29 CFR 825.114 - Inpatient care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

29 CFR 825.114 - Inpatient care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

29 CFR 825.114 - Inpatient care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

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.

Medicare program; home health prospective payment system rate update for calendar year 2011; changes in certification requirements for home health agencies and hospices. Final rule.

PubMed

2010-11-17

This final rule sets forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: the national standardized 60-day episode rates, the national per-visit rates, the nonroutine medical supply (NRS) conversion factors, and the low utilization payment amount (LUPA) add-on payment amounts, under the Medicare prospective payment system for HHAs effective January 1, 2011. This rule also updates the wage index used under the HH PPS and, in accordance with the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), updates the HH PPS outlier policy. In addition, this rule revises the home health agency (HHA) capitalization requirements. This rule further adds clarifying language to the "skilled services" section. The rule finalizes a 3.79 percent reduction to rates for CY 2011 to account for changes in case-mix, which are unrelated to real changes in patient acuity. Finally, this rule incorporates new legislative requirements regarding face-to-face encounters with providers related to home health and hospice care.

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;…

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

Code of Federal Regulations, 2010 CFR

2010-10-01

... total Medicare payment to a hospice for care furnished during a cap period is limited by the hospice cap... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.308 Limitation...

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.

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.

[Development and evaluation of "Hospice Smart Patient" service program].

PubMed

Park, Chai-Soon; Yoo, Yang-Sook; Choi, Dong-Won; Park, Hyun-Jeong; Kim, Ji-In

2011-02-01

The purpose of this study was to develop and implement the Hospice Smart Patient Program and to evaluate its effectiveness. It was quasi-experimental non-equivalent pre-post study. Breast cancer patients who underwent surgery, chemotherapy or radiotherapy, or who needed palliative care, participated in the study. Participants were divided into two groups, experimental and control groups based on their preferences. The program was developed after literature review and discussion among experts on hospice and palliative care. Participants who were in the experimental group received either face-to-face or phone "Hospice Smart Patient" Service at least once a week for 5 months. There was a significant difference in quality of life and communication skill between the two groups after the service was provided. In addition, participants in experimental group showed improved decision making skills, mastery sense, and understanding of hospice and palliative care, which would be beneficial in improving their quality of life. We have concluded that the "Hospice Smart Patient" Program is useful for cancer patients in decision making, improving self-control and choosing hospice care to improve their quality of life.

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 director...

Linking Family Life and Health Professionals, Volunteers, and Family Life Students in a Community Hospice Program.

ERIC Educational Resources Information Center

Fruit, Dorothy

This paper describes the Portage County, Ohio community hospice program, emphasizing the linkages between family life specialists, health professionals, volunteers, and students. Hospice service is defined as a specialized, home-based program for the management of pain and other symptoms of terminal illness, with the family as the unit of care.…

The effects of hospice coverage on Medicare expenditures.

PubMed Central

Kidder, D

1992-01-01

This article reports on the findings of a study of the effects of the hospice program on Medicare Part A expenditures during the first three years of the program. The analysis compared treatment costs between hospice beneficiaries and nonbenefit patients with diagnosis of malignant cancer during their last seven months of life. It was estimated that during the first three years of the hospice program, Medicare saved $1.26 for every dollar spent on Part A expenditures. While the methodology included use of data from Medicare claims to adjust for confounding factors, including self-selection bias, our estimated savings might still have been overstated due to persistent selection effects. The extent of savings also varied according to the hospice's organization. Freestanding hospices, in contrast to those affiliated with either a hospital, nursing home, or home health agency, achieved the greatest savings by utilizing home care more extensively. However, we note that payment rates are increasing and the limits on the benefit period are being lifted, making it possible that the savings related to the hospice program found in this study will not continue. Of greater importance may be the long-term access and quality effects engendered by the benefit's preference for home care. PMID:1592605

The effects of hospice coverage on Medicare expenditures.

