured (lowest among those with Medicaid: aOR (95% CI): 0.41 (0.37 - 0.46)). Conclusions This study identified potentially modifiable factors associated with disparities in transition to hospice care during EOL hospitalizations of older adults with dementia, which persisted across comorbidity and severity of illness measures. The prevalent discharge to hospice involving prior critical care suggests that key discussions about

  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. Hospice Care: What Services Do Patients and Their Families Receive?

    PubMed Central

    Carlson, Melissa D A; Morrison, R Sean; Holford, Theodore R; Bradley, Elizabeth H

    2007-01-01

    Objective To determine the degree to which patients and families enrolled with hospice received services across key categories of palliative care, the extent of hospice-level variability in services delivered, and changes over time in services delivered. Data Source Nationally representative sample of 9,409 discharged patients from 2,066 hospices in the National Home and Hospice Care Survey. Study Design Observational, cross-sectional study conducted from 1992 to 2000. The primary outcome is the receipt of services across five key categories of palliative care: nursing care, physician care, medication management, psychosocial care, and caregiver support. Data Collection Data were obtained via interview with the hospice staff member most familiar with the patient's care, in conjunction with medical record review. Principle Findings In 2000, 22 percent of patients enrolled with hospice received services across five key categories of palliative care. There was marked variation across hospices in service delivery. One-third of hospices provided patients and families services in one or two of the five key categories of palliative care, whereas 14 percent of hospices provided services across five key categories of palliative care. In multivariable analysis, the odds of receiving any additional hospice service was significantly greater in later compared with earlier years (odds ratio = 1.10, 95 percent confidence interval 1.01–1.20). Nevertheless, the percentages of patients in 2000 receiving medication management (59 percent), respite care (7 percent), and physician services (30 percent) remained low. Conclusions Hospice care for patients and families varies substantially across hospices. Whereas some hospices provide services across the key categories of palliative care, other hospices do not provide this breadth of services. Greater understanding of the causes of variation in service delivery as well as its impact on patient and family outcomes and satisfaction with

  19. Family Perspectives on Hospice Care Experiences of Patients with Cancer.

    PubMed

    Kumar, Pallavi; Wright, Alexi A; Hatfield, Laura A; Temel, Jennifer S; Keating, Nancy L

    2017-02-01

    Purpose To determine whether hospice use by patients with cancer is associated with their families' perceptions of patients' symptoms, goal attainment, and quality of end-of-life (EOL) care. Methods We interviewed 2,307 families of deceased patients with advanced lung or colorectal cancer who were enrolled in the Cancer Care Outcomes Research and Surveillance study (a multiregional, prospective, observational study) and died by 2011. We used propensity-score matching to compare family-reported outcomes for patients who did and did not receive hospice care, including the presence and relief of common symptoms (ie, pain, dyspnea), concordance with patients' wishes for EOL care and place of death, and quality of EOL care. We also examined associations between hospice length of stay and these outcomes among hospice enrollees. Results In a propensity-score-matched sample of 1,970 individuals, families of patients enrolled in hospice reported more pain in their patient compared with those not enrolled in hospice. However, families of patients enrolled in hospice more often reported that patients received "just the right amount" of pain medicine (80% v 73%; adjusted difference, 7 percentage points; 95% confidence interval [CI], 1 to 12 percentage points) and help with dyspnea (78% v 70%; adjusted difference, 8 percentage points; 95% CI, 2 to 13 percentage points). Families of patients enrolled in hospice also more often reported that patients' EOL wishes were followed (80% v 74%; adjusted difference, 6 percentage points; 95% CI, 2 to 11 percentage points) and "excellent" quality EOL care (57% v 42%; adjusted difference, 15 percentage points; 95% CI, 11 to 20). Families of patients who received > 30 days of hospice care reported the highest quality EOL outcomes. Conclusion Hospice care is associated with better symptom relief, patient-goal attainment, and quality of EOL care. Encouraging earlier and increased hospice enrollment may improve EOL experiences for patients with

  20. 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.

  1. Social Work Assessment Notes: A Comprehensive Outcomes-Based Hospice Documentation System.

    PubMed

    Hansen, Angela Gregory; Martin, Ellen; Jones, Barbara L; Pomeroy, Elizabeth C

    2015-08-01

    This article describes the development of an integrated psychosocial patient and caregiver assessment and plan of care for hospice social work documentation. A team of hospice social workers developed the Social Work Assessment Notes as a quality improvement project in collaboration with the information technology department. Using the Social Work Assessment Tool as an organizing framework, this comprehensive hospice social work documentation system is designed to integrate assessment, planning, and outcomes measurement. The system was developed to guide the assessment of patients' and caregivers' needs related to end-of-life psychosocial issues, to facilitate collaborative care plan development, and to measure patient- and family-centered outcomes. Goals established with the patient and the caregiver are documented in the plan of care and become the foundation for patient-centered, strengths-based interventions. Likert scales are used to assign numerical severity levels for identified issues and progress made toward goals and to track the outcome of social work interventions across nine psychosocial constructs. The documentation system was developed for use in an electronic health record but can be used for paper charting. Future plans include automated aggregate outcomes measurement to identify the most effective interventions and best practices in end-of-life care.

  2. What explains racial differences in the use of advance directives and attitudes toward hospice care?

    PubMed Central

    Johnson, Kimberly S.; Kuchibhatla, Maragatha; Tulsky, James A.

    2008-01-01

    Cultural beliefs and values are thought to account for differences between African Americans and Whites in the use of advance directives and beliefs about hospice care. However, little data clarifies which beliefs and values explain these differences. We surveyed 205 older adults (≥ age 65) who received primary care in the Duke University Health System. The survey included five scales: Hospice Beliefs and Attitudes, Preferences for Care, Spirituality, Healthcare System Distrust, and Beliefs about Dying and Advance Care Planning. Compared to Whites, African Americans were less likely to have completed an advance directive (35.5% vs. 67.4%, P<.001) and had less favorable beliefs about hospice care (Hospice Beliefs and Attitudes Scale score, P<.001). African Americans were more likely to express discomfort discussing death, want aggressive care at the end of life, have spiritual beliefs which conflict with the goals of palliative care, and distrust the healthcare system. In multivariate analyses, none of these factors alone completely explained racial differences in either possession of an advance directive or beliefs about hospice care. However, when all of these factors were combined, race was no longer a significant predictor of either of the two outcomes. Our findings suggest that ethnicity is a marker of common cultural beliefs and values which in combination influence decision-making at the end of life. This study has implications for the design of healthcare delivery models and programs which provide culturally-sensitive end-of-life care to a growing population of ethnically diverse older adults. PMID:18771455

  3. 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

  4. [A consideration in the care of elderly patients receiving home hospice care: administration of parenteral nutrition at home].

    PubMed

    Tomita, M; Nagura, Y; Honda, K; Shimizu, C

    1998-12-01

    Due to the recent increase in the elderly population in Japan, the number of elderly patients with gastric cancer has also increased. As a result, not only the need for care of these patients has increased but also the care system has become diverse. In our hospital, more than 30% of patients who received home hospice care were over 70 years old and home hospice care of elderly patients with terminal cancer has become an important activity of our hospital. Whether home parenteral nutrition (HPN) procedures should be administered in the home for these patients is controversial. Our hospital has decided to inform patients with malignant disease of their true diagnosis under the doctrine of informed consent. In 1997, 94.1% of patients above 70 years, of age were informed of the actual nature of their disease. As a result, they were allowed to make a choice regarding home hospice care. An 81-year-old patient with terminal gastric cancer chose home hospice care and successfully managed the treatment procedures, including the use of a pump for intravenous alimentation. Through this case, we report here an ideal model of home hospice care of elderly patients under the concept of informed consent.

  5. 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.

  6. 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)

  7. 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)

  8. 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)

  9. Staff Efficiency Trends Among Pediatric Hospices, 2002–2011

    PubMed Central

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

    2016-01-01

    Delivering care for children at end of life often takes considerable time and effort by the hospice staff. The purpose of this study was to examine trends in staff technical efficiency among California pediatric hospice providers from 2002 and 2011. PMID:27265950

  10. The impact of hospice programs on U.S. hospitals.

    PubMed

    Harrison, Jeffrey P; Ford, Dennis; Wilson, Kelly

    2005-01-01

    This study demonstrates that hospice programs are more likely in communities with favorable economic factors and higher Medicare populations. Large hospitals with high occupancy rates and more clinical services use the hospice as an alternative to inpatient care thereby improving hospital efficiency and profitability.

  11. Introducing contemporary shift patterns in a hospice setting.

    PubMed

    Greene, Kay

    For many nurses, quality of life is dependent on the balance of work and home life. Registered, skilled and experienced nurses are necessary to ensure that a high-quality service is provided. The hospice recognised that its main asset in providing such a service is its nursing workforce. This article describes how the hospice introduced new working patterns for nursing staff.

  12. Needs for Psychosocial Support in Home Care Hospice Patients.

    ERIC Educational Resources Information Center

    Gotay, Carolyn Cook

    There is little research documenting the psychosocial support needs of hospice patients and their families. To assess hospice patients' and families' use of and perceptions of need for support, 77 patients and their families were interviewed during home care for terminal illness (Group 1), and 50 family members (84% spouses) were interviewed 1…

  13. Palliative Care Questions and Answers (Hospice Care Comparison)

    MedlinePlus

    ... Answers Palliative Care Questions and Answers Question Palliative Care Hospice Care Who can receive this care? Anyone with a ... a package deal? No, there is no ‘palliative care’ benefit package Yes, hospice is a comprehensive benefit covered by Medicare and ...

  14. 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…

  15. 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…

  16. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... nursing care on a continuous basis at home. Home health aide (also known as a hospice aide) or homemaker.... (b) Payment amounts are determined within each of the following categories: (1) Routine home care day. A routine home care day is a day on which an individual who has elected to receive hospice care is...

  17. Humanistic Nursing Theory: application to hospice and palliative care.

    PubMed

    Wu, Hung-Lan; Volker, Deborah L

    2012-02-01

    This article presents a discussion of the relevance of Humanistic Nursing Theory to hospice and palliative care nursing. The World Health Organization has characterized the need for expert, palliative and end-of-life care as a top priority for global health care. The specialty of hospice and palliative care nursing embraces a humanistic caring and holistic approach to patient care. As this resonates with Paterson and Zderad's Humanistic Nursing Theory, an understanding of hospice nurses' experiences can be investigated by application of relevant constructs in the theory. This article is based on Paterson and Zderad's publications and other theoretical and research articles and books focused on Humanistic Nursing Theory (1976-2009), and data from a phenomenological study of the lived experience of Taiwanese hospice nurses conducted in 2007. Theoretical concepts relevant to hospice and palliative nursing included moreness-choice, call-and-response, intersubjective transaction, uniqueness-otherness, being and doing and community. The philosophical perspectives of Humanistic Nursing Theory are relevant to the practice of hospice and palliative care nursing. By 'being with and doing with', hospice and palliative nurses can work with patients to achieve their final goals in the last phase of life. Use of core concepts from Humanistic Nursing Theory can provide a unifying language for planning care and describing interventions. Future research efforts in hospice and palliative nursing should define and evaluate these concepts for efficacy in practice settings. © 2011 Blackwell Publishing Ltd.

  18. 42 CFR 418.309 - Hospice aggregate cap.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... deflation for cap years that end after October 1, 1984, by using the percentage change in the medical care... which represents the portion of a patient's total days of care in all hospices and all years that was... based on updated data. (c) Patient-by-patient proportional methodology defined. A hospice's...

  19. A Collaborative Responsive Teacher Center Model for Preparing Teachers.

    ERIC Educational Resources Information Center

    Miller, James R.

    A collaborative responsive model for teacher education using the potentials of the teacher center concept is described. This model was created in response to the theory practice gap commonly found in many teacher education programs. Utilizing the model, two field based programs were initiated. The two teacher centers involved were each served by…

  20. 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…

  1. 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…

  2. Racial/Ethnic Perspectives on the Quality of Hospice Care

    PubMed Central

    Campbell, Cathy L.; Baernholdt, Marianne; Yan, Guofen; Hinton, Ivora D.; Lewis, Erica

    2013-01-01

    Diversity in the US population is increasing, and evaluating the quality of culturally sensitive hospice care is important. A survey design was used to collect data from 743 patients enrolled in hospice or their family members or caregivers. Race/ethnicity was not significantly associated with any of the hospice interventions or outcomes. Patients were less likely to be satisfied with the overall hospice care (OR = 0.23, 95% CI = 0.065-0.796, P = .021) compared to other type of respondents. Satisfaction with emotional support was substantially associated with the increased likelihood of satisfaction with pain management (OR = 3.82, 95% CI = 1.66-8.83, P = .002), satisfaction with other symptom management (OR = 6.17, 95% CI = 2.80-13.64, P < .001), and of overall satisfaction with hospice care (OR = 20.22, 95% CI = 8.64-47.35, P < .001). PMID:22952128

  3. Racial/ethnic perspectives on the quality of hospice care.

    PubMed

    Campbell, Cathy L; Baernholdt, Marianne; Yan, Guofen; Hinton, Ivora D; Lewis, Erica

    2013-06-01

    Diversity in the US population is increasing, and evaluating the quality of culturally sensitive hospice care is important. A survey design was used to collect data from 743 patients enrolled in hospice or their family members or caregivers. Race/ethnicity was not significantly associated with any of the hospice interventions or outcomes. Patients were less likely to be satisfied with the overall hospice care (OR = 0.23, 95% CI = 0.065-0.796, P = .021) compared to other type of respondents.  Satisfaction with emotional support was substantially associated with the increased likelihood of satisfaction with pain management (OR = 3.82, 95% CI = 1.66-8.83, P = .002), satisfaction with other symptom management (OR = 6.17, 95% CI = 2.80-13.64, P < .001), and of overall satisfaction with hospice care (OR = 20.22, 95% CI = 8.64-47.35, P < .001).

  4. The effect of pediatric knowledge on hospice care costs.

    PubMed

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

    2014-05-01

    The cost of hospice care is rising. Although providing care for children at end of life may be costly for hospices, it is unclear whether or not gaining pediatric knowledge and even establishing a pediatric program may be done cost effectively. The purpose of our study was to examine the effect of possessing pediatric knowledge (i.e., pediatric program, pediatric experience) on core hospice care costs. Using 2002 to 2008 California hospice data, the findings of the regression analysis suggest that having pediatric knowledge does not significantly increase nursing, physician, and medical social service costs. Having a pediatric program was related to increased counseling costs. Our findings shed important light on the minimal costs incurred when hospices decide to develop pediatric knowledge.

  5. African Americans and Hospice Care: A Narrative Analysis.

    PubMed

    Dillon, Patrick J; Roscoe, Lori A

    2015-01-01

    Recent studies suggest that terminally ill African Americans' care is generally more expensive and of lower quality than that of comparable non-Hispanic white patients. Scholars argue that increasing hospice enrollment among African Americans will help improve end-of-life care for this population, yet few studies have examined the experiences of African American patients and their loved ones after accessing hospice care. In this article, we explore how African American patients and lay caregivers evaluated their hospice experiences. Drawing from 39 in-depth interviews with 26 participants, we use a modified version of Bute and Jensen's (2011) narrative typology to organize patients' and caregivers' stories into three general categories: narratives of satisfaction, narratives of regret, and narratives of ambivalence. Building from these categories, we discuss the implications of this research for understanding hospice experiences, promoting hospice access, and improving end-of-life care for marginalized populations.

  6. 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.