PubMed

Kidder, D

1992-06-01

This article reports on the findings of a study of the effects of the hospice program on Medicare Part A expenditures during the first three years of the program. The analysis compared treatment costs between hospice beneficiaries and nonbenefit patients with diagnosis of malignant cancer during their last seven months of life. It was estimated that during the first three years of the hospice program, Medicare saved $1.26 for every dollar spent on Part A expenditures. While the methodology included use of data from Medicare claims to adjust for confounding factors, including self-selection bias, our estimated savings might still have been overstated due to persistent selection effects. The extent of savings also varied according to the hospice's organization. Freestanding hospices, in contrast to those affiliated with either a hospital, nursing home, or home health agency, achieved the greatest savings by utilizing home care more extensively. However, we note that payment rates are increasing and the limits on the benefit period are being lifted, making it possible that the savings related to the hospice program found in this study will not continue. Of greater importance may be the long-term access and quality effects engendered by the benefit's preference for home care.

Improving Access to Hospice Care: Informing the Debate

PubMed Central

CARLSON, MELISSA D.A.; MORRISON, R. SEAN; BRADLEY, ELIZABETH H.

2015-01-01

The most frequently cited policy solution for improving access to hospice care for patients and families is to expand hospice eligibility criteria under the Medicare Hospice Benefit. However, the substantial implications of such a policy change have not been fully articulated or evaluated. This paper seeks to identify and describe the implications of expanding Medicare Hospice Benefit eligibility on the nature of hospice care, the cost of hospice care to the Medicare program, and the very structure of hospice and palliative care delivery in the United States. The growth in hospice has been dramatic and the central issue facing policymakers and the hospice industry is defining the appropriate target population for hospice care. As policymakers and the hospice industry discuss the future of hospice and potential changes to the Medicare Hospice Benefit, it is critical to clearly delineate the options—and the implications and challenges of each option—for improving access to hospice care for patients and families. PMID:18363486

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.

Medicare Hospice Benefits

MedlinePlus

... Choosing to start hospice care is a difficult decision. The information in this booklet and support from a doctor ... may need hospice care in all health care decisions. The information in this booklet describes the Medicare Program at ...

A Survey of Hospice Volunteer Coordinators: Training Methods and Objectives of Current Hospice Volunteer Training Programs.

PubMed

Brock, Cara M; Herndon, Christopher M

2017-06-01

Currently more than 5800 hospice organizations operate in the United States. 1 Hospice organizations are required by the Centers for Medicare and Medicaid Services (CMS) to use volunteers for services provided to patients. 2 Although CMS regulates the amount of hours hospice volunteers should provide, there are currently no national requirements for objectives of training. 3 The purpose of this study was to gather information from a sample of hospices regarding volunteer coordinator background, current training for volunteers, importance of training objectives, and any comments regarding additional objectives. Representative state hospice organizations were contacted by e-mail requesting their participation and distribution of the survey throughout their member hospices. The survey asked demographical questions, along with ratings of training components based on perceived level of importance and time spent on each objective. A total of 90 surveys were received, and the response rate was undeterminable. Results showed the majority of hospices were nonprofit, had less than 100 currently trained volunteers, and maintained an average daily patient census of less than 50. Questions regarding training programs indicated that most use live lecture methods of approximately 19 hours or less in duration. Overall, responding hospice organizations agreed that all objectives surveyed were important in training volunteers. The small number of respondents to this survey makes generalization nationwide difficult, however it is a strong starting point for the development of further surveys on hospice volunteer training and achieving a standardized set of training objectives and delivery methods.

A contemplative care approach to training and supporting hospice volunteers: a prospective study of spiritual practice, well-being, and fear of death.

PubMed

Scherwitz, Larry; Pullman, Marcie; McHenry, Pamela; Gao, Billy; Ostaseski, Frank

2006-01-01

Inspired by a 2,500-year-old Buddhist tradition, the Zen Hospice Project (ZHP) provides residential hospice care, volunteer programs, and educational efforts that cultivate wisdom and compassion in service. The present study was designed to understand how being with dying hospice residents affects hospice volunteers well-being and the role of spiritual practice in ameliorating the fear of death. A one-year longitudinal study of two volunteer cohorts (N = 24 and N = 22) with repeated measures of spiritual practice, well-being, and hospice performance during one-year service as volunteers. The Zen Hospice Guest House and Laguna Honda Residential Hospital of San Francisco, CA. All 46 individuals who became ZHP volunteers during two years. A 40-hour training program for beginning hospice volunteers stressing compassion, equanimity, mindfulness, and practical bedside care; a one-year caregiver assignment five hours per week; and monthly group meeting. Self-report FACIT spiritual well-being, general well-being, self-transcendence scale, and a volunteer coordinator-rated ZHP performance scale. The volunteers had a high level of self-care and well-being at baseline and maintained both throughout the year; they increased compassion and decreased fear of death. Those (n = 20) practicing yoga were found to have consistently lower fear of death than the group average (P = .04, P = .008, respectively). All rated the training and program highly, and 63% continued to volunteer after the first year's commitment. The results suggest that this approach to training and supporting hospice volunteers fosters emotional well-being and spiritual growth.