  7. The psychological and physical health of hospice caregivers.

    PubMed

    Chentsova-Dutton, Y; Shuchter, S; Hutchin, S; Strause, L; Burns, K; Zisook, S

    2000-03-01

    This study explores the psychological distress of caring for a dying family member and examines the differences in depression, anxiety, health, social and occupational functioning, and social support among hospice caregivers and community controls. It compares psychological functioning of spousal and adult child hospice caregivers. Caregivers of terminally ill hospice patients were assessed prior to death as a part of a longitudinal bereavement study. Caregivers reported experiencing higher levels of depression, anxiety, anger, and health problems than controls. Hospice caregiving was associated with deterioration in physical health and in social and occupational functioning. The comparisons between adult children and spouse caregivers revealed that levels of psychological and physical morbidity were very similar for the two generations of caregivers. An awareness of distress symptoms among hospice caregivers could lead to timely proactive clinical intervention that may prevent bereavement complications.

  8. 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

  9. Pursuit of happiness as the CEO: the business of doing hospice business.

    PubMed

    Telli, Susan G

    2003-11-01

    The growth of hospice over the past 20 years has been rapid. Hospices have expanded staff and expanded services to meet increasing demand and a greater variety of patients. Hospice CEOs have had to spearhead these changes. This article presents the challenges that one hospice CEO has faced over her 20-year career.

  10. The ACTive Intervention in Hospice Interdisciplinary Team Meetings: Exploring family caregiver and hospice team communication.

    PubMed

    Wittenberg-Lyles, Elaine; Parker Oliver, Debra; Demiris, George; Baldwin, Paula

    2010-04-01

    This paper presents the theoretical framework and rationale for the ACTive intervention which proposes the use of video technology to facilitate patient and family participation in hospice interdisciplinary team meetings where plans of care are determined. It is surmised that patient and family involvement will improve communication and compliance in hospice care. An analysis of data from a pilot project of the ACTive intervention was conducted to explore active participation among family caregivers and the hospice team. Through the use of videophone technology caregivers participated in video-recorded team meetings. The actual communication behaviors of caregivers and team members were analyzed for active participation. Findings revealed that team-prompted caregiver participation was most common, however, team use of supportive talk in this context was considerably less frequent. The study also found that the team's use of active participation behaviors elicits caregiver active participation behaviors. The results of this study suggest the intervention was an effective way to involve family caregivers as active participants in the designing of care for their loved one. Findings also suggest that hospice staff would benefit from education and training on best practices for communicating with caregivers in the team meeting setting.

  11. The ACTive Intervention in Hospice Interdisciplinary Team Meetings: Exploring family caregiver and hospice team communication

    PubMed Central

    Wittenberg-Lyles, Elaine; Parker Oliver, Debra; Demiris, George; Baldwin, Paula

    2010-01-01

    This paper presents the theoretical framework and rationale for the ACTive intervention which proposes the use of video technology to facilitate patient and family participation in hospice interdisciplinary team meetings where plans of care are determined. It is surmised that patient and family involvement will improve communication and compliance in hospice care. An analysis of data from a pilot project of the ACTive intervention was conducted to explore active participation among family caregivers and the hospice team. Through the use of videophone technology caregivers participated in video-recorded team meetings. The actual communication behaviors of caregivers and team members were analyzed for active participation. Findings revealed that team–prompted caregiver participation was most common, however, team use of supportive talk in this context was considerably less frequent. The study also found that the team’s use of active participation behaviors elicits caregiver active participation behaviors. The results of this study suggest the intervention was an effective way to involve family caregivers as active participants in the designing of care for their loved one. Findings also suggest that hospice staff would benefit from education and training on best practices for communicating with caregivers in the team meeting setting. PMID:20543889

  12. 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

    ... Major Provisions C. Summary of Costs, Benefits, and Transfers II. Background A. Hospice Care B. History... Quality Reporting 4. Alternatives Considered C. Accounting Statement D. Conclusion 1. Regulatory... rate (Sec. 418.302(e)(4)). B. History of the Medicare Hospice Benefit Before the creation of the...

  13. An exploratory investigation of hospice marketing: How are palliative care providers marketing their services?

    PubMed

    Matthews, Michael; Peters, Cara; Lawson, Stephanie

    2017-01-01

    Hospice and palliative care is a recent, but fast growing, industry in healthcare. Demographics suggest that hospice care will only increase. The purpose of this article is to examine strategic marketing initiatives hospice organizations currently employ. Data were collected at a hospice regional conference, capturing opinions from hospice organizations located in North and South Carolina. The results show that many hospice organizations do not have a dedicated marketing staff person, have a limited marketing budget, do not fully utilize all strategic planning tools, and have yet to differentiate themselves via branding. Implications of these findings for hospice providers are discussed.

  14. The use of videophones for patient and family participation in hospice interdisciplinary team meetings: a promising approach.

    PubMed

    Parker Oliver, D; Demiris, G; Wittenberg-Lyles, E; Porock, D

    2010-11-01

    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. © 2009 The Authors. European Journal of Cancer Care © 2009 Blackwell Publishing Ltd.

  15. Physical function in hospice patients and physiotherapy interventions: a profile of hospice physiotherapy.

    PubMed

    Cobbe, Sinead; Kennedy, Norelee

    2012-07-01

    There is a dearth of international research on hospice physiotherapy. This study aims to profile hospice physiotherapy in an Irish setting in order to inform practice internationally. The study design consisted of a retrospective chart audit over 6 months. The study took place at a specialist palliative care inpatient unit (hospice) in Limerick, Ireland. All patients were discharged (through death or discharge onwards) from January to June 2010. The Edmonton Functional Assessment Tool (EFAT-2) was used as an outcome measure. Sixty-five percent were referred for physiotherapy; 58% (n=144) were assessed and treated. A wide range of patients was referred (mean functional score 11, range 1-23, SD 5). Rehabilitation activities were widespread: 48% with more than one functional score recorded made improvements; 53% of physiotherapy patients were eventually discharged home; 47% of physiotherapy patients died, of whom 52% received physiotherapy in the last week of life. The median physiotherapy program lasted 11 days (range 1-186, SD 22) whereas the median number of treatments was four (range 1-99, SD 10). The most common interventions were gait re-education (67%), transfer training (58%), and exercises (53%). One third of treatment attempts were unsuccessful because of the unavailability/unsuitability of patients. Challenges for physiotherapists included frequent suspension of treatment and large functional fluctuations in patients. There was a high referral rate to physiotherapy in this hospice. Functional changes in hospice patients were mapped, showing that physiotherapy involved both rehabilitative and quality of life/supportive measures. The most common treatments were physical activity interventions.

  16. A Model Academic Integrated Information Center.

    ERIC Educational Resources Information Center

    Adams, Carl; And Others

    1991-01-01

    Discusses three configurations that were developed for the Integrated Information Center (IIC) at the University of Minnesota. These configurations--basic, intermediate, and advanced--represent increasing sophistication of support capabilities, increasing costs, and possible stages of implementation, depending on the requirements of the academic…

  17. 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…

  18. A Model Learning Resource Center. Final Report.

    ERIC Educational Resources Information Center

    Crowley's Ridge Vocational Technical School, Forrest City, AR.

    Enrollees (aged 16-21) at Crowley's Ridge Vocational Technical School (Forrest City, Arkansas) had trouble mastering the vocational curriculum because they lacked academic skills in reading, mathematics, and language. Through research, it was determined that a Learning Resource Center could be the instructional tool that would remedy the academic…

  19. 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…

  20. 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…

  1. 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…

  2. Model photo reaction centers via genetic engineering

    SciTech Connect

    Zhiyu Wang; DiMagno, T.J.; Popov, M.; Norris, J.R. |; Chikin Chan; Fleming, G.; Jau Tang; Hanson, D.; Schiffer, M.

    1992-12-31

    A series of reaction centers of Rhodococcus capsulatus isolated from a set of mutated organisms modified by site-directed mutagenesis at residues M208 and L181 are described. Changes in the amino acid at these sites affect both the energetics of the systems as well as the chemical kinetics for the initial ET event. Two empirical relations among the different mutants for the reduction potential and the ET rate are presented.

  3. Model photo reaction centers via genetic engineering

    SciTech Connect

    Zhiyu Wang; DiMagno, T.J.; Popov, M.; Norris, J.R. Chicago Univ., IL . Dept. of Chemistry); Chikin Chan; Fleming, G. . Dept. of Chemistry); Jau Tang; Hanson, D.; Schiffer, M. )

    1992-01-01

    A series of reaction centers of Rhodococcus capsulatus isolated from a set of mutated organisms modified by site-directed mutagenesis at residues M208 and L181 are described. Changes in the amino acid at these sites affect both the energetics of the systems as well as the chemical kinetics for the initial ET event. Two empirical relations among the different mutants for the reduction potential and the ET rate are presented.

  4. Trends in length of hospice care from 1996 to 2007 and the factors associated with length of hospice care in 2007: findings from the National Home and Hospice Care Surveys.

    PubMed

    Sengupta, Manisha; Park-Lee, Eunice; Valverde, Roberto; Caffrey, Christine; Jones, Adrienne

    2014-06-01

    Using the National Home and Hospice Care Surveys, we examined trends in length of hospice care from 1996 to 2007 and the factors associated with length of care in 2007. Results suggest that the increasing average lengths of care over time reflect the increase in the longest duration of care. For-profit ownership is associated with hospice care received for over a year.

  5. Strategic groups and outcomes in the US hospice care industry.

    PubMed

    Kirby, Eric G

    2012-01-01

    As a result of a drastic increase in new patients, two major shifts are occurring in the US hospice care industry: an increase in the number of for-profit providers, and hospices are increasing in size through acquisitions and mergers. Hospices are trying to both increase the number of innovative programs they offer and decrease their operating expenses to improve their margins and attract more patients. This study seeks to investigate if strategic groups exist within the industry as hospices try to become more innovative and efficient, which grouping factors are most significant, and to determine whether there is a relationship between group membership and performance. Cluster analysis and ANOVA are used to analyze data from 93 California hospices. Three strategic groups exist within the market, innovative practices significantly affect group membership, and innovation-oriented groups outperform others in terms of quality of care. Many hospices focus on innovation, and evidence suggests that continued pursuit of innovative practices is critical, whereas efficiency does not appear to have a significant impact on quality of care. Focus on such evidence-based practices is important for long-term success. This is the first study to investigate strategic group formation in the hospice care industry.

  6. A personal exploration of the German hospice system.

    PubMed

    Farnon, C

    1996-01-01

    While on vacation in Germany, I explored the German hospice system and its differences from that in the United States. I conducted an informal survey asking 10 individuals who were not associated with hospice work, about end-of-life issues. Knowledge of the hospice movement and of advance directives was found to be quite low. Through contact with German hospice associations, I learned that the modern German hospice movement was inspired by the British example. After a difficult beginning, the German hospice system is growing steadily. Professional providers of end-of-life care are paid according to the traditional fee-for-service system. As suggested by the World Health Organization, pain management is provided according to the three-step analgesic ladder. Physician-assisted suicide is illegal as it is in the United States. A federal self-determination law has not yet been enacted. Overall, the German hospice system has many similarities and a few interesting dissimilarities with that in the United States.

  7. Family caregiver participation in hospice interdisciplinary team meetings: How does it affect the nature and content of communication?

    PubMed Central

    Wittenberg-Lyles, Elaine; Oliver, Debra Parker; Kruse, Robin L.; Demiris, George; Gage, L. A.; Wagner, Ken

    2012-01-01

    Collaboration between family caregivers and healthcare providers is necessary to ensure patient-centered care, especially for hospice patients. During hospice care, interdisciplinary team members meet bi-weekly to collaborate and develop holistic care plans that address the physical, spiritual, psychological, and social needs of patients and families. The purpose of this study was to explore team communication when video-conferencing is used to facilitate the family caregiver’s participation in a hospice team meeting. Video-recorded team meetings with and without family caregiver participation were analyzed for communication patterns using the Roter Interaction Analysis System. Standard meetings that did not include caregivers were shorter in duration and task-focused, with little participation from social workers and chaplains. Meetings that included caregivers revealed an emphasis on biomedical education and relationship-building between participants, little psychosocial counseling, and increased socio-emotional talk from social workers and chaplains. Implications for family participation in hospice team meetings are highlighted. PMID:22435889

  8. Frequency of outpatient antibiotic prescription on discharge to hospice care.

    PubMed

    Furuno, Jon P; Noble, Brie N; Horne, Kristi N; McGregor, Jessina C; Elman, Miriam R; Bearden, David T; Walsh, Eric W; Fromme, Erik K

    2014-09-01

    The use of antibiotics is common in hospice care despite limited evidence that it improves symptoms or quality of life. Patients receiving antibiotics upon discharge from a hospital may be more likely to continue use following transition to hospice care despite a shift in the goals of care. We quantified the frequency and characteristics for receiving a prescription for antibiotics on discharge from acute care to hospice care. This was a cross-sectional study among adult inpatients (≥18 years old) discharged to hospice care from Oregon Health & Science University (OHSU) from 1 January 2010 to 31 December 2012. Data were collected from an electronic data repository and from the Department of Care Management. Among 62,792 discharges, 845 (1.3%) patients were discharged directly to hospice care (60.0% home and 40.0% inpatient). Most patients discharged to hospice were >65 years old (50.9%) and male (54.6%) and had stayed in the hospital for ≤7 days (56.6%). The prevalence of antibiotic prescription upon discharge to hospice was 21.1%. Among patients discharged with an antibiotic prescription, 70.8% had a documented infection during their index admission. Among documented infections, 40.3% were bloodstream infections, septicemia, or endocarditis, and 38.9% were pneumonia. Independent risk factors for receiving an antibiotic prescription were documented infection during the index admission (adjusted odds ratio [AOR]=7.00; 95% confidence interval [95% CI]=4.68 to 10.46), discharge to home hospice care (AOR=2.86; 95% CI=1.92 to 4.28), and having a cancer diagnosis (AOR=2.19; 95% CI=1.48 to 3.23). These data suggest that a high proportion of patients discharged from acute care to hospice care receive an antibiotic prescription upon discharge.

  9. Support Center for Regulatory Atmospheric Modeling (SCRAM)

    EPA Pesticide Factsheets

    This technical site provides access to air quality models (including computer code, input data, and model processors) and other mathematical simulation techniques used in assessing air emissions control strategies and source impacts.

  10. The Sacred Heart Hospice: an Australian centre for palliative medicine.

    PubMed

    Stuart-Harris, R

    1995-09-01

    The Sacred Heart Hospice, Sydney, was founded in 1890 and is the largest inpatient palliative-care facility in Australia. Patients with advanced cancer form the predominant patient group, although patients with HIV/AIDS account for approximately 20% of admissions. A community-outreach service, established in 1983, cares for more patients at home than in the Hospice. Recently the Hospice has participated in a number of clinical trials and intends to become a regional centre for palliative-care research, education and training.

  11. 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

  12. Medicare's hospice benefit: analysis of utilization and resource use.

    PubMed

    Bogasky, Susan; Sheingold, Steven; Stearns, Sally C

    2014-01-01

    This work provides descriptive statistics on hospice users. It also explores the magnitude of relative resource use during hospice episodes and whether such patterns vary by episode length for patients who only use routine home care as compared to those who use multiple levels of hospice care. Examining resource use for hospice users who require different hospice levels of care within an episode versus solely routine home care provides insight to the varied resource use associated with the different patient populations (i.e., those who may require steady routine home care across the entire episode versus those who require varied levels of care across the episode). The analyses were based on a longitudinal analytic file that was constructed from 100% of Medicare claims for hospice users with completed episodes spanning September 1, 2008 through the end of calendar year 2011. In examining resource use for routine home care users and all levels of hospice care, the analyses were restricted to single episode decedents who began their hospice episode on or after April 1, 2010 and whose date of death was on or before December 31, 2011. Daily wage-weighted visit units (WWVUs) were calculated for each patient during their hospice stay. In order to compute a WWVU, one-fourth of the Bureau of Labor Statistics hourly wage rate for each visit discipline (i.e., skilled nursing, medical social services, home health aide, and an average for therapies) was multiplied by the corresponding number of visit units reported on hospice claims. Using enhanced data on the intensity of service use, the results confirm previous research that suggested a curved pattern to service use during a hospice episode. For several measures of resource intensity, service use is more intensive during the initial days in the episode and for the last few days prior to death relative to the middle days of the episode. The pattern becomes more pronounced as episodes increase in length, but is otherwise a

  13. Joining forces, joining futures: hospice at the crossroads.

    PubMed

    Pietroburgo, Julie

    2004-01-01

    Faced with health-policy changes, increased competition, and limited funding, hospices must either find more efficient ways to provide end-of-life care or risk organizational demise. Increasingly, hospices are re-evaluating their organizations to stretch resources and remain viable. Prevalent restructuring options for addressing environmental pressures are integration, alliance, and collaboration with other organizations. This study examines the restructuring phenomenon by evaluating trends among nonprofit hospices in six states. The study identifies demographic characteristics predictive of organizational decisions to join forces, and it examines the dominant political and economic reasons that propel or impede restructuring decisions. In addition, the study evaluates the results of restructuring actions.

  14. Progress in Valve Modeling at Stennis Space Center

    NASA Technical Reports Server (NTRS)

    Daines, Russell L.; Woods, Jody L.; Sulyma, Peter

    2003-01-01

    Understanding valve behavior will aid testing of rocket components at Stennis Space Center. The authors of this viewgraph presentation have developed a computational model for a cryogenic liquid control valve, and a gas pressure regulator valve. The model is a compressible/incompressible pressure-based FDNS code from Marshall Space Flight Center (MSFC). It is a k-epsilon turbulence model with wall functions.

  15. Joint Typhoon Warning Center (JTWC92) Model.

    DTIC Science & Technology

    1992-05-01

    model development, and model testing and implementation. The period of performance was September 15, 1989 through July 23, 1992. Progress was interrupted... testing and implementation. The period of performance was September 15, 1989 through July 23, 1992. Progress was interrupted between and within phases...NHC90 (Neumann and McAdie, 1991) models. Supporting documents delivered under separate covers were: Software Design Document, Software Test Plan, and

  16. Strategies to support spirituality in health care communication: a home hospice cancer caregiver case study.

    PubMed

    Reblin, Maija; Otis-Green, Shirley; Ellington, Lee; Clayton, Margaret F

    2014-12-01

    Although there is growing recognition of the importance of integrating spirituality within health care, there is little evidence to guide clinicians in how to best communicate with patients and family about their spiritual or existential concerns. Using an audio-recorded home hospice nurse visit immediately following the death of a patient as a case-study, we identify spiritually-sensitive communication strategies. The nurse incorporates spirituality in her support of the family by 1) creating space to allow for the expression of emotions and spiritual beliefs and 2) encouraging meaning-based coping, including emphasizing the caregivers' strengths and reframing negative experiences. Hospice provides an excellent venue for modeling successful examples of spiritual communication. Health care professionals can learn these techniques to support patients and families in their own holistic practice. All health care professionals benefit from proficiency in spiritual communication skills. Attention to spiritual concerns ultimately improves care. © The Author(s) 2014.

  17. Spouse cancer caregivers' burden and distress at entry to home hospice: The role of relationship quality.

    PubMed

    Reblin, Maija; Donaldson, Gary; Ellington, Lee; Mooney, Kathi; Caserta, Michael; Lund, Dale

    2016-08-01

    High-quality relationships may be protective for family caregivers. This study focuses on relationship quality categories (supportive and ambivalent) in spouse caregivers in cancer home hospice. The goals of this article are to, first, describe relationship quality categories among end-of-life caregivers and, second, test the effects of relationship quality categories on caregiver burden and distress within a stress process model. Using questionnaire data collected at entry to home hospice, we found relationship quality categories were proportionally similar to those seen in noncaregiver older adults. Relationship quality significantly predicted caregiver burden, which completely mediated the relationship between caregiver relationship quality and distress. Caregivers whose social contexts place them at risk for greater distress may benefit from increased clinical attention or intervention.

  18. Assessing Caregivers for Team Interventions (ACT): A New Paradigm for Comprehensive Hospice Quality Care

    PubMed Central

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

    2009-01-01

    This article provides a framework labeled ACT that aims to successfully integrate family caregivers and patients into one unit of care, as dictated by the hospice philosophy. ACT (assessing caregivers for team interventions) is based on the ongoing assessment of the caregiver background context, primary, secondary, and intrapsychic stressors as well as outcomes of the caregiving experience and subsequently, the design and delivery of appropriate interventions to be delivered by the hospice interdisciplinary team. Interventions have to be tailored to a caregiver’s individual needs; such a comprehensive needs assessment allows teams to customize interventions recognizing that most needs and challenges cannot be met by only one health care professional or only one discipline. The proposed model ensures a holistic approach to address the multifaceted challenges of the caregiving experience. PMID:19116302

  19. Hospice care in a commercial preferred provider organization population in Tennessee.

    PubMed

    Coulter, Steven L; Melvin, Terry; Carden, J Payne; Mathis, Rick S

    2015-03-01

    This study was undertaken to examine two aspects of care at the end of life. First, we wanted to see whether the cost savings demonstrated repeatedly in the US Medicare hospice population would also be observed in a commercial population in Tennessee. They were. The second primary interest we had was whether there were certain medical services that seemed to presage death. We found four categories of services that profoundly increase in number as the end of life is approached: primary care, hospital-based specialist, non-hospital based specialist, and oncologist services. It is hoped that these findings could lead to a simple predictive model based on readily available claims data to help identify candidates for Hospice Care earlier.

  20. Model Validation | Center for Cancer Research

    Cancer.gov

    Research Investigation and Animal Model Validation This activity is also under development and thus far has included increasing pathology resources, delivering pathology services, as well as using imaging and surgical methods to develop and refine animal models in collaboration with other CCR investigators.

  1. 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.

  2. 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…

  3. The Converging Literacies Center: An Integrated Model for Writing Programs

    ERIC Educational Resources Information Center

    Carter, Shannon; Dunbar-Odom, Donna

    2009-01-01

    The Converging Literacies Center (CLiC) is a deeply integrated model for writing programs, bringing together the writing center, first-year writing, basic writing, professional development activities, graduate coursework, and research activities to re-imagine and support twenty-first-century literacies. What is unique about CLiC is not merely the…

  4. What Makes a Comprehensive School Reform Model Learner Centered?

    ERIC Educational Resources Information Center

    McCombs, Barbara L.; Quiat, Melinda

    2002-01-01

    Surveyed urban elementary students and teachers, noting whether implementing the Community for Learning (CFL) model would meet the criterion of being learner centered and result in positive changes and whether teachers identified as implementing the CFL program to a high degree had high scores on a learner-centered rubric. There were some highly…

  5. Two dimensional thick center vortex model

    SciTech Connect

    Rafibakhsh, Shahnoosh; Ahmadi, Alireza

    2016-01-22

    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.

  6. 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.

  7. 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.

  8. Terminally Ill Obese People Less Likely to Get Hospice Care

    MedlinePlus

    ... about how obesity shapes late-life care, including nursing home care, hospice use and end-of-life care." ... 40. Body mass index (BMI) is a rough measure of a person's body fat based on height ...

  9. 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)

  10. Use of electronic documentation for quality improvement in hospice.

    PubMed

    Cagle, John G; Rokoske, Franziska S; Durham, Danielle; Schenck, Anna P; Spence, Carol; Hanson, Laura C

    2012-01-01

    Little evidence exists about the use of electronic documentation (ED) in hospice and its relationship to quality improvement (QI) practices. The purposes of this study were to (1) estimate the prevalence of ED use in hospice, (2) identify organizational characteristics associated with use of ED, and (3) determine whether quality measurement practices differed based on documentation format (electronic vs nonelectronic). Surveys concerning the use of ED for QI practices and the monitoring of quality-related care and outcomes were collected from 653 hospices. Users of ED were able to monitor a wider range of quality-related data than users of non-ED. Quality components such as advanced care planning, cultural needs, experience during care of the actively dying, and the number/types of care being delivered were more likely to be documented by users of ED. Use of ED may help hospices monitor quality and compliance.

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. Do not go gentle: intractable value differences in hospices.

    PubMed

    Harmer, Brian M

    2006-01-01

    As hospices have evolved and grown, from small community-based cottage institutions to larger and more complex healthcare providers, they have begun to acquire staff with characteristics that are significantly different from those of their founding members. Because the timeline of the modern hospice movement is so short, many still have founding members at work, and institutions find themselves employing people with diverse aspirations and motivations. Such value differences would normally be a sufficient basis for conflict in most organizations. In the particular context of hospices, and perhaps other healthcare institutions, such conflict often goes underground, as each protagonist tries to live up to its image of what is appropriate. This narrative research, based in five New Zealand hospices, explores the problem of hidden but unresolved tensions and suggests some possible avenues for management involvement.

  16. Examining variables related to successful collaboration on the hospice team.

    PubMed

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

    2005-11-01

    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 high level of interdisciplinary collaboration with colleagues. Whereas education, hospice census, the presence of other social workers, and quality of care were found to be unrelated to overall levels of collaboration, individual items measuring collaboration proved to be linked with hospice census, the presence of other social workers on the team, and quality of care. Further research is required to investigate other possible related variables and their impact on successful interdisciplinary collaboration and service delivery.

  17. Finding Peace Beyond the Pain: Sunder's Journey in the Hospice.

    PubMed

    Rao, Seema

    2016-09-01

    Dame Cicely Saunders revolutionized the concept of pain by coining the term "total pain", the sum of the physical, psychological, social, spiritual, emotional components that make up the total pain experience. Optimal pain relief may not be possible until all elements of the pain and suffering are addressed. This narrative describes the journey of Sunder in the hospice. A caring husband, and a doting father, he came to the hospice by force, in immense pain and suffering. He stayed on by choice and found the peace he was looking for beyond his pain and sufferings, ably supported by the dedicated hospice team. He was able to live the last few months of his life as comfortably as was possible, and left this world in peace, with dignity. The narrative reiterates the belief that hospice, with its philosophy of active "total care" is an ideal place for addressing the concept of "total pain."

  18. 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

  19. 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)

  20. Quality of Hospice Care: Comparison between Rural and Urban Residents

    PubMed Central

    Baernholdt, Marianne; Campbell, Cathy L.; Hinton, Ivora D.; Yan, Guofen; Lewis, Erica

    2015-01-01

    Discrepancies between needed and received hospice care exist especially in rural areas. Hospice care quality ratings for 743 rural and urban patients and families were compared. Rural participants reported higher overall satisfaction and with pain/symptom management. Regardless of geographic location, satisfaction was higher when patients were informed and emotionally supported. Patients and family ratings did not differ. Findings support prior reports using retrospective rather than our study’s point-of care surveys. PMID:25546093

  1. 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.

  2. Trivial center element and Coulombic potential of the thick center vortex model

    NASA Astrophysics Data System (ADS)

    Ahmadi, Alireza; Rafibakhsh, Shahnoosh

    2017-01-01

    The thick center vortex potentials in the SU(3) gauge group have been calculated by means of the modified inter-quark potential which consists of two terms. One term is the result of the area law fall-off for the large Wilson loop which leads to the linear potentials. The second term represents vacuum fluctuations leading to the perimeter law fall-off believed to contain the trivial center element. We introduce a new Gaussian flux limited to vary in a finite region of space which causes the corresponding group factor to have only some small deviations from the trivial center element. So, this flux increases the role of the trivial center element and W0 is enhanced in the induced potential of the model at small quark separations. Using both trivial and non-trivial center elements in the potential between static color sources, results in the correct 3-ality dependence at large quark separations and a very good agreement with Casimir scaling at short and intermediate distances. In fact, the ratios of the potential of each representation to that of the fundamental one have been improved - in comparison with the previous work on the short distance potentials, remarkably. So, one might use the thick center vortex model to describe the inter-quark potential of every regime.

  3. Organizational Barriers to Cultural Competence in Hospice.

    PubMed

    Reese, Dona J; Beckwith, Samira K

    2015-11-01

    This national mixed method study with directors of 207 hospices identified major barriers to cultural competence, including (1) lack of funding for additional staff for community outreach or development of culturally competent programs, (2) lack of applications from diverse professionals, and (3) lack of knowledge about diverse cultures and what cultural groups in the community are not being served. Qualitative results indicated that elements of an organizational culture, which create barriers to access included (1) failure to prioritize cultural competence, (2) failure to budget for culturally competent services, and (3) a staff that does not value awareness of cultural differences, is uncomfortable with diversity, and stereotypes diverse individuals. In phase 2, an interactive session with a 100-symposium audience provided strategies to address the barriers.

  4. Compassion Fatigue and Compassion Satisfaction in Hospice Social Work.

    PubMed

    Pelon, Sally B

    2017-01-01

    As part of the interprofessional team of hospice caregivers, social workers are exposed to multiple stressors, both in their work with dying patients and their families and in functioning as professionals within rapidly changing health care organizations. Ongoing exposure to such stressors prompts concern about the emotional and psychological effect working with people who are dying may have on those who do it. Further, an understanding is needed regarding how hospice social workers interpret the costs and benefits of their work and how they cope with the dying and loss that pervade their everyday work lives. This descriptive, cross-sectional study explored the prevalence of compassion fatigue among hospice social workers and considered compassion satisfaction as a means to mitigate compassion fatigue. Fifty-five hospice social workers from 34 hospice organizations in Michigan completed an online survey. Results suggested that compassion fatigue is indeed a concern among hospice social workers. In addition, compassion fatigue and compassion satisfaction were found to be negatively correlated and suggested that compassion satisfaction may act as a protective mechanism against compassion fatigue. These results may provide insight regarding how best to mitigate this professional hazard in end-of-life social work.

  5. Characterizing care of hospice patients in the hospital setting.

    PubMed

    Olsen, Molly L; Bartlett, Ann L; Moynihan, Timothy J

    2011-02-01

    One measure of quality hospice care is minimization of hospitalization. Few studies have explored reasons for hospitalization and characteristics of care received by hospice patients in the hospital. To characterize the experience of hospice patients in the hospital and determine factors associated with high intensiveness of care. Retrospective review of patient medical records in the Mayo Hospice Program in 2007. Of 263 hospice patients, 17% were hospitalized in 2007. Of those hospitalized, 42% percent died in the hospital. Average length of stay was 4 days. Almost half were admitted through the emergency department. Common reasons for admission included delirium, pain, and falls. Most patients (52%) received care of a moderate level of intensity, with 18% receiving the most intensive level of care. Receiving care of high intensity was associated with emergency department admission. Charges to patient accounts averaged over $9,000 per stay. Concordance of care in the hospital to preexisting patient goals was high, but could not be determined in 39% of cases due to lack of documentation of patient goals. Hospitalization of hospice patients is costly to the health care system. Most care was of low or moderate intensiveness. Quality improvements focusing on concise communication of patient goals and prevention of pain, delirium, and falls have the potential for the greatest impact on reducing hospitalizations and minimizing care that is discordant with patient goals.

  6. [Experience of Spiritual Conflict in Hospice Nurses: A Phenomenological Study].

    PubMed

    Lee, Byoung Sook; Kwak, Su Young

    2017-02-01

    This aim of this phenomenological study was to describe and understand the experience of spiritual conflict in hospice nurses by identifying the meanings and structures of the experience. Participants were 12 nurses working for one year or more at hospice units of general hospitals in a metropolitan city and experiencing of spiritual conflict as hospice nurses. Over six months data were collected using individual in-depth interviews and analyzed with the method suggested by Colaizzi. The experience of spiritual conflict in participants was organized into three categories, six theme-clusters, and 13 themes. The participants felt existential anxiety on death and a fear of death which is out of human control and skepticism for real facts of human beings facing death. They also experienced agitation of fundamental beliefs about life with agitation of the philosophy of life guiding themselves and mental distress due to fundamental questions that are difficult to answer. Also they had distress about poor spiritual care with guilty feelings from neglecting patients' spiritual needs and difficulties in spiritual care due to lack of practical competencies. Findings indicate the experience of spiritual conflict in hospice nurses is mainly associated with frequent experience of death in hospice patients. The experience of spiritual conflict consisted of existential anxiety, agitation of fundamental beliefs and distress over poor spiritual care. So, programs to help relieve anxiety, agitation and distress are necessary to prevent spiritual conflict and then spiritual burnout in hospice nurses.