A Hospice Rotation for Military Medical Residents: A Mixed Methods, Multi-Perspective Program Evaluation

PubMed Central

Boyden, Jackelyn Y.; Kalish, Virginia B.; Muir, J. Cameron; Richardson, Suzanne; Connor, Stephen R.

2016-01-01

Abstract Background: An estimated 6,000 to 18,000 additional hospice and palliative medicine (HPM) physicians are needed in the United States. A source could be the military graduate medical education system where 15% of U.S. medical residents are trained. A community-based hospice and palliative care organization created a one-week rotation for military residents including participation in interdisciplinary group visits at patients' homes, facilities, and an inpatient hospice unit. Objective: Our goal was to evaluate the effectiveness of a one-week community HPM rotation for military medical residents. Methods: A mixed-methods, multi-stakeholder perspective program evaluation model was used for program years 2011 to 2013. Data were managed and analyzed using Microsoft Excel and Atlas.ti. Participants in the rotation were residents training at two local military hospitals. Program evaluation data were collected from residents, military program liaisons, and hospice clinical preceptors. Quantitative data included pre- and post-tests based on Accreditation Council for Graduate Medical Education competencies completed by residents. Qualitative data included resident essays and semi-structured interviews with hospice preceptors and military program liaisons. Results: Quantitative and qualitative data suggested that the rotation increased military residents' knowledge, attitudes, and comfort level with HPM. Quantitative analysis of test scores indicated improvements from pre- to post-tests in each of five areas of learning. Qualitative data indicated the rotation created a greater appreciation for the overall importance of HPM and increased understanding of eligibility and methods for pain and symptom management. Conclusions: A one-week community hospice rotation for medical military residents impacts participant's knowledge of and attitudes toward HPM. PMID:27139524

Caring to learn, learning to care: Inmate Hospice Volunteers and the Delivery of Prison End-of-Life Care

PubMed Central

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

2017-01-01

The increasing numbers of aging and chronically ill prisoners incarcerated in Western nations is well documented, as is the growing need for prison-based palliative and end-of-life care. Less often discussed is specifically how end-of-life care can and should be provided, by whom, and with what resources. One strategy incorporates prisoner volunteers into end-of-life services within a peer care program. This article reports on one such program based on focused ethnographic study including in-depth interviews with inmate hospice volunteers, nursing staff, and corrections officers working in the hospice program. We describe how inmate volunteers learn hospice care through formal education and training, supervised practice, guidance from more experienced inmates, and support from correctional staff. We discuss how emergent values of mentorship and stewardship are seen by volunteers and staff as integral to prison hospice sustainability and discuss implications of this volunteer-centric model for response-ability for the end-of-life care of prisoners. PMID:28100141

SARP: a value-based approach to hospice admissions triage.

PubMed

MacDonald, D

1995-01-01

As hospices become established and case referrals increase, many programs are faced with the necessity of instituting waiting lists. Prioritizing cases for order of admission requires a triage method that is rational, fair, and consistent. This article describes the SARP method of hospice admissions triage, which evaluates prospective cases according to seniority, acuity, risk, and political significance. SARP's essential features, operative assumptions, advantages, and limitations are discussed, as well as the core hospice values which underlie its use. The article concludes with a call for trial and evaluation of SARP in other hospice settings.

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... (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.531 Hospice care services. (a) If a Medicare enrollee of...

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... (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Risk Basis § 417.585 Special rules: Hospice care. (a) No payment is made...

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…

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)

The volunteer program in a Children's Hospice.