  7. Examining ethical dilemmas as obstacles to hospice and palliative care for advanced cancer patients.

    PubMed

    Daugherty, Christopher K

    2004-01-01

    Oncologists deal almost exclusively with patients with serious and life-threatening diseases, many who are terminally ill. While hospice care remains an ideal model of care for cancer patients with life-ending disease, many obstacles are present in the clinical setting that either impede or prevent the otherwise appropriate referral of patients eligible for this type of end-of-life care. These obstacles are best viewed as ethical dilemmas for oncology clinicians, as they often challenge or obscure a clinician's perceptions about what is in the best interests of their advanced cancer patients. These dilemmas include: Issues surrounding prognosis determination and communication, Concerns about effectively communicating a terminal prognosis while still allowing patients and families to maintain hope, Conflicts of interests for involved clinicians and, Potential problems of the current reimbursement mechanisms for hospice which may be inadequate to meet the needs of all dying cancer patients. For oncologists caring for advanced cancer patients, it is essential that they have a working knowledge regarding these ethical issues, and overt dilemmas, present in end-of-life cancer care in order that they might better appreciate how, and when, to initiate palliative and hospice care for as many of their patients as possible.

  8. Voices of resilience: older adults in hospice care.

    PubMed

    Nelson-Becker, Holly B

    2006-01-01

    Terminally ill older adults have the capacity to live well in the context of dying. Having negotiated a lifetime of challenges, they have resources to demonstrate resilience and achieve wholeness in life's final phase, but research has not adequately investigated this process. This qualitative research study considered the paths to resilience used by 30 older adult hospice clients in Kansas and Illinois. Responses were coded using the grounded theory method of Strauss and Corbin (1990) where data drives interpretation and text is coded into categories. Results centered on four themes that included: (1) a redefinition of self; (2) use of religion/spirituality or openness to uncertainty; (3) maintenance of social investments; and (4) guarding independence even as the scope of life contracted. Results imply that attention should be paid to building environments of wellness. This may be accomplished paradoxically through facilitating continuity of client interests and yet opportunities for creativity and growth as well. Listening with a healing stance and cultivating a habit of being fully present in interactions with clients assist in this process.

  9. Development of Models for Regional Cardiac Surgery Centers

    PubMed Central

    Park, Choon Seon; Park, Nam Hee; Sim, Sung Bo; Yun, Sang Cheol; Ahn, Hye Mi; Kim, Myunghwa; Choi, Ji Suk; Kim, Myo Jeong; Kim, Hyunsu; Chee, Hyun Keun; Oh, Sanggi; Kang, Shinkwang; Lee, Sok-Goo; Shin, Jun Ho; Kim, Keonyeop; Lee, Kun Sei

    2016-01-01

    Background This study aimed to develop the models for regional cardiac surgery centers, which take regional characteristics into consideration, as a policy measure that could alleviate the concentration of cardiac surgery in the metropolitan area and enhance the accessibility for patients who reside in the regions. Methods To develop the models and set standards for the necessary personnel and facilities for the initial management plan, we held workshops, debates, and conference meetings with various experts. Results After partitioning the plan into two parts (the operational autonomy and the functional comprehensiveness), three models were developed: the ‘independent regional cardiac surgery center’ model, the ‘satellite cardiac surgery center within hospitals’ model, and the ‘extended cardiac surgery department within hospitals’ model. Proposals on personnel and facility management for each of the models were also presented. A regional cardiac surgery center model that could be applied to each treatment area was proposed, which was developed based on the anticipated demand for cardiac surgery. The independent model or the satellite model was proposed for Chungcheong, Jeolla, North Gyeongsang, and South Gyeongsang area, where more than 500 cardiac surgeries are performed annually. The extended model was proposed as most effective for the Gangwon and Jeju area, where more than 200 cardiac surgeries are performed annually. Conclusion The operation of regional cardiac surgery centers with high caliber professionals and quality resources such as optimal equipment and facility size, should enhance regional healthcare accessibility and the quality of cardiac surgery in South Korea. PMID:28035295

  10. Development and assessment of a biotechnology workforce development center model

    NASA Astrophysics Data System (ADS)

    Huxley, Mary Pat

    Life science and biotechnology companies are the fastest growing industries in the nation, with more than 30% of these companies and close to 50% of the nation's life science workers located in California. The need for well-trained biotechnology workers continues to grow. Educational institutions and industry professionals have attempted to create the training and the workforce for the bioscience and biotechnology industry. Many have concluded that one way would be to create a multiuse training center where trainees from high school age through late adulthood could receive up-to-date training. This case study had 2 unique phases. Phase 1 consisted of examining representative stakeholder interview data for characteristics of an ideal biotechnology shared-use regional education (B-SURE) center, which served as the basis for an assessment tool, with 107 characteristics in 8 categories. This represented what an ideal center model should include. Phase 2 consisted of using this assessment tool to gather data from 6 current biotechnology regional centers to determine how these centers compared to the ideal model. Results indicated that each center was unique. Although no center met all ideal model characteristics, the 6 centers could clearly be ranked. Recommendations include refining the core characteristics, further assessing the existing and planned centers; evaluating and refining the interview instrument in Phase 1 and the assessment tool in Phase 2 by including additional stakeholders in both phases and by adding reviewers of Phase 1 transcripts; and determining a method to demonstrate a clear return on investment in a B-SURE center.

  11. Medicare program; FY 2014 hospice wage index and payment rate update; hospice quality reporting requirements; and updates on payment reform. final rule.

    PubMed

    2013-08-07

    This final rule updates the hospice payment rates and the wage index for fiscal year (FY) 2014, and continues the phase out of the wage index budget neutrality adjustment factor (BNAF). Including the FY 2014 15 percent BNAF reduction, the total 5 year cumulative BNAF reduction in FY 2014 will be 70 percent. The BNAF phase-out will continue with successive 15 percent reductions in FY 2015 and FY 2016. This final rule also clarifies how hospices are to report diagnoses on hospice claims, and provides updates to the public on hospice payment reform. Additionally, this final rule changes the requirements for the hospice quality reporting program by discontinuing currently reported measures and implementing a Hospice Item Set with seven National Quality Forum (NFQ) endorsed measures beginning July 1, 2014, as proposed. Finally, this final rule will implement the hospice Experience of Care Survey on January 1, 2015, as proposed.

  12. 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.

  13. Current reinforcement model reproduces center-in-center vein trajectory of Physarum polycephalum.

    PubMed

    Akita, Dai; Schenz, Daniel; Kuroda, Shigeru; Sato, Katsuhiko; Ueda, Kei-Ichi; Nakagaki, Toshiyuki

    2017-06-01

    Vein networks span the whole body of the amoeboid organism in the plasmodial slime mould Physarum polycephalum, and the network topology is rearranged within an hour in response to spatio-temporal variations of the environment. It has been reported that this tube morphogenesis is capable of solving mazes, and a mathematical model, named the 'current reinforcement rule', was proposed based on the adaptability of the veins. Although it is known that this model works well for reproducing some key characters of the organism's maze-solving behaviour, one important issue is still open: In the real organism, the thick veins tend to trace the shortest possible route by cutting the corners at the turn of corridors, following a center-in-center trajectory, but it has not yet been examined whether this feature also appears in the mathematical model, using corridors of finite width. In this report, we confirm that the mathematical model reproduces the center-in-center trajectory of veins around corners observed in the maze-solving experiment. © 2017 Japanese Society of Developmental Biologists.

  14. Transition to Operations Support at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Hesse, M.

    2005-01-01

    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, as well as distributed computing facilities provided by the US Air Force. CCMC also provides, to the research community, access to state-of-the-art space research models. This paper will focus on a status report on CCMC activities in support of model transition to operations at US space weather forecasting centers. In particular, an update will be given on past and present transition activities, on developments that address operational needs, and on future opportunities for transition-to-operations support.

  15. Vocabulary and Experiences to Develop a Center of Mass Model

    NASA Astrophysics Data System (ADS)

    Kaar, Taylor; Pollack, Linda B.; Lerner, Michael E.; Engels, Robert J.

    2017-10-01

    The use of systems in many introductory courses is limited and often implicit. Modeling two or more objects as a system and tracking the center of mass of that system is usually not included. Thinking in terms of the center of mass facilitates problem solving while exposing the importance of using conservation laws. We present below three laboratory activities that build this systems thinking for introductory physics students.

  16. 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)

  17. Hospitals Vary in Moving Stroke Patients to Comfort or Hospice Care

    MedlinePlus

    ... news/fullstory_165954.html Hospitals Vary in Moving Stroke Patients to Comfort or Hospice Care Study found ... differ greatly in how often they move new stroke patients from treatment to comfort or hospice care, ...

  18. A Model Vocational Evaluation Center in a Public School System.

    ERIC Educational Resources Information Center

    Quinones, Wm. A.

    A model public school vocational evaluation center for handicapped students is described. The model's battery of work samples and tests of vocational aptitudes, personal and social adjustment, physical capacities, and work habits are listed. In addition, observation of such work behaviors as remembering instructions, correcting errors, reacting to…

  19. A Model Vocational Evaluation Center in a Public School System.

    ERIC Educational Resources Information Center

    Quinones, Wm. A.

    A model public school vocational evaluation center for handicapped students is described. The model's battery of work samples and tests of vocational aptitudes, personal and social adjustment, physical capacities, and work habits are listed. In addition, observation of such work behaviors as remembering instructions, correcting errors, reacting to…

  20. 25. CURRENT METERS: GURLEY MODEL NO. 665 AT CENTER, GURLEY ...

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

    25. CURRENT METERS: GURLEY MODEL NO. 665 AT CENTER, GURLEY MODEL NO. 625 'PYGMY' CURRENT METER AT LEFT, AND WES MINIATURE PRICE-TYPE CURRENT METER AT RIGHT. - Waterways Experiment Station, Hydraulics Laboratory, Halls Ferry Road, 2 miles south of I-20, Vicksburg, Warren County, MS

  1. New Teacher Center Induction Model. What Works Clearinghouse Intervention Report

    ERIC Educational Resources Information Center

    What Works Clearinghouse, 2015

    2015-01-01

    The "New Teacher Center (NTC) Induction Model" is a systemic approach to support beginning teachers (i.e., teachers new to the profession). Based on the research, the "NTC Induction Model" was found to have no discernible effects on teacher retention in the school district, teacher retention in the profession, or teacher…

  2. Space Weather Products at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Hesse, Michael; Kuznetsova, M.; Pulkkinen, A.; Maddox, M.; Rastaetter, L.; Berrios, D.; MacNeice, P.

    2010-01-01

    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. The second CCMC activity is to support Space Weather forecasting at national Space Weather Forecasting Centers. This second activity involves model evaluations, model transitions to operations, and the development of space weather forecasting tools. Owing to the pace of development in the science community, new model capabilities emerge frequently. Consequently, space weather products and tools involve not only increased validity, but often entirely new capabilities. This presentation will review the present state of space weather tools as well as point out emerging future capabilities.

  3. Customer-centered careflow modeling based on guidelines.

    PubMed

    Huang, Biqing; Zhu, Peng; Wu, Cheng

    2012-10-01

    In contemporary society, customer-centered health care, which stresses customer participation and long-term tailored care, is inevitably becoming a trend. Compared with the hospital or physician-centered healthcare process, the customer-centered healthcare process requires more knowledge and modeling such a process is extremely complex. Thus, building a care process model for a special customer is cost prohibitive. In addition, during the execution of a care process model, the information system should have flexibility to modify the model so that it adapts to changes in the healthcare process. Therefore, supporting the process in a flexible, cost-effective way is a key challenge for information technology. To meet this challenge, first, we analyze various kinds of knowledge used in process modeling, illustrate their characteristics, and detail their roles and effects in careflow modeling. Secondly, we propose a methodology to manage a lifecycle of the healthcare process modeling, with which models could be built gradually with convenience and efficiency. In this lifecycle, different levels of process models are established based on the kinds of knowledge involved, and the diffusion strategy of these process models is designed. Thirdly, architecture and prototype of the system supporting the process modeling and its lifecycle are given. This careflow system also considers the compatibility of legacy systems and authority problems. Finally, an example is provided to demonstrate implementation of the careflow system.

  4. 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

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

    PubMed

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

    2015-06-01

    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. 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. A national cross-sectional survey of a random sample of hospices (n = 591; 84% response rate) from September 2008 to November 2009. 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 6.38; 95% CI 3.40, 11.99) and for-profit hospices had lower odds of employing a CAM therapist compared with nonprofit hospices (adjusted odds ratio 0.52; 95% CI 0.32, 0.85). Forty-four percent of hospices in the Mountain/Pacific region reported employing a CAM therapist vs. 17% in the South Central region. 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. Published by Elsevier Inc.

  6. Short distance potential and the thick center vortex model

    SciTech Connect

    Deldar, S.; Rafibakhsh, S.

    2009-09-01

    The short distance potentials between heavy SU(3) and SU(4) sources are calculated by increasing the role of vortex fluxes piercing Wilson loops with contributions close to the trivial center element and by fluctuating the vortex core size in the model of thick center vortices. By this method, a Coulombic potential consistent with Casimir scaling is obtained. In addition, all other features of the potential, including a linear intermediate potential in agreement with Casimir scaling and a large distance potential proportional to the N-ality of the representation, are restored. Therefore, the model of thick center vortices may be used as a phenomenological model, which is able to describe the potential for all regimes.

  7. 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…

  8. 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... SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.28 Revoking the election of hospice care. (a) An individual or representative may revoke the...

  9. 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…

  10. 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…

  11. 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...

  12. 78 FR 26250 - Payment for Home Health Services and Hospice Care to Non-VA Providers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-06

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and Hospice Care to Non-VA Providers... services and hospice care. Because the newly applicable methodology cannot supersede rates for which VA has specifically contracted, this rulemaking will only affect home health and hospice care providers who do...

  13. 76 FR 26805 - Medicare Program; Hospice Wage Index for Fiscal Year 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-09

    .... Finally, this proposed rule would begin implementation of a hospice quality reporting program. DATES... CONTACT: For information regarding ``Quality Reporting for Hospices'' and ``Collection of Information... Employee 3. Timeframe for Face-to-Face Encounters 4. Hospice Aide and Homemaker Services E....

  14. 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…

  15. 42 CFR 418.28 - Revoking the election of hospice care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Revoking the election of hospice care. 418.28... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.28 Revoking the election of hospice care. (a) An individual or representative may revoke...

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE... hospice and other care options. In addition, the services may include advising the individual regarding advanced care planning. (3) Provision of pre-election hospice services. (i) The services must be...

  17. 42 CFR 418.21 - Duration of hospice care coverage-Election periods.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Duration of hospice care coverage-Election periods... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.21 Duration of hospice care coverage—Election periods. (a) Subject to...

  18. 42 CFR 418.28 - Revoking the election of hospice care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Revoking the election of hospice care. 418.28... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.28 Revoking the election of hospice care. (a) An individual or representative may revoke...

  19. 42 CFR 418.205 - Special requirements for hospice pre-election evaluation and counseling services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE... hospice and other care options. In addition, the services may include advising the individual regarding advanced care planning. (3) Provision of pre-election hospice services. (i) The services must be...

  20. 42 CFR 418.21 - Duration of hospice care coverage-Election periods.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Duration of hospice care coverage-Election periods... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.21 Duration of hospice care coverage—Election periods. (a) Subject to...

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

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 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. 42 CFR 418.28 - Revoking the election of hospice care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Revoking the election of hospice care. 418.28... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.28 Revoking the election of hospice care. (a) An individual or representative may revoke...

  3. 42 CFR 418.205 - Special requirements for hospice pre-election evaluation and counseling services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE... hospice and other care options. In addition, the services may include advising the individual regarding advanced care planning. (3) Provision of pre-election hospice services. (i) The services must be...

  4. 42 CFR 418.28 - Revoking the election of hospice care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Revoking the election of hospice care. 418.28... SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.28 Revoking the election of hospice care. (a) An individual or representative may revoke the...

  5. 42 CFR 418.21 - Duration of hospice care coverage-Election periods.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Duration of hospice care coverage-Election periods... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.21 Duration of hospice care coverage—Election periods. (a) Subject to...

  6. 42 CFR 418.312 - Data submission requirements under the hospice quality reporting program.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Payment for Hospice Care § 418.312 Data submission requirements under the hospice quality reporting program. (a... 42 Public Health 3 2014-10-01 2014-10-01 false Data submission requirements under the...

  7. 77 FR 34363 - Disability and Rehabilitation Research Projects and Centers Program; Traumatic Brain Injury Model...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-11

    ... Disability and Rehabilitation Research Projects and Centers Program; Traumatic Brain Injury Model Systems... Program--Disability Rehabilitation Research Project (DRRP)-- Traumatic Brain Injury Model Systems Centers... priority for Traumatic Brain Injury Model Systems (TBIMS) Centers. The Assistant Secretary may use...

  8. The Provision of Spiritual Care in Hospices: A Study in Four Hospices in North Rhine-Westphalia.

    PubMed

    Walker, Andreas; Breitsameter, Christof

    2017-04-25

    This article considers the role and the practices of spiritual care in hospices. While spiritual care was firmly established as one of the four pillars of practical hospice care alongside medical, psychological and social care by Cicely Saunders, the importance and functions of spiritual care in daily practice remain arguable. When speaking about spirituality, what are we actually speaking about? What form do the spiritual relations take between full-time staff and volunteers on the one hand, and the patients and their family members on the other? These were central questions of a qualitative study that we carried out in four hospices in North Rhine-Westphalia, Germany, to explore how spiritual care is provided in hospices and what significance spirituality has in hospices. The study shows that the advantages of a broader definition of spirituality lie in "spiritual care" no longer being bound to one single profession, namely that of the chaplain. It also opens the way for nurses and volunteers-irrespective of their own religious beliefs-to provide spiritual end-of-life care to patients in hospices. If the hospice nurses and volunteers were able to mitigate the patients' fear not only by using medications but also in a psychosocial or spiritual respect, then they saw this as a successful psychological and spiritual guidance. The spiritual guidance is to some degree independent of religious belief because it refers to a "spirit" or "inner core" of human beings. But this guidance needs assistance from professional knowledge considering religious rituals if the patients are deeply rooted in a (non-Christian) religion. Here, the lack of knowledge could be eliminated by further education as an essential but not sufficient condition.

  9. A Problem Solving Intervention for hospice caregivers: a pilot study.

    PubMed

    Demiris, George; Oliver, Debra Parker; Washington, Karla; Fruehling, Lynne Thomas; Haggarty-Robbins, Donna; Doorenbos, Ardith; Wechkin, Hope; Berry, Donna

    2010-08-01

    The Problem Solving Intervention (PSI) is a structured, cognitive-behavioral intervention that provides people with problem-solving coping skills to help them face major negative life events and daily challenges. PSI has been applied to numerous settings but remains largely unexplored in the hospice setting. The aim of this pilot study was to demonstrate the feasibility of PSI targeting informal caregivers of hospice patients. We enrolled hospice caregivers who were receiving outpatient services from two hospice agencies. The intervention included three visits by a research team member. The agenda for each visit was informed by the problem-solving theoretical framework and was customized based on the most pressing problems identified by the caregivers. We enrolled 29 caregivers. Patient's pain was the most frequently identified problem. On average, caregivers reported a higher quality of life and lower level of anxiety postintervention than at baseline. An examination of the caregiver reaction assessment showed an increase of positive esteem average and a decrease of the average value of lack of family support, impact on finances, impact on schedules, and on health. After completing the intervention, caregivers reported lower levels of anxiety, improved problem solving skills, and a reduced negative impact of caregiving. Furthermore, caregivers reported high levels of satisfaction with the intervention, perceiving it as a platform to articulate their challenges and develop a plan to address them. Findings demonstrate the value of problem solving as a psycho-educational intervention in the hospice setting and call for further research in this area.

  10. Question asking by family caregivers in hospice interdisciplinary team meetings.

    PubMed

    Wittenberg-Lyles, Elaine; Oliver, Debra Parker; Demiris, George; Washington, Karla T; Regehr, Kelly; Wilder, Heidi M

    2010-04-01

    This article reports findings from a pilot study that enabled family caregivers to use videophone technology to participate in hospice interdisciplinary team meetings. The goal of the study was to ascertain which issues were important to caregivers and the hospice team. A qualitative content analysis of video-recorded team meetings between team members and caregivers was conducted. In a sample of 12 caregivers in 36 discussions, caregivers asked a total of 137 questions, with the majority being Yes/No questions (45.1%), primarily used to seek clarification (19.6%). Hospice staff asked 396 questions, with the majority consisting of Yes/No questions (66.5%), mainly used to ask about the overall condition of the patient (22.2%). Data from this study suggest that when given the opportunity to participate in hospice team meetings, caregivers will ask questions of hospice staff. In addition, in light of prior research, this study's findings suggest that caregivers may have questions that go unaddressed, specifically regarding pain and medication. Copyright 2010, SLACK Incorporated.

  11. Advance Directives in Hospice Healthcare Providers: A Clinical Challenge.

    PubMed

    Luck, George R; Eggenberger, Terry; Newman, David; Cortizo, Jacqueline; Blankenship, Derek C; Hennekens, Charles H

    2017-08-07

    On a daily basis, healthcare providers, especially those dealing with terminally ill patients, such as hospice workers, witness how advance directives help ensure the wishes of patients. They also witness the deleterious consequences when patients fail to document the care they desire at their end of life. To the best of our knowledge there are no data concerning the prevalence of advance directives among hospice healthcare providers. We therefore explored the prevalence and factors influencing completion rates in a survey of hospice healthcare providers. Surveys that included 32 items to explore completion rates, as well as barriers, knowledge, and demographics, were e-mailed to 2097 healthcare providers, including employees and volunteers, at a nonprofit hospice. Of 890 respondents, 44% reported having completed an advance directive. Ethnicity, age, relationship status, and perceived knowledge were all significant factors influencing the completion rates, whereas years of experience or working directly with patients had no effect. Procrastination, fear of the subject, and costs were common reasons reported as barriers. Upon completion of the survey, 43% said they will now complete an advance directive, and 45% will talk to patients and families about their wishes. The majority of hospice healthcare providers have not completed an advance directive. These results are very similar to those for other healthcare providers treating patients with terminal diseases, specifically oncologists. Because, at completion, 43% said that they would now complete an advance directive, such a survey of healthcare providers may help increase completion rates. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Center for Modeling of Turbulence and Transition: Research Briefs, 1995

    NASA Technical Reports Server (NTRS)

    1995-01-01

    This research brief contains the progress reports of the research staff of the Center for Modeling of Turbulence and Transition (CMOTT) from July 1993 to July 1995. It also constitutes a progress report to the Institute of Computational Mechanics in Propulsion located at the Ohio Aerospace Institute and the Lewis Research Center. CMOTT has been in existence for about four years. In the first three years, its main activities were to develop and validate turbulence and combustion models for propulsion systems, in an effort to remove the deficiencies of existing models. Three workshops on computational turbulence modeling were held at LeRC (1991, 1993, 1994). At present, CMOTT is integrating the CMOTT developed/improved models into CFD tools which can be used by the propulsion systems community. This activity has resulted in an increased collaboration with the Lewis CFD researchers.

  13. Lean business model and implementation of a geriatric fracture center.

    PubMed

    Kates, Stephen L

    2014-05-01

    Geriatric hip fracture is a common event associated with high costs of care and often with suboptimal outcomes for the patients. Ideally, a new care model to manage geriatric hip fractures would address both quality and safety of patient care as well as the need for reduced costs of care. The geriatric fracture center model of care is one such model reported to improve both outcomes and quality of care. It is a lean business model applied to medicine. This article describes basic lean business concepts applied to geriatric fracture care and information needed to successfully implement a geriatric fracture center. It is written to assist physicians and surgeons in their efforts to implement an improved care model for their patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. 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.

  15. 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

  16. Children's perspectives of a pediatric hospice program.

    PubMed

    Davies, Betty; Collins, John B; Steele, Rose; Cook, Karen; Brenner, Amy; Smith, Stephany

    2005-01-01

    Little attention has been paid to documenting the experiences of children in pediatric palliative care programs, both those who are ill and their siblings. In this evaluation study of Canuck Place, a Canadian, free-standing hospice program, 26 ill children and 41 of their siblings completed mail-out questionnaires. In addition, four ill children and 10 siblings participated in face-to-face interviews. Results indicate that nearly all children were enthusiastic about the program's activities and the physical environment at Canuck Place. Engaging activities, physical amenities, and the social climate promoted by staff, volunteers, and other families were important contributors to the children's satisfaction. Suggestions for better serving adolescents included: a wider range of age-appropriate activities, games, and toys--especially for teens and older children; more trips and tours outside the building and around town; and caring staff and volunteers who are "attentive-in-the-moment". From the children's perspective, the key to Canuck Place's success is its social climate of caring, safety, friendliness, acceptance, and variety.

  17. Center for modeling of turbulence and transition: Research briefs, 1993

    NASA Technical Reports Server (NTRS)

    Liou, William W. (Editor)

    1994-01-01

    This research brief contains the progress reports of the research staff of the Center for Modeling of Turbulence and Transition (CMOTT) from June 1992 to July 1993. It is also an annual report to the Institute for Computational Mechanics in Propulsion located at Ohio Aerospace Institute and NASA Lewis Research Center. The main objectives of the research activities at CMOTT are to develop, validate, and implement turbulence and transition models for flows of interest in propulsion systems. Currently, our research covers eddy viscosity one- and two-equation models, Reynolds-stress algebraic equation models, Reynolds-stress transport equation models, nonequilibrium multiple-scale models, bypass transition models, joint scalar probability density function models, and Renormalization Group Theory and Direct Interaction Approximation methods. Some numerical simulations (LES and DNS) have also been carried out to support the development of turbulence modeling. Last year was CMOTT's third year in operation. During this period, in addition to the above mentioned research, CMOTT has also hosted the following programs: an eighteen-hour short course on 'Turbulence--Fundamentals and Computational Modeling (Part I)' given by CMOTT at the NASA Lewis Research Center; a productive summer visitor research program that has generated many encouraging results; collaborative programs with industry customers to help improve their turbulent flow calculations for propulsion system designs; a biweekly CMOTT seminar series with speakers from within and without the NASA Lewis Research Center including foreign speakers. In addition, CMOTT members have been actively involved in the national and international turbulence research activities. The current CMOTT roster and organization are listed in Appendix A. Listed in Appendix B are the abstracts of the biweekly CMOTT seminar. Appendix C lists the papers contributed by CMOTT members.

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

    PubMed

    2015-08-06

    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.

  19. A Development Center Through the Community Based Programming Model.

    ERIC Educational Resources Information Center

    Reichard, Donald L.; Wood, Mary T.

    1999-01-01

    Outlines the development of a leadership-training center at James Sprunt Community College. A community-based programming (CBP) model was followed to encourage community input, support, and participation in the process. CBP is recommended as a way for other colleges to collaborate with their communities on issue definition and resolution. (VWC)

  20. A Model for a Health Career Information Center.

    ERIC Educational Resources Information Center

    Bruhn, John G.; And Others

    1980-01-01

    One part of a model health career information center was a toll-free health careers hotline which provided information to high school and college students, parents, counselors, and teachers. Evaluation of the hotline indicates that it fills a need, is considered useful by callers, and is of relatively small cost. (Author/CT)

  1. Family Members’ Experience with Hospice in Nursing Homes

    PubMed Central

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

    2014-01-01

    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

  2. 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.

  3. 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.

  4. Creating social work competencies for practice in hospice palliative care.

    PubMed

    Bosma, Harvey; Johnston, Meaghen; Cadell, Susan; Wainwright, Wendy; Abernethy, Ngaire; Feron, Andrew; Kelley, Mary Lou; Nelson, Fred

    2010-01-01

    Social workers play an important role in the delivery of Hospice Palliative Care in many diverse settings. The profession brings a unique perspective to end-of-life care that reflects and supports the holistic philosophy of Hospice Palliative Care. Despite the prominent and longstanding position of social work in this area, the role and functions of social workers had not been clearly defined. A Canadian task group of social work practitioners and educators utilized a modified Delphi process to consult front line clinicians nationally, and thereby achieved consensus regarding the identification and description of eleven core competencies in Hospice Palliative Care. These competencies are relevant for social workers at different experience levels across care settings. They can be used to inform social work practice, as well as professional development and educational curricula in this area.

  5. 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

  6. Hospice and palliation in the English-speaking Caribbean.

    PubMed

    Macpherson, Cheryl Cox; Chiochankitmun, Nina; Akpinar-Elci, Muge

    2014-07-01

    This article presents empirical data on the limited availability of hospice and palliative care to the 6 million people of the English-speaking Caribbean. Ten of the 13 nations therein responded to a survey and reported employing a total of 6 hospice or palliative specialists, and having a total of 15 related facilities. The evolving socioeconomic and cultural context in these nations bears on the availability of such care, and on the willingness to report, assess, and prioritize pain, and to prescribe opiates for pain. Socioeconomics and culture also impinge on what medications and modalities of care are routinely available for pain or other conditions and can challenge professionalism, empathy, and responsiveness to patients' unrelieved pain. Although all respondents report having a protocol for pain management, hospice, or end-of-life care, their annual medical use of opiates is well below the global mean. The International Narcotics Control Board (INCB), which monitors such use, encourages Caribbean and other low- and middle-income countries to increase their use of opiates to treat pain, and to overcome both unfounded fears of addiction and overly restrictive interpretation of related laws and regulations. Contextual considerations like those described here are important to the success of policies and capacity-building programs aiming to increase access to hospice and palliation, and perhaps to improving other aspects of health and healthcare. Exploring and responding to the realities of socioeconomic and cultural conditions will enhance public and policy dialogue and improve the design of interventions to increase access to palliative and hospice care. Improving access to palliative and hospice care in the Caribbean demonstrates beneficence and helps to fulfill human rights conventions.

  7. Some observations of a psychiatric consultant to a hospice.

    PubMed

    Shanfield, S B

    1983-01-01

    The experience of a psychiatric consultant to the inpatient and bereavement components of a hospice is reported. The bulk of the consultation is to the hospice staff. Activities of the consultant include attendance at a weekly patient care meeting and patient and staff groups, consultation with the bereavement team and the administrative leadership, and the evaluation of patients. Clarification of the inevitable psychologic problems that arise in dealing with the mostly elderly very ill patients with end-stage cancer as well as with their families is a major function. Many of the problems special to the hospice relate to loss, mourning, and death. Psychiatric diagnostic input has been helpful in the treatment of organic and functional psychiatric disorders including the treatment of the emotional components of pain and disordered grief which is manifest as depression. Consultation is provided to individuals at risk of problems in the bereavement period. The psychiatric consultant to a hospice is helpful in establishing and maintaining a sensitive therapeutic system of care for the patient and family. He provides an important presence and a forum for the discussion of psychologic issues for the staff. In addition, he has an important role in clarifying the psychodynamic issues involved with death, loss, and mourning for the patient, family, and staff. He provides input around the treatment of functional and organic psychiatric problems seen in the patient and family. Such activities require the continuing membership and leadership of a psychiatrist on the hospice team. The hospice is a laboratory for the understanding of death, loss, and mourning. Although they have been the subject of much inquiry, these issues can be studied fruitfully at the hospice because of the accessibility to dying patients and the bereaved, both before and after the death of their loved one (Kubler-Ross, 1970; Parkes, 1972; Schoenberg, Carr, Kutscher, Peretz, and Goldberg, 1974; Jacobs and

  8. Attitudes toward assisted suicide: a survey of hospice volunteers.

    PubMed

    Zehnder, P W; Royse, D

    1999-01-01

    Technological advances have lengthened our years and, often, the dying process as well. While studies have been conducted of physicians and dying patients concerning their views on assisted suicide, no prior studies have examined the attitudes of hospice volunteers. This survey of 277 hospice volunteers found that overall their attitudes were more supportive of assisted suicide than that of a convenience sample of the public. Thirty-seven percent of the volunteers endorsed the view that there are situations when assisting death may be morally acceptable; 4% had been asked to provide assistance to help a patient end his or her life.