PubMed

Duggal, Shalu; Farah, Peggy; Straatman, Lynn Patricia; Freeman, Leanne; Dickson, Susan

2008-09-01

Canuck Place Children's Hospice (CPCH) is regarded as one of the leading pediatric palliative care systems in the world. Since 1995, it has been providing hospice care free of charge to children and their families living with life-threatening conditions. The pediatric palliative hospice is a relatively new practice in health care, in comparison to the longstanding adult model. As a result, development and implementation of volunteer programs in pediatric hospices is not currently represented in literature. With over 300 volunteers at present, CPCH has built a successful program that can serve as a model in pediatric volunteer services. To present the unique volunteer roles and experience at CPCH, and share ways volunteers work to support the efforts of the clinical team. Strategies to address current challenges in the volunteer program are also addressed. Descriptive design. A current CPCH volunteer discusses the volunteer program. Interviews were conducted with the founding volunteer director of CPCH and current volunteers. The volunteer program at CPCH fully embraces the life of each child and family. Volunteer selection is the groundwork for ensuring a cohesive work force, while training equips volunteers with the knowledge to carry out their role with confidence. Areas of improvement that have been recognized include offering effective feedback to volunteers and delivering adequate level of training for non-direct care roles. The talents of volunteers at CPCH are diverse, and CPCH aims to recognize and thank volunteers for their continuous contributions.

Cost savings and enhanced hospice enrollment with a home-based palliative care program implemented as a hospice-private payer partnership.

PubMed

Kerr, Christopher W; Donohue, Kathleen A; Tangeman, John C; Serehali, Amin M; Knodel, Sarah M; Grant, Pei C; Luczkiewicz, Debra L; Mylotte, Kathleen; Marien, Melanie J

2014-12-01

In the United States, 5% of the population is responsible for nearly half of all health care expenditures, with a large concentration of spending driven by individuals with expensive chronic conditions in their last year of life. Outpatient palliative care under the Medicare Hospice Benefit excludes a large proportion of the chronically ill and there is widespread recognition that innovative strategies must be developed to meet the needs of the seriously ill while reducing costs. This study aimed to evaluate the impact of a home-based palliative care program, implemented through a hospice-private payer partnership, on health care costs and utilization. This was a prospective, observational database study where insurance enrollment and claims data were analyzed. The study population consisted of Home Connections (HC) program patients enrolled between January 1, 2010 and December 31, 2012 who subsequently expired (n=149) and who were also Independent Health members. A control group (n=537) was derived using propensity-score matching. The primary outcome variable was overall costs within the last year of life. Costs were also examined at six months, three months, one month, and two weeks. Inpatient, outpatient, ancillary, professional, and pharmacy costs were compared between the two groups. Medical service utilization and hospice enrollment and length of stay were also evaluated. Cost savings were apparent in the last three months of life—$6,804 per member per month (PMPM) cost for palliative care participants versus $10,712 for usual care. During the last two weeks of life, total allowed PMPM was $6,674 versus $13,846 for usual care. Enhanced hospice entry (70% versus 25%) and longer length of stay in hospice (median 34 versus 9 days) were observed. Palliative care programs partnered with community hospice providers may achieve cost savings while helping provide care across the continuum.

Who Knew? Hospice Is a Business. What that Means for All of Us.

PubMed

Rahman, Anna N

2017-02-01

A seasoned gerontologist whose work has explored end-of-life care, I thought I knew what I was getting into when I undertook care for my brother Jim. In April 2014, Jim, whose health was then declining rapidly due to liver cancer, moved from his apartment in Minneapolis to my house in Santa Monica. Jim had come for a liver transplant evaluation at the University of California, Los Angeles (UCLA). When the UCLA team declined to list him-his cancer was just too widespread-Jim elected to stay with my family and me, enrolling in hospice. I did my homework when shopping for a hospice provider. Colleagues in the field gave me referrals. I googled their recommendations and read the reviews. I interviewed admissions counselors. When Jim signed the admission papers, I was confident that we were in good hands with the agency we selected. For the most part, we were. Hospice is widely considered an effective program. Studies show that it prevents pain and suffering among dying patients and increases satisfaction with care. Although other health care programs are regularly pilloried in the press, hospice programs are often lauded. Indeed, they sometimes appear so mission driven that one might mistake them for charities. They are not. Whether for-profit or not-for-profit enterprises, they are businesses-and concerned about their bottom line. Through Jim's story and mine, this article highlights the implications of this business orientation for patients and providers. Methods for evaluating hospice programs nationally are critiqued. Finally, recommendations for improving the business of hospice care are offered. © 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.