  9. Hospice volunteer training: making the experience more meaningful.

    PubMed

    Wilson, P E

    2000-01-01

    Each volunteer coordinator continues to make changes and adjustments in the hospice training classes--some changes arise from circumstances such as staff availability, and some are conscious choices to try new ways of structuring the learning environment. As we shape and refine the experience that we provide for our new volunteers, let us make a special effort to create one that offers not only a comprehensive overview of hospice goals, philosophy, and end-of-life issues, but also a personally challenging and enriching team interaction.

  10. Reduced-order autoregressive modeling for center-frequency estimation.

    PubMed

    Kuc, R; Li, H

    1985-07-01

    The center frequency of a narrowband, discrete-time random process, such as a reflected ultrasound signal, is estimated from the parameter values of a reduced, second-order autoregressive (AR) model. This approach is proposed as a fast estimator that performs better than the zero-crossing count estimate for determining the center-frequency location. The parameter values are obtained through a linear prediction analysis on the correlated random process, which in this case is identical to the maximum entropy method for spectral estimation. The frequency of the maximum of the second-order model spectrum is determined from these parameters and is used as the center-frequency estimate. This estimate can be computed very efficiently, requiring only the estimates of the first three terms of the process autocorrelation function. The bias and variance properties of this estimator are determined for a random process having a Gaussian-shaped spectrum and compared to those of the ideal FM frequency discriminator, zero-crossing count estimator and a correlation estimator. It is found that the variance values for the reduced-order AR model center-frequency estimator lie between those for the ideal FM frequency discriminator and the zero-crossing count estimator.

  11. Patterns of Hospice Care Among Military Veterans and Non-veterans

    PubMed Central

    Wachterman, Melissa W.; Lipsitz, Stuart R.; Simon, Steven R.; Lorenz, Karl A.; Keating, Nancy L.

    2014-01-01

    Context Historically, hospice use by veterans has lagged behind that of non-veterans. Little is known about hospice use by veterans at a population level. Objectives To determine whether veteran and non-veteran hospice users differ by demographics, primary diagnosis, location of care, and service utilization. Methods Using the 2007 National Home and Hospice Care Survey, we identified 483 veteran and 932 non-veteran male hospice users representing 287,620 hospice enrollees nationally. We used chi-square and t-tests to compare veterans and non-veterans by demographic characteristics, primary diagnosis, and location of hospice care. We used multivariate regression to assess for differences in hospice diagnosis and location of care, adjusting for demographic and clinical factors. We also compared length of stay and number of visits by hospice personnel between veterans and non-veterans using multivariate regression. Results Veteran hospice users were older than non-veterans (77.0 vs. 74.3 years, P = 0.02) but did not differ by other demographics. In adjusted analyses, cancer was a more common primary diagnosis among veterans than non-veterans (56.4% vs. 48.4%; P = 0.02), and veteran hospice users were more likely than non-veterans to receive hospice at home (68.4% vs. 57.6%; P = 0.007). The median adjusted length of stay and number of nurse or social worker visits did not differ by veteran status (all P > 0.10), but veterans received fewer home health aide visits than non-veterans (one every 5.3 days vs. one every 3.7 days; P = 0.002). Conclusion Although veteran and non-veteran hospice users were similar on most demographic measures, important differences in hospice referral patterns and utilization exist. PMID:24275325

  12. Dignity, death, and dilemmas: a study of Washington hospices and physician-assisted death.

    PubMed

    Campbell, Courtney S; Black, Margaret A

    2014-01-01

    The legalization of physician-assisted death in states such as Washington and Oregon has presented defining ethical issues for hospice programs because up to 90% of terminally ill patients who use the state-regulated procedure to end their lives are enrolled in hospice care. The authors recently partnered with the Washington State Hospice and Palliative Care Organization to examine the policies developed by individual hospice programs on program and staff participation in the Washington Death with Dignity Act. This article sets a national and local context for the discussion of hospice involvement in physician-assisted death, summarizes the content of hospice policies in Washington State, and presents an analysis of these findings. The study reveals meaningful differences among hospice programs about the integrity and identity of hospice and hospice care, leading to different policies, values, understandings of the medical procedure, and caregiving practices. In particular, the authors found differences 1) in the language used by hospices to refer to the Washington statute that reflect differences among national organizations, 2) the values that hospice programs draw on to support their policies, 3) dilemmas created by requests by patients for hospice staff to be present at a patient's death, and 4) five primary levels of noninvolvement and participation by hospice programs in requests from patients for physician-assisted death. This analysis concludes with a framework of questions for developing a comprehensive hospice policy on involvement in physician-assisted death and to assist national, state, local, and personal reflection. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  13. Patterns of hospice care among military veterans and non-veterans.

    PubMed

    Wachterman, Melissa W; Lipsitz, Stuart R; Simon, Steven R; Lorenz, Karl A; Keating, Nancy L

    2014-07-01

    Historically, hospice use by veterans has lagged behind that of non-veterans. Little is known about hospice use by veterans at a population level. To determine whether veteran and non-veteran hospice users differ by demographics, primary diagnosis, location of care, and service utilization. Using the 2007 National Home and Hospice Care Survey, we identified 483 veteran and 932 non-veteran male hospice users representing 287,620 hospice enrollees nationally. We used chi-square and t-tests to compare veterans and non-veterans by demographic characteristics, primary diagnosis, and location of hospice care. We used multivariate regression to assess for differences in hospice diagnosis and location of care, adjusting for demographic and clinical factors. We also compared length of stay and number of visits by hospice personnel between veterans and non-veterans using multivariate regression. Veteran hospice users were older than non-veterans (77.0 vs. 74.3 years, P = 0.02) but did not differ by other demographics. In adjusted analyses, cancer was a more common primary diagnosis among veterans than non-veterans (56.4% vs. 48.4%; P = 0.02), and veteran hospice users were more likely than non-veterans to receive hospice at home (68.4% vs. 57.6%; P = 0.007). The median adjusted length of stay and number of nurse or social worker visits did not differ by veteran status (all P > 0.10), but veterans received fewer home health aide visits than non-veterans (one every 5.3 days vs. one every 3.7 days; P = 0.002). Although veteran and non-veteran hospice users were similar on most demographic measures, important differences in hospice referral patterns and utilization exist. Published by Elsevier Inc.

  14. Establishing hospice care for prison populations: An integrative review assessing the UK and USA perspective.

    PubMed

    Stone, Katie; Papadopoulos, Irena; Kelly, Daniel

    2012-12-01

    models of care based on the hospice model have delivered effective support to dying people since their inception. Over the last 20 years this form of care has also been introduced into the prison system (mainly in the United States) to afford terminally ill inmates the right to die with dignity. the aim of this review is to examine the evidence from the United States and the United Kingdom on the promotion of palliative care in the prison sector, summarizing examples of good practice and identifying barriers for the provision of end-of-life care within the prison environment both in the USA and UK. an integrative review design was adopted using the Green et al. model incorporating theoretical and scientific lines of enquiry. literature was sourced from six electronic databases between the years 2000 and 2011; the search rendered both qualitative and quantitative papers, discussion papers, 'grey literature' and other review articles. the results highlight a number of issues surrounding the implementation of palliative care services within the prison setting and emphasize the disparity between the USA model of care (which emphasizes the in-prison hospice) and the UK model of care (which emphasizes palliative care in-reach) for dying prisoners. the provision of palliative care for the increasing prison population remains under-researched globally, with a notable lack of evidence from the United Kingdom.

  15. Introducing music therapy in hospice and palliative care: an overview of one hospice's experience.

    PubMed

    Pawuk, Laura G; Schumacher, John E

    2010-01-01

    A middle-aged man with lung cancer breathes more easily and reduces his need for pain medication after participating in music-focused relaxation. An 8-year-old boy with cancer writes songs and records a CD for his family. An elderly woman in the final stages of Alzheimer's who is no longer able to speak sings a few words of her favorite lullaby to her adult daughter. A much-loved grandmother dies peacefully as her family sings her favorite spiritual songs to the accompaniment of a music therapist's folk harp. These illustrations demonstrate the role that music therapy plays in attending to the physical, emotional, and spiritual needs of hospice and palliative care patients and families while respecting their dignity and celebrating their lives.

  16. Correlates of a good death and the impact of hospice involvement: findings from the national survey of households affected by cancer.

    PubMed

    Cagle, John G; Pek, Jolynn; Clifford, Maggie; Guralnik, Jack; Zimmerman, Sheryl

    2015-03-01

    Knowing how to improve the dying experience for patients with end-stage cancer is essential for cancer professionals. However, there is little evidence on the relationship between clinically relevant factors and quality of death. Also, while hospice has been linked with improved outcomes, our understanding of factors that contribute to a "good death" when hospice is involved remains limited. This study (1) identified correlates of a good death and (2) provided evidence on the impact of hospice on quality of death. Using data from a survey of US households affected by cancer (N = 930, response rate 51 %), we fit regression models with a subsample of 158 respondents who had experienced the death of a family member with cancer. Measures included quality of death (good/bad) and clinically relevant factors including: hospice involvement, symptoms during treatment, whether wishes were followed, provider knowledge/expertise, and compassion. Respondents were 60 % female, 89 % White, and averaged 57 years old. Decedents were most often a respondent's spouse (46 %). While 73 % of respondents reported a good death, Hispanics were less likely to experience good death (p = 0.007). Clinically relevant factors, including hospice, were associated with good death (p < 0.05)--an exception being whether the physician said the cancer was curable/fatal. With adjustments, perceptions of provider knowledge/expertise was the only clinical factor that remained associated with good death. Enhanced provider training/communication, referrals to hospice and greater attention to symptom management may facilitate improved quality of dying. Additionally, the cultural relevance of the concept of a "good death" warrants further research.

  17. Correlates of a Good Death and the Impact of Hospice Involvement: Findings from the National Survey of Households Affected by Cancer

    PubMed Central

    Cagle, John G.; Pek, Jolynn; Clifford, Maggie; Guralnik, Jack; Zimmerman, Sheryl

    2017-01-01

    Purpose Knowing how to improve the dying experience for patients with end-stage cancer is essential for cancer professionals. However, there is little evidence on the relationship between clinically relevant factors and quality of death. Also, while hospice has been linked with improved outcomes, our understanding of factors that contribute to a “good death” when hospice is involved remains limited. This study (1) identified correlates of a good death; and, (2) provided evidence on the impact of hospice on quality of death. Methods Using data from a survey of US households affected by cancer (N=930, response rate 51%), we fit regression models with a subsample of 158 respondents who had experienced the death of a family member with cancer. Measures included quality of death (good/bad) and clinically relevant factors including: hospice involvement, symptoms during treatment, whether wishes were followed, provider knowledge/expertise and compassion. Results Respondents were 60% female, 89% White, and averaged 57 years old. Decedents were most often a respondent's spouse (46%). While 73% of respondents reported a good death, Hispanics were less likely to experience good death (p=.007). Clinically relevant factors, including hospice, were associated with good death (p<.05) -- an exception being whether the physician said the cancer was curable/fatal. With adjustments, perceptions of provider knowledge/expertise was the only clinical factor that remained associated with good death. Conclusions Enhanced provider training/communication, referrals to hospice and greater attention to symptom management may facilitate improved quality of dying. Additionally, the cultural relevance of the concept of a “good death” warrants further research. PMID:25194877

  18. [Fusing empowerment concept into patient-centered collaborative care model].

    PubMed

    Wu, Chia-Chen; Lin, Chiu-Chu

    2014-12-01

    Chronic diseases are incurable, long-term illnesses. To improve quality of life, patients with chronic diseases must adjust their own personal lifestyle to cope with their diseases and eventually learn to achieve a balance between disease control and daily life. Therefore, self-management necessarily plays a key role in chronic disease management. Different from physician-centered healthcare, the self-management practiced by chronic disease patients is more patient-centered with a greater emphasis on active patient participation. The main goal of this article is to elucidate the essence of the empowerment concept. An example of diabetes care, this article introduces a detailed five-step application as a basic model for incorporating the empowerment concept into the healthcare of patients with chronic disease. The author suggests that healthcare providers apply the empowerment model in clinical practice to assist patients to maintain an optimal balance between their health status and personal lives.

  19. A source-controlled data center network model.

    PubMed

    Yu, Yang; Liang, Mangui; Wang, Zhe

    2017-01-01

    The construction of data center network by applying SDN technology has become a hot research topic. The SDN architecture has innovatively separated the control plane from the data plane which makes the network more software-oriented and agile. Moreover, it provides virtual multi-tenancy, effective scheduling resources and centralized control strategies to meet the demand for cloud computing data center. However, the explosion of network information is facing severe challenges for SDN controller. The flow storage and lookup mechanisms based on TCAM device have led to the restriction of scalability, high cost and energy consumption. In view of this, a source-controlled data center network (SCDCN) model is proposed herein. The SCDCN model applies a new type of source routing address named the vector address (VA) as the packet-switching label. The VA completely defines the communication path and the data forwarding process can be finished solely relying on VA. There are four advantages in the SCDCN architecture. 1) The model adopts hierarchical multi-controllers and abstracts large-scale data center network into some small network domains that has solved the restriction for the processing ability of single controller and reduced the computational complexity. 2) Vector switches (VS) developed in the core network no longer apply TCAM for table storage and lookup that has significantly cut down the cost and complexity for switches. Meanwhile, the problem of scalability can be solved effectively. 3) The SCDCN model simplifies the establishment process for new flows and there is no need to download flow tables to VS. The amount of control signaling consumed when establishing new flows can be significantly decreased. 4) We design the VS on the NetFPGA platform. The statistical results show that the hardware resource consumption in a VS is about 27% of that in an OFS.

  20. A source-controlled data center network model

    PubMed Central

    Yu, Yang; Liang, Mangui; Wang, Zhe

    2017-01-01

    The construction of data center network by applying SDN technology has become a hot research topic. The SDN architecture has innovatively separated the control plane from the data plane which makes the network more software-oriented and agile. Moreover, it provides virtual multi-tenancy, effective scheduling resources and centralized control strategies to meet the demand for cloud computing data center. However, the explosion of network information is facing severe challenges for SDN controller. The flow storage and lookup mechanisms based on TCAM device have led to the restriction of scalability, high cost and energy consumption. In view of this, a source-controlled data center network (SCDCN) model is proposed herein. The SCDCN model applies a new type of source routing address named the vector address (VA) as the packet-switching label. The VA completely defines the communication path and the data forwarding process can be finished solely relying on VA. There are four advantages in the SCDCN architecture. 1) The model adopts hierarchical multi-controllers and abstracts large-scale data center network into some small network domains that has solved the restriction for the processing ability of single controller and reduced the computational complexity. 2) Vector switches (VS) developed in the core network no longer apply TCAM for table storage and lookup that has significantly cut down the cost and complexity for switches. Meanwhile, the problem of scalability can be solved effectively. 3) The SCDCN model simplifies the establishment process for new flows and there is no need to download flow tables to VS. The amount of control signaling consumed when establishing new flows can be significantly decreased. 4) We design the VS on the NetFPGA platform. The statistical results show that the hardware resource consumption in a VS is about 27% of that in an OFS. PMID:28328925

  1. Burnout and death anxiety in hospice social workers.

    PubMed

    Quinn-Lee, Lisa; Olson-McBride, Leah; Unterberger, April

    2014-01-01

    Hospice work has been regarded as particularly stressful due to the complexity inherent in the provision of end-of-life care. Burnout and death anxiety are especially relevant to hospice social workers because they regularly function in a high-stress, high-loss environment. The purpose of this study was threefold: to determine the prevalence of burnout and death anxiety among hospice social workers; to examine associations between burnout and death anxiety; and to explore the factors which may contribute to the development of death anxiety and burnout. Participants completed four items: the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), the Death Anxiety Questionnaire (DAQ), a demographic questionnaire, and a set of open-ended questions. Findings indicate that mean scores on the subscales of the MBI-HSS ranged from the low to moderate range and that a strong positive correlation existed between death anxiety and the depersonalization subscale of the MBI. Three key themes emerged from the qualitative data: (a) personal interest in hospice social work developed through a variety of ways; (b) although death anxiety decreased from exposure and understanding of the death process, there was increased death anxiety surrounding working with certain patients; and (c) burnout was primarily related to workload or difficult cases.