42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE... level of understanding, involvement, and agreement with the plan of care, in accordance with the hospice... communication and integration, in accordance with the hospice's own policies and procedures, to— (1) Ensure that...

Medical students as hospice volunteers: the benefits to a hospice organization.

PubMed

Setla, Judith; Watson, Linda

2006-01-01

Hospices have regulatory requirements to provide volunteers who can assist families in a variety of ways. Hospices also typically provide large amounts of uncompensated education for students in various life sciences as part of their mission to promote quality care for those at the end-of-life. Separately, there is evidence of the educational benefits of exposing medical students to hospice patients and practices. But little has been published about the costs or benefits such teaching programs incur at the hospices involved. Hospice of Central New York developed a service-learning elective where first-year medical students were trained as volunteers. Despite initial concerns that significant staff time would be required to develop and maintain this elective, it appears to be an efficient way to satisfy the need for volunteers while contributing to the education of the involved students.

Researching a Best-Practice End-of-Life Care Model for Canada

ERIC Educational Resources Information Center

Wilson, Donna M.; Birch, Stephen; Sheps, Sam; Thomas, Roger; Justice, Christopher; MacLeod, Rod

2008-01-01

The vast majority of the 220,000 Canadians who die each year, principally of old age and progressive ill health, do not have access to specialized hospice or palliative care. Hospice and palliative care programs are unevenly distributed across Canada, with existing programs limited in capacity and services varying considerably across programs.…

Diversity among hospice volunteers: a challenge for the development of a responsive volunteer program.

PubMed

Roessler, A; Carter, H; Campbell, L; MacLeod, R

1999-01-01

Voluntary organizations such as hospices are increasingly being called upon to substitute for state health and social welfare delivery at a time when volunteer contributions are threatened because of organizational and demographic changes. These changes include: the adoption by the nonprofit sector of market strategies in response to health and social welfare reforms, increases in the size and complexity of hospices, increasing professionalization of staff, and the move of women away from voluntary work in the health and welfare services to paid employment. With these changes, hospices must be knowledgeable about their volunteer workforce and resourceful if they are to continue to attract and retain volunteers. A survey of volunteers conducted at the Mary Potter Hospice, Wellington, New Zealand, examined differences in volunteers' characteristics, motivations for joining hospice, and factors affecting work satisfaction according to age, gender, and the length of time volunteers had worked. Those findings of particular relevance to program development were: (1) the tendency for the recently recruited volunteers to be in paid employment; (2) the mixed motivations of the younger volunteers, reflecting both altruistic and personal gain needs; and (3) the rewards commonly identified by volunteers, such as feeling their work is of value, being accepted by hospice staff, and feeling like important team members. Practical outcomes of the study are described.

Do Community and Caregiver Factors Influence Hospice Use at the End of Life Among Older Adults With Alzheimer Disease?

PubMed

Karikari-Martin, Pauline; McCann, Judith J; Hebert, Liesi E; Haffer, Samuel C; Phillips, Marcia

2012-05-01

Hospice is an underused service among people with Alzheimer disease. This study used the Hospice Use Model to examine community, care recipient, and caregiver characteristics associated with hospice use before death among 145 community-dwelling care recipients with Alzheimer disease and their caregivers. Secondary analysis using logistic regression modeling indicated that older age, male gender, black race, and better functional health of care recipients with Alzheimer disease were associated with a decreased likelihood of using hospice (model χ 2 5 = 23.5, P = .0003). Moreover, care recipients recruited from an Alzheimer clinic were more likely to use hospice than those recruited from adult day-care centers. Caregiver factors were not independent predictors of hospice use. However, there was a significant interaction between hours of care provided each week and recruitment site. Among care recipients from the Alzheimer clinic, the probability of hospice use increased as caregiving intensity increased. This relationship was reversed in care recipients from day-care centers. Results suggest that adult day-care centers need to partner with hospice programs in the community. In conclusion, care recipient and community service factors influence hospice use in individuals with Alzheimer disease.

The Maryland Division of Correction hospice program.

PubMed

Boyle, Barbara A

2002-10-01

The Maryland Division of Correction houses 24,000 inmates in 27 geographically disparate facilities. The inmate population increasingly includes a frail, elderly component, as well as many inmates with chronic or progressive diseases. The Division houses about 900 human immunodeficiency virus (HIV)-positive detainees, almost one quarter with an acquired immune deficiency syndrome (AIDS) diagnosis. A Ryan White Special Project of National Significance (SPNS) grant and the interest of a community hospice helped transform prison hospice from idea to reality. One site is operational and a second site is due to open in the future. Both facilities serve only male inmates, who comprise more than 95% of Maryland's incarcerated. "Medical parole" is still the preferred course for terminally ill inmates; a number have been sent to various local community inpatient hospices or released to the care of their families. There will always be some who cannot be medically paroled, for whom hospice is appropriate. Maryland's prison hospice program requires a prognosis of 6 months or less to live, a do-not-resuscitate (DNR) order and patient consent. At times, the latter two of these have been problematic. Maintaining the best balance between security requirements and hospice services to dying inmates takes continual communication, coordination and cooperation. Significant complications in some areas remain: visitation to dying inmates by family and fellow prisoners; meeting special dietary requirements; what role, if any, will be played by inmate volunteers. Hospice in Maryland's Division of Correction is a work in progress.

75 FR 70371 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

...This final rule sets forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: the national standardized 60-day episode rates, the national per-visit rates, the nonroutine medical supply (NRS) conversion factors, and the low utilization payment amount (LUPA) add-on payment amounts, under the Medicare prospective payment system for HHAs effective January 1, 2011. This rule also updates the wage index used under the HH PPS and, in accordance with the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), updates the HH PPS outlier policy. In addition, this rule revises the home health agency (HHA) capitalization requirements. This rule further adds clarifying language to the ``skilled services'' section. The rule finalizes a 3.79 percent reduction to rates for CY 2011 to account for changes in case-mix, which are unrelated to real changes in patient acuity. Finally, this rule incorporates new legislative requirements regarding face-to-face encounters with providers related to home health and hospice care.

42 CFR 418.307 - Periodic interim payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.307 Periodic interim payments... payments. The biweekly interim payment amount is based on the total estimated Medicare payments for the...

Caring to Learn and Learning to Care.

PubMed

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

2017-01-01

The increasing numbers of aging and chronically ill prisoners incarcerated in Western nations is well-documented, as is the growing need for prison-based palliative and end-of-life care. Less often discussed is specifically how end-of-life care can and should be provided, by whom, and with what resources. One strategy incorporates prisoner volunteers into end-of-life services within a peer-care program. This article reports on one such program based on focused ethnographic study including in-depth interviews with inmate hospice volunteers, nursing staff, and corrections officers working in the hospice program. We describe how inmate volunteers learn hospice care through formal education and training, supervised practice, guidance from more experienced inmates, and support from correctional staff. We discuss how emergent values of mentorship and stewardship are seen by volunteers and staff as integral to prison hospice sustainability and discuss implications of this volunteer-centric model for response-ability for the end-of-life care of prisoners.

Provider-Based Research Networks Demonstrate Greater Hospice Use for Minority Patients With Lung Cancer

PubMed Central

Penn, Dolly C.; Stitzenberg, Karyn B.; Cobran, Ewan K.; Godley, Paul A.