  2. A pilot study of palliative medicine fellows' hospice home visits.

    PubMed

    Shoemaker, Laura K; Aktas, Aynur; Walsh, Declan; Hullihen, Barbara; Khan, Mohammed I Ahmed; Russell, Kraig M; Davis, Mellar P; Lagman, Ruth; LeGrand, Susan

    2012-12-01

    This was a prospective descriptive study of hospice physician home visits (HVs) conducted by Hospice and Palliative Medicine Fellows. Our objectives were 1) to improve our knowledge of hospice care at home by describing physician HVs 2) to identify the indications for physician HVs and the problems addressed during the HV. Data was collected on 58 consecutive patients using a standardized form completed before and after the home visit. More than half of the persons were women. Most were Caucasian. Median age was 75 years; 57% had cancer; 77% were do-not-resuscitate. 76% HV occurred in the home. The median visit duration was 60 minutes; median travel distance and time 25 miles and 42 minutes, respectively. A hospice nurse case manager was present in 95%. The most common issues addressed during HVs were: health education, symptom management, and psychosocial support. Medication review was prominent. Physicians identified previously unreported issues. Symptom control was usually pain, although 27 symptoms were identified. Medications were important; all home visits included drug review and two thirds drug change. Physicians had unique responsibilities and identified important issues in the HV. Physicians provided both education and symptom management. Physician HVs are an important intervention. HVs were important in continuity of care, however, time-consuming, and incurred considerable travel, and professional time and costs.

  3. 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…

  4. Retrospective Analysis of a Home Care Hospice Program.

    ERIC Educational Resources Information Center

    Brescia, Frank J.; And Others

    1985-01-01

    Presents a retrospective study of patients who died in a hospice home care program to examine quality of care and differences between patients who died at home and in the hospital. No prediction could be made of which patients could remain at home until death. (JAC)

  5. 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…

  6. 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…

  7. Dementia deaths in hospice: a retrospective case note audit.

    PubMed

    Vries, Kay de; Nowell, Allyson

    2011-12-01

    Dementia is now recognized as a progressive terminal illness and it is established that people with dementia have significant palliative care needs as they approach the end of life. However, population prevalence studies suggest that very few people with dementia access hospice services in the UK. The literature further suggests that hospice staff may be inadequately prepared to care for people with dementia. A retrospective internal case note audit covering a 3-month period of referrals was undertaken in one hospice in the south of England as part of work to establish staff education requirements arising from patient make-up. Only patients over the age of 65 were included. Of the 288 case notes audited, 9% of the patients had either been diagnosed with dementia or suffered with dementia as a comorbidity. The results of the audit suggest that the number of people with dementia referred to hospice services may have increased in the last decade. This is in keeping with expectations and future predictions resulting from increased disease surveillance and an increasingly ageing population.

  8. Sources of Stress in Nursing Terminal Patients in a Hospice.

    ERIC Educational Resources Information Center

    Gray-Toft, Pamela; Anderson, James G.

    1987-01-01

    Investigated sources of stress experienced by hospice nurses. Stress sources included: physical characteristics of the unit as well as staffing policies designed to improve the quality of care; procedures followed in admitting patients; policies related to the preparation of meals and open visitation; and greater involvement with the patient and…

  9. Sources of Stress in Nursing Terminal Patients in a Hospice.

    ERIC Educational Resources Information Center

    Gray-Toft, Pamela; Anderson, James G.

    1987-01-01

    Investigated sources of stress experienced by hospice nurses. Stress sources included: physical characteristics of the unit as well as staffing policies designed to improve the quality of care; procedures followed in admitting patients; policies related to the preparation of meals and open visitation; and greater involvement with the patient and…

  10. 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…

  11. Pediatric nurses' attitudes toward hospice and pediatric palliative care.

    PubMed

    Knapp, Caprice A; Madden, Vanessa; Wang, Hua; Kassing, Kristin; Curtis, Charlotte; Sloyer, Phyllis; Shenkman, Elizabeth A

    2011-01-01

    Several studies have investigated nurses' attitudes toward hospice and palliative care for adults, yet little information exists about pediatrics. Assessing pediatric nurses' attitudes is especially important in Florida, where a publicly funded pediatric palliative care program operates in eight cities across the State. The aims of this study were 1) to assess the attitudes toward hospice and palliative care, and 2) to examine the associations between sociodemographic and nursing care factors and nurses' attitudes toward hospice and palliative care. A cross-sectional research design using online and mail-in survey data was used to address the study aims. Surveys were conducted with 279 pediatric nurses across Florida. Bivariate results showed there were significant differences between the attitudes of pediatric nurses employed in a city with a pediatric palliative care program versus those not employed in a program site (p = 0.05). Multivariate analyses also showed that being employed in a program site increased attitudinal scores toward hospice and pediatric palliative care by 0.6 points. Beyond being employed in an area city where a pediatric palliative care program operates, results also suggest that having prior training in palliative care could alter nurses' attitudes, which might subsequently lead to increased referrals and improved outcomes for children and families.

  12. 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…

  13. Strength in numbers: patient experiences of group exercise within hospice palliative care.

    PubMed

    Malcolm, Lorna; Mein, Gill; Jones, Alison; Talbot-Rice, Helena; Maddocks, Matthew; Bristowe, Katherine

    2016-12-13

    Exercise is increasingly recognized as a core component of palliative rehabilitation. The group exercise model is often adopted as a means of reaching more patients with limited resource. Despite the growth of quantitative research examining this area of practice, few qualitative studies have looked at the patient experience of participating in group exercise in a palliative setting, and most exclude patients with a non-cancer diagnosis. The aim of this study was to explore patients' experiences of participating in group exercise classes in a hospice setting. In this qualitative, phenomenological study, nine patients participating in a group exercise programme at a South London hospice completed semi-structured interviews. Participants were purposively sampled by gender, age, ethnicity and diagnosis; to include diagnoses across cancer, respiratory and neurological conditions. Transcripts were interpreted using thematic analysis. All patients reported positive experiences of participating in group exercise classes. Improvements reported in physical function had a positive effect on ability to complete activities of daily living and enhanced patient mood. Other reported psychosocial benefits included: promotion of self-management; space and opportunity for reflection; supportive relationships; sharing of information; and a deeper appreciation of patients' own abilities. This study highlights the positive experiences and value of group exercise classes to groups of people with diverse cancer and non-cancer conditions. The physical, emotional and psychosocial benefits suggest hospices and other palliative services should explore similar programmes as part of their rehabilitation services. The recognition that exercise groups can be mixed and need not be bespoke to one condition has positive cost and staff resource ramifications.

  14. Hospice use among nursing home and non-nursing home patients.

    PubMed

    Unroe, Kathleen T; Sachs, Greg A; Dennis, M E; Hickman, Susan E; Stump, Timothy E; Tu, Wanzhu; Callahan, Christopher M

    2015-02-01

    For nursing home patients, hospice use and associated costs have grown dramatically. A better understanding of hospice in all care settings, especially how patients move across settings, is needed to inform debates about appropriateness of use and potential policy reform. Our aim was to describe characteristics and utilization of hospice among nursing home and non-nursing home patients. Medicare, Medicaid and Minimum Data Set data, 1999-2008, were merged for 3,771 hospice patients aged 65 years and above from a safety net health system. Patients were classified into four groups who received hospice: 1) only in nursing homes; 2) outside of nursing homes; 3) crossover patients utilizing hospice in both settings; and 4) "near-transition" patients who received hospice within 30 days of a nursing home stay. Differences in demographics, hospice diagnoses and length of stay, utilization and costs are presented with descriptive statistics. Nursing home hospice patients were older, and more likely to be women and to have dementia (p < 0.0001). Nearly one-third (32.3 %) of crossover patients had hospice stays > 6 months, compared with the other groups (16 % of nursing home hospice only, 10.7 % of non-nursing home hospice and 7.6 % of those with near transitions) (p < 0.0001). Overall, 27.7 % of patients had a hospice stay <1 week, but there were marked differences between groups-48 % of near-transition patients vs. 7.4 % of crossover patients had these short hospice stays (p < 0.0001). Crossover and near-transition hospice patients had higher costs to Medicare compared to other groups (p < 0.05). Dichotomizing hospice users only into nursing home vs. non-nursing home patients is difficult, due to transitions across settings. Hospice patients with transitions accrue higher costs. The impact of changes to the hospice benefit on patients who live or move through nursing homes near the end of life should be carefully considered.

  15. Center for Integrated Nanotechnologies (CINT) Chemical Release Modeling Evaluation

    SciTech Connect

    Stirrup, Timothy Scott

    2016-12-20

    This evaluation documents the methodology and results of chemical release modeling for operations at Building 518, Center for Integrated Nanotechnologies (CINT) Core Facility. This evaluation is intended to supplement an update to the CINT [Standalone] Hazards Analysis (SHA). This evaluation also updates the original [Design] Hazards Analysis (DHA) completed in 2003 during the design and construction of the facility; since the original DHA, additional toxic materials have been evaluated and modeled to confirm the continued low hazard classification of the CINT facility and operations. This evaluation addresses the potential catastrophic release of the current inventory of toxic chemicals at Building 518 based on a standard query in the Chemical Information System (CIS).

  16. Hospice and palliative medicine: new subspecialty, new opportunities.

    PubMed

    Quest, Tammie E; Marco, Catherine A; Derse, Arthur R

    2009-07-01

    Palliative care is the physical, psychological, social, and spiritual care provided to patients from diagnosis to death or resolution of a life-threatening illness. Hospice care is a comprehensive program of care that is appropriate when patients with chronic, progressive, and eventually fatal illness are determined to have a prognosis of 6 months or fewer. Hospice and palliative medicine has now been recognized by the American Board of Medical Subspecialties as a field with a unique body of knowledge and practice. With 9 other specialty boards, the American Board of Emergency Medicine has cosponsored hospice and palliative medicine as an official subspecialty. As a result, board-certified emergency physicians may now pursue certification in hospice and palliative medicine through either fellowship training or, for a limited time, completing practice track requirements, followed by a written examination in the subspecialty. As the practice of palliative medicine grows in hospitals, emergency physicians can develop a core of generalist palliative medicine skills for use with adults and children. These would include assessing and communicating prognoses, managing the relief of pain and other distressing symptoms, helping articulate goals of patient care, understanding ethical and legal requirements; and ensuring the provision of culturally appropriate spiritual care in the last hours of living. Front-line emergency physicians possessing these basic palliative medicine skills will be able to work collaboratively with subspecialty physicians who are dually certified in emergency medicine and hospice and palliative medicine. Together, generalist and specialist emergency physicians can advance research, education, and policy in this new field to reach the common goals of high-quality, efficient, evidence-based palliative care in the emergency department.

  17. A qualitative study of the emotional and spiritual needs of Hispanic families in hospice.

    PubMed

    Nuñez, Alicia; Holland, Jason M; Beckman, Lisa; Kirkendall, Abbie; Luna, Nora

    2017-05-02

    As the older U.S. population becomes more ethnically diverse, there will be an increased need for culturally sensitive hospice care services. Hispanics often experience multiple barriers to quality end-of-life care services. To address the underlying disparities in the cultural, emotional, and spiritual aspects of hospice care, the objective of the present qualitative study was to examine the emotional and spiritual needs of Hispanic patients' families while in hospice. Semistructured in-person interviews were conducted with 29 Hispanic patients' families regarding their perceived experience of the hospice-based emotional and spiritual support received. Demographic information was collected on both the family member and the patient. Interviews were digitally recorded, transcribed, and analyzed using thematic content analysis. Participant narratives fell into five main themes: (1) the influence of Hispanic culture in the relationship with hospice care providers; (2) types of social support received from hospice; (3) barriers to receiving support; (4) lack of health literacy regarding hospice care; and (5) cultural preferences for religious/spiritual support in hospice. Our results provide insight into the specific emotional and spiritual needs of Hispanic families receiving hospice services. Our findings highlight that cultural values play an important role in the hospice care experiences of Hispanic families.

  18. Hospice Utilization in Nursing Homes: Association With Facility End-of-Life Care Practices

    PubMed Central

    Zheng, Nan Tracy

    2013-01-01

    Objectives: Hospice care provided to nursing home (NH) residents has been shown to improve the quality of end-of-life (EOL) care. However, hospice utilization in NHs is typically low. This study examined the relationship between facility self-reported EOL practices and residents’ hospice use and length of stay. Design: The study was based on a retrospective cohort of NH residents. Medicare hospice claims, Minimum Data Set, Online Survey, Certification, and Reporting system and the Area Resource File were linked with a survey of directors of nursing (DON) regarding institutional EOL practice patterns (EOLC Survey). Setting and Participants: In total, 4,540 long-term–care residents who died in 2007 in 290 facilities which participated in the EOLC Survey were included in this study. Measurements: We measured NHs’ tendency to offer hospice to residents and to initiate aggressive treatments (hospital transfers and feeding tubes) for EOL residents based on DON’s responses to survey items. Residents’ hospice utilization was determined using Medicare hospice claims. Results: The prevalence of hospice use was 18%. The average length of stay was 93 days. After controlling for individual risk factors, facilities’ self-reported practice measures associated with residents’ likelihood of using hospice were tendency to offer hospice (p = .048) and tendency to hospitalize (p = .002). Residents in NHs reporting higher tendency to hospitalize tended to enroll in hospice closer to death. Conclusion: Residents’ hospice utilization is not only associated with individual and facility characteristics but also with NHs’ self-reported EOL care practices. Potential interventions to effect greater use of hospice may need to focus on facility-level care processes and practices. PMID:23231947

  19. Hospice Use, Hospitalization, and Medicare Spending at the End of Life.

    PubMed

    Zuckerman, Rachael B; Stearns, Sally C; Sheingold, Steven H

    2016-05-01

    Prior studies associate hospice use with reduced hospitalization and spending at the end of life based on all Medicare hospice beneficiaries. In this study, we examine the impact of different lengths of hospice care and nursing home residency on hospital use and spending prior to death across 5 disease groups. We compared inpatient hospital days and Medicare spending during the last 6 months of life using hospice versus propensity matched non-hospice beneficiaries who died in 2010, were enrolled in fee for service Medicare throughout the last 2 years of life, and were in at least 1 of 5 disease groups. Comparisons were based on length of hospice use and whether the decedent was in a nursing home during the seventh month prior to death. We regressed a categorical measure of hospice days on outcomes, controlling for observed patient characteristics. Hospice use over 2 weeks was associated with decreased hospital days (1-5 days overall, with greater decreases for longer hospice use) for all beneficiaries; spending was $900-$5,000 less for hospice use of 31-90 days for most beneficiaries not in nursing homes, except beneficiaries with Alzheimer's. Overall spending decreased with hospice use for beneficiaries in nursing homes with lung cancer only, with a $3,500 reduction. The Medicare hospice benefit is associated with reduced hospital care at the end of life and reduced Medicare expenditures for most enrollees. Policies that encourage timely initiation of hospice and discourage extremely short stays could increase these successes while maintaining program goals. Published by Oxford University Press on behalf of the Gerontological Society of America 2015.