2014-01-01

Purpose: The Community Clinical Oncology Program (CCOP) and Minority-Based Community Clinical Oncology Program (MBCCOP) are provider-based research networks (PBRN) that improve minority enrollment in cancer-focused clinical trials. We hypothesized that affiliation with a PBRN may also mitigate racial differences in hospice enrollment for patients with lung cancer. Methods: We used the SEER-Medicare data, linked to the National Cancer Institute's CCOP program data, to identify all patients (≥ age 65 years) with lung cancer, diagnosed from 2001 to 2007. We defined clinical treatment settings as CCOP, MBCCOP, academic, or community-affiliated and used multivariable logistic regression analysis to determine factors associated with hospice enrollment. Results: Forty-one thousand eight hundred eighty-five (55.1%) patients with lung cancer enrolled in hospice before death. Approximately 55% of CCOP, 57% of MBCCOP, 57% of academic, and 52% of community patients enrolled. Patients who were more likely to enroll were female (odds ratio [OR], 1.36; 95% CI, 1.31 to 1.40); ≥ age 79 years (OR, 1.11; 95%CI, 1.06 to 1.16); white; lived in more educated areas; had minimal comorbidities; and had distant disease. Asian and black patients in academic (41.1% and 50.4%, respectively) and community practices (35.2% and 43.4%, respectively) were less likely to enroll in hospice compared with white patients (academic, 58.8%; community, 53.1%). However, hospice enrollment was equivalent for black and white patients in MBCCOP (59.5% v 57.2%) and CCOP (52.2% v 56.3%) practices. Conclusion: Minority patients with lung cancer receiving treatment in cancer-focused PBRN- affiliated practices have greater hospice enrollment than those treated in academic and community practices. PMID:24781367

The home health workforce: a distinction between worker categories.

PubMed

Stone, Robyn; Sutton, Janet P; Bryant, Natasha; Adams, Annelise; Squillace, Marie

2013-01-01

The demand for home health aides is expected to rise, despite concerns about the sustainability of this workforce. Home health workers receive low wages and little training and have high turnover. It is difficult to recruit and retain workers to improve clinical outcomes. This study presents national estimates to examine how home health workers and the subgroup of workers differ in terms of sociodemographic characteristics, compensation, benefits, satisfaction, and retention. Hospice aides fare better than other categories of workers and are less likely to leave their job. Policymakers should consider strategies to increase the quality and stability of this workforce.

Solidarity and compassion-prisoners as hospice volunteers in Poland.

PubMed

Krakowiak, Piotr; Deka, Renata; Janowicz, Anna

2018-04-01

Democracy in Eastern Europe arrived after a long fight with a communist regime, and the activities of medical volunteers have been developing in opposition to the existing then in Poland mentality called Homo Sovieticus. From 1981 onwards the Polish Hospice Movement there was inspired by practitioners and international experiences brought by visits of Dr. Cicely Saunders. The history of modern end-of-life care in Poland was connected to caring communities, which could be called compassionate, because of the volunteering of all hospice team members. When palliative medicine started to become a part of the national healthcare programme, the hospice movement was slowly losing its exceptional character of professionals working together with volunteers, accompanied by considerable involvement of church communities. The new way of talking about end-of-life care was proposed in XXI century, and promotion of volunteering was part of it. In Gdansk an innovative program to reintegrate prisoners into society through voluntary work with hospice patients began. Since 2008 the WHAT project was aimed at social reintegration of prisoners through voluntary activities in hospices and correctional institutions from around Poland. In June 2009 Poland was awarded a prestigious prize 'The Crystal Scales of Justice' by The Council of Europe for a project called Voluntary Service of the Convicted in Poland implementing an innovative form of cooperation among prisons, hospices and social welfare homes. The research involving prisoners performing hospice-palliative care volunteering indicates a diverse range of life goals from the inmates not involved in hospices. These innovative correctional programs truly help local communities and prisoners who are currently working in 40 hospices and 70 nursing homes, helping those in need. Adequately prepared inmates who proved to be effective volunteers could be an inspiration to all who want to make end-of-life care more social, more humane and a more universal duty of compassionate communities.

Being a hospice volunteer influenced medical students' comfort with dying and death: a pilot study.

PubMed

Stecho, Will; Khalaf, Roy; Prendergast, Patrick; Geerlinks, Ashley; Lingard, Lorelei; Schulz, Valerie

2012-01-01

Being comfortable with death and communicating with patients near the end of life are important attributes in palliative care. We developed a hospice volunteer program to teach these attitudes and skills to preclinical medical students. Using a mixed-methods approach, validated surveys measured participants' and non-participants fear of death and communication apprehension regarding dying. Journals and focus groups examined participants' subjective experiences as their patient relationships evolved. Survey scores were significantly lower for participant hospice volunteers, indicating lower levels of death anxiety and communication apprehension regarding dying. An explanatory framework, using journals and focus groups, captured participants' sense of development over time into three categories: challenges, learning, and growth. This pilot project provides insight into the medical students' experiential learning as they participate in our hospice volunteer program.

The competencies required by professional hospice palliative care spiritual care providers.

PubMed

Cooper, Dan; Aherne, Michael; Pereira, José

2010-07-01

The Canadian Hospice Palliative Care Association (2002) identifies spiritual care of the dying and their families as a core service for Hospice Palliative Care programs. Yet, until the Spiritual Care Development Initiative of the Canadian Pallium Project, there was no published literature indicating systematic profiling of occupationally relevant core competencies or competency-based training programs specific to this specialized field of practice. This article describes a Canadian Community of Practice process to develop an occupational analysis-based competency profile for the Professional Hospice Palliative Care Spiritual Care Provider utilizing a modified Developing a Curriculum (DACUM) methodology. Competency profiles are important contributions to the development of curricula to train care providers who are recognized by other professions and by institutions as possessing the requisite theoretical and clinical expertise, particularly in academic tertiary care settings.

Volunteer satisfaction and program evaluation at a pediatric hospice.

PubMed

Pascuet, Elena; Beauchemin, Lise; Vaillancourt, Régis; Cowin, Lloyd; Ni, Andy; Rattray, Marion

2012-05-01

Volunteers are essential to the functioning of palliative care programs and serve as important members of the hospice team. They devote much time, effort, and diverse skills and talent to enhance the quality of care at Roger's House--a pediatric palliative care hospice. To evaluate volunteering in a pediatric palliative care hospice and to assess the level of satisfaction from the perspective of hospice volunteers. A survey was sent to all active Roger's House volunteers. Questions were related to their demographics, their overall impression of their volunteering experience, and 47 closed (fixed-choice) statements, divided into 6 parts: 1) Orientation; 2) Training; 3) Feedback/Performance; 4) Communication; 5) Social Contacts; and 6) Value and Respect. Each statement was rated by the participants using a six-point Likert rating scale. Volunteers fully completing the survey were 159 online and 4 on paper, giving a response rate of 66%. The greater number (66, 40.5%) of respondents were 50 years or older and they were mostly female (141, 86.5%). Successes identified included the volunteers' orientation, training, and feedback and performance. Challenges identified included certain aspects of communication, social contacts, and respect/value for the volunteer. Volunteers at Roger's House are generally satisfied with their volunteer position and the environment in which they work. Greater insight into volunteer satisfaction and factors that bring feelings of reward and/or dissatisfaction to the volunteers have allowed Roger's House to identify informed and effective interventions to improve the quality of and satisfaction with the hospice volunteer program.

Implementing the first regional hospice palliative care program in Ontario: the Champlain region as a case study.

PubMed

Pereira, José; Contant, Jocelyne; Barton, Gwen; Klinger, Christopher

2016-07-26

Regionalization promotes planning and coordination of services across settings and providers to meet population needs. Despite the potential advantages of regionalization, no regional hospice palliative care program existed in Ontario, Canada, as of 2010. This paper describes the process and early results of the development of the first regional hospice palliative care program in Ontario. The various activities and processes undertaken and the formal agreements, policies and documents are described. A participative approach, started in April 2009, was used. It brought together over 26 health service providers, including residential hospices, a palliative care unit, community and hospital specialist consultation teams, hospitals, community health and social service agencies (including nursing), individual health professionals, volunteers, patients and families. An extensive stakeholder and community vetting process was undertaken that included work groups (to explore key areas such as home care, the hospital sector, hospice and palliative care unit beds, provision of care in rural settings, e-health and education), a steering committee and input from over 320 individuals via e-mail and town-halls. A Transitional Leadership Group was elected to steer the implementation of the Regional Program over the summer of 2010. This group established the by-laws and details regarding the governance structure of the Regional Program, including its role, responsibilities, reporting structures and initial performance indicators that the Local Health Integration Network (LHIN) approved. The Regional Program was formally established in November 2010 with a competency-based Board of 14 elected members to oversee the program. Early work involved establishing standards and performance indicators for the different sectors and settings in the region, and identifying key clinical needs such as the establishment of more residential hospice capacity in Ottawa and a rural framework to ensure access for citizens in rural and remote regions. Challenges encountered are explored as are the process enablers and facilitators. The paper views the development and implementation process from the perspectives of several frameworks and models related to change management. Following