  20. 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

    ... philosophy and practice for those who are terminally ill. It is a holistic approach to treatment that... identification, assessment and treatment of pain and other issues. In addition, palliative care in hospice... findings, current medication and treatment orders, and information about unrelated conditions...

  1. 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

    .../IID to assist in the administration of prescribed therapies included in the plan of care only to the... attending physician, and other physicians participating in the provision of care to the patient as needed to coordinate the hospice care of the hospice patient with the medical care provided by other physicians. (3...

  2. 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

    .../IID to assist in the administration of prescribed therapies included in the plan of care only to the... attending physician, and other physicians participating in the provision of care to the patient as needed to coordinate the hospice care of the hospice patient with the medical care provided by other physicians. (3...

  3. 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

    .../IID to assist in the administration of prescribed therapies included in the plan of care only to the... attending physician, and other physicians participating in the provision of care to the patient as needed to coordinate the hospice care of the hospice patient with the medical care provided by other physicians. (3...

  4. Modelling the "ideal" self care--limited care dialysis center.

    PubMed

    Piccoli, G B; Calderini, M; Bechis, F; Iadarola, A M; Iacuzzo, C; Mezza, E; Vischi, M; Trione, L; Poltronieri, E; Gai, M; Anania, P; Pacitti, A; Jeantet, A; Segoloni, G P

    2001-01-01

    Limited care dialysis is an interesting option, which has gained attention in several settings because of the aging of the uremic cohort. The aim of this study was to assess its potential in the Piedmont region in northern Italy, evaluating patients' and care-givers' preferences and testing them in a mathematical model of organisation. The study was conducted in the satellite unit of a university hospital (200-210 dialysis patients), following 35 patients (15 at home, 20 in the center, 10 on daily dialysis). Opinions were collected with a questionnaire and features identified were empirically tested through a simulation model. Most patients (34/35) preferred a small unit, with a stable caring team. Further options were flexibility of dialysis schedule, multiple treatment options, integrated center/home care. These needs could be met by a flexible organization including conventional dialysis (3/week) and daily dialysis (6/week). We employed a simulation model (ARENA software) to calculate the nurses required for each shift and the opening hours and best schedule for the unit. Addition of daily dialysis (2-3 hours) to two conventional 4-5 hour sessions to increased the number of patients followed or "spared" beds, ensuring flexibility. According to patients' best choice (7 dialysis stations), and to the recorded calls, the needs are for two nurses per shift, two shifts per day and six nurses for up to 30 patients in limited care. In conclusion, small centers with flexible schedules can tailor dialysis to patients' needs. A managerial approach is valuable for testing cost/benefit ratios in specific contexts.

  5. [Well connected - optimally cared for! : Beneficial factors of collaboration in hospice and palliative care networks in Bavaria].

    PubMed

    Herbst, Franziska A; Heckel, Maria; Stiel, Stephanie; Ostgathe, Christoph

    2017-01-01

    The Bavarian State Ministry of Health and Care fosters the establishment of regional hospice and palliative care networks in Bavaria, Germany. Little is known about well-tried structures and beneficial strategies of collaboration within such networks. The present study aims to investigate general conditions under which hospice and palliative care networks in Bavaria perform successfully and to explore modes of working, forms of organisation, and channels of communication. Data were collected between March and June 2015 in semi-structured interviews with ten coordinators and chairpersons of ten Bavarian hospice and palliative care networks. Results of this status quo analysis concerning aspects of network models and beneficial factors of networking were discussed in a subsequent workshop. The workshop took place in November 2015 with eight representatives of five networks. Individual interviews and the discussion of the diagnostic workshop were audiotaped and transcribed verbatim. Data were analysed with the aid of the computer-assisted qualitative data analysis software MAXQDA (Software für qualitative Datenanalyse (1989-2015). VERBI Software Consult Sozialforschung GmbH, Berlin, Germany). Hypotheses were formulated adapted from Grounded Theory. Networking factors and characteristics are quite congruent. Beneficial and diverse factors identified by network coordinators and moderators represent three major topics: network organisation and coordination, communication and information channels, and public visibility. Well-tried and established practices of networking are present in the hospice and palliative care networks included in the study. The experiences and visions of the networks will foster the compilation of a best practice recommendation for the establishment of new and the enhancement of existing networks.

  6. Online resources for culturally and linguistically appropriate services in home healthcare and hospice: resources for Spanish-speaking patients.

    PubMed

    Young, Judith S

    2014-05-01

    Home healthcare and hospice clinicians are increasingly working with patients for whom English is not their primary language. Provision of culturally respectful and acceptable patient-centered care includes both an awareness of cultural beliefs that influence the patient's health and also the ability to provide the patient with health information in the language with which he or she is most comfortable. This article identifies resources for understanding the cultural norms of different Spanish-speaking groups as well as materials appropriate for Spanish-speaking patients that healthcare professionals and government agencies from around the world have made available for others to use.

  7. Analyst-centered models for systems design, analysis, and development

    NASA Technical Reports Server (NTRS)

    Bukley, A. P.; Pritchard, Richard H.; Burke, Steven M.; Kiss, P. A.

    1988-01-01

    Much has been written about the possible use of Expert Systems (ES) technology for strategic defense system applications, particularly for battle management algorithms and mission planning. It is proposed that ES (or more accurately, Knowledge Based System (KBS)) technology can be used in situations for which no human expert exists, namely to create design and analysis environments that allow an analyst to rapidly pose many different possible problem resolutions in game like fashion and to then work through the solution space in search of the optimal solution. Portions of such an environment exist for expensive AI hardware/software combinations such as the Xerox LOOPS and Intellicorp KEE systems. Efforts are discussed to build an analyst centered model (ACM) using an ES programming environment, ExperOPS5 for a simple missile system tradeoff study. By analyst centered, it is meant that the focus of learning is for the benefit of the analyst, not the model. The model's environment allows the analyst to pose a variety of what if questions without resorting to programming changes. Although not an ES per se, the ACM would allow for a design and analysis environment that is much superior to that of current technologies.

  8. Modeling mine units as activity-based profit centers

    SciTech Connect

    Grayson, R.L.

    1996-12-31

    Now that mine operators have built an experience in managing their cost performances very tightly in response to the ultra-competitive coal market, activity-based cost monitoring tools are in demand. This paper presents an activity-based linear programming methodology for scheduling unit production (or other) activity with concomitant output of projected consumptions of manpower, supplies, materials, etc., as well as the unit-related costs associated with the activity-based consumptions. The modeling establishes the various mine units as profit/cost centers which then become responsive to a cost control philosophy adopted by management. Comparisons can be made among units, which when coupled with production unit conditions and productivity levels, whether similar or dissimilar, highlight the differences among unit cost performances. It is a simple extension to couple statistical process control techniques with such a model to monitor cost fluctuations in a systematic manner. Example data from a formerly operating mine is used to demonstrate and validate the technique for underground production units. A second example is given to demonstrate how a preparation plant can be converted into a profit center as well. It focuses on maximization of profit by modeling revenues and cost factors associated with various levels of coal processing for meeting the demands and specifications for both metallurgical and steam coal customers.

  9. 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.

  10. Improving cultural competency among hospice and palliative care volunteers: recommendations for social policy.

    PubMed

    Jovanovic, Maja

    2012-06-01

    This case study of 14 hospice and palliative care volunteers looked for recommendations and suggestions on how to increase cultural competency among hospice volunteers. In-depth interviews were conducted with a hospice in Toronto, Canada, and findings reveal that volunteers have very specific and diverse recommendations on how they prefer to be briefed and educated on cultural competency issues surrounding their patients. Findings also reveal hospice volunteers want more cultural competency training and acknowledge the importance of being culturally competent. This article concludes with a précis on recommendations for increasing cultural competency in hospice and palliative care for both volunteers and agencies and discusses the top 4 future trends in cultural competency for hospice care.

  11. Communication dynamics in hospice teams: understanding the role of the chaplain in interdisciplinary team collaboration.

    PubMed

    Wittenberg-Lyles, Elaine; Oliver, Debra Parker; Demiris, George; Baldwin, Paula; Regehr, Kelly

    2008-12-01

    Hospice chaplains provide a specific expertise to patient and family care, however, individual roles and responsibilities that facilitate the interdisciplinary team environment are less well known. The primary aim of this study was to investigate how hospice chaplains perceive their role in interdisciplinary team meetings and to what extent hospice chaplains share common experiences within the interdisciplinary team approach in hospice. Hospice chaplains within a 10-state region participated in a 39-item phone survey about professional roles, group roles, and structural characteristics that influence their ability to participate in interdisciplinary collaboration. Findings revealed that professional role conflict is experienced, primarily with social workers. Informal group task and maintenance roles included team spiritual care advisor and conflict manager, and structural characteristics consisted of extracurricular communication outside of the organization. Although chaplains foster interdisciplinary collaboration within the hospice team, future research needs to address improvements to the chaplain's role within the interdisciplinary team process.

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

    PubMed Central

    Lindley, Lisa C.; Edwards, Sheri L.

    2014-01-01

    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

  13. 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

  14. 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

  15. Space Weather Products at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Hesse, Michael

    2010-01-01

    In addition to supporting space research in the international community, the Community Coordinated Modeling Center (CCMC) has as its second objective to bring to apply the power of modern research models toward space weather specification and forecasting. Initially motivated by the objective to test models and to ease the transition of research models to space weather forecasting organization, the CCMC has developed a number of real-time modeling systems, as well as large number of modeling and data products for space weather forecasting. Over time, these activities have evolved into tailored products for partners, as well as into a direct support of the space weather needs within NASA robotic mission community. Accessible through a customizable interface, users within the US or at partnering institutions internationally have access to space weather tools driven by the most advanced space research models. Through partnering with agencies and institutions in the US and abroad, the CCMC strives to set up further data sharing agreements to the benefit of all participating institutions. In this presentation, we provide an overview of existing CCMC space weather services and products, and we will explore additional avenues for international collaborations.

  16. Space weather products at the Community Coordinated Modeling Center

    NASA Astrophysics Data System (ADS)

    Hesse, Michael

    In addition to supporting space research in the international community, the Community Co-ordinated Modeling Center (CCMC) has as its second objective to bring to apply the power of modern research models toward space weather specification and forecasting. Initially motivated by the objective to test models and to ease the transition of research models to space weather forecasting organization, the CCMC has developed a number of real-time modeling systems, as well as large number of modeling and data products for space weather forecasting. Over time, these activities have evolved into tailored products for partners, as well as into a direct support of the space weather needs within NASA robotic mission community. Accessible through a customizable interface, users within the US or at partnering institutions internationally have access to space weather tools driven by the most advanced space research models. Through partnering with agencies and institutions in the US and abroad, the CCMC strives to set up further data sharing agreements to the benefit of all participating institutions. In this presen-tation, we provide an overview of existing CCMC space weather services and products, and we will explore additional avenues for international collaborations.

  17. "It is the 'starting over' part that is so hard": Using an online group to support hospice bereavement.

    PubMed

    Wittenberg-Lyles, Elaine; Washington, Karla; Oliver, Debra Parker; Shaunfield, Sara; Gage, L Ashley; Mooney, Megan; Lewis, Alexandria

    2015-04-01

    Although hospice agencies are required to provide informal caregivers (family or friends of the patient) with formal bereavement support when their loved one passes, most bereavement interventions lack standardization and remain untested. We employed the Dual Processing Model of Bereavement as a theoretical framework for assessing the potential of a secret Facebook group for bereaved hospice caregivers. A mixed-methods approach was utilized to analyze online communication (posts and comments) in the secret Facebook group, and self-reported outcome measures on depression and anxiety were compared pre- and post-intervention. Sixteen caregivers participated in the secret Facebook group over a period of nine months. The majority of online talk was oriented to restoration, revealing abrupt and anticipated triggers that evoked feelings of loss. Caregivers also shared loss orientation through storytelling, sharing and giving advice, and encouraging others to manage the challenges of coping. Caregiver anxiety and depression were lower after the intervention. This pilot study provides insight into the use of a secret Facebook group to facilitate bereavement support to caregivers. Findings highlight the promise of Facebook for hospice bereavement support. Providers and researchers are encouraged to explore the positive outcomes associated with bereavement support.

  18. COMPLICATED GRIEF SYMPTOMS IN CAREGIVERS OF PERSONS WITH LUNG CANCER: THE ROLE OF FAMILY CONFLICT, INTRAPSYCHIC STRAINS, AND HOSPICE UTILIZATION*

    PubMed Central

    KRAMER, BETTY J.; KAVANAUGH, MELINDA; TRENTHAM-DIETZ, AMY; WALSH, MATTHEW; YONKER, JAMES A.

    2012-01-01

    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 care-givers 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

  19. Center vortices, nexuses, and the Georgi-Glashow model

    NASA Astrophysics Data System (ADS)

    Cornwall, John M.

    1999-06-01

    In a gauge theory with no Higgs fields the mechanism for confinement is by center vortices, but in theories with adjoint Higgs fields and generic symmetry breaking, such as the Georgi-Glashow model, Polyakov showed that in d=3 confinement arises via a condensate of 't Hooft-Polyakov monopoles. We study the connection in d=3 between pure-gauge-theory and the theory with adjoint Higgs fields by varying the Higgs VEV v. As one lowers v from the Polyakov semiclassical regime v>>g (g is the gauge coupling) toward zero, where the unbroken theory lies, one encounters effects associated with the unbroken theory at a finite value v~=g, where dynamical mass generation of a gauge-symmetric gauge-boson mass m~=g2 takes place, in addition to the Higgs-generated non-symmetric mass M~=vg. This dynamical mass generation is forced by the infrared instability (in both 3 and 4 dimensions) of the pure-gauge theory. We construct solitonic configurations of the theory with both m,M≠0 which are generically closed loops consisting of nexuses (a class of soliton recently studied for the pure-gauge theory), each paired with an antinexus, sitting like beads on a string of center vortices with vortex fields always pointing into (out of) a nexus (antinexus); the vortex magnetic fields extend a transverse distance 1/m. An isolated nexus with vortices is continuously deformable from the 't Hooft-Polyakov (m=0) monopole to the pure-gauge-nexus-vortex complex (M=0). In the pure-gauge M=0 limit the homotopy Π2(SU(2)/U(1))=Z [or its analog for SU(N)] of the 't Hooft-Polyakov monopoles is no longer applicable, and is replaced by the center-vortex homotopy Π1(SU(N)/ZN)=ZN of the center vortices.

  20. Electing Full Code in Hospice: Patient Characteristics and Live Discharge Rates.

    PubMed

    Ankuda, Claire K; Fonger, Evan; O'Neil, Thomas

    2017-09-05

    It is unknown how many hospice enrollees elect to be full code and if this is associated with higher hospice live discharge rates. To measure the rates of hospice enrollees electing full code, the characteristics predicting full code status, and the association of full code status with various hospice live discharge patterns. Retrospective cohort study of electronic medical record data. A total of 25,636 decedents enrolled in two Michigan hospices between 2009 and 2014. Code status was defined as full code versus do-not-resuscitate (DNR) orders. Covariates include demographics, location (home, hospice facility, nursing home, and hospital), primary diagnosis, and length of stay. Hospice live discharge was defined as short (0-14 days), medium (15-179 days), and long (>179 days). A total of 12.9% of hospice enrollees elected full code status. This was significantly (p < 0.05) predicted by male sex, younger age, nonwhite race, home setting of care, and cancer diagnosis. Those with full code status had 1.76 times the adjusted odds of hospice live discharge compared with those with DNR orders (95% confidence interval [CI] 1.44-2.16) and 2.47 times the odds of short live discharge (95% CI 1.69-3.62) with no significant difference in long live discharge. The association of full code orders with hospice live discharge was stronger for nonwhite enrollees, with a live discharge rate of 23.8% versus 11.6% for African Americans with full code versus DNR orders. Those electing full code status on admission to hospice are at high risk of live hospice discharge after short enrollments, particularly nonwhite enrollees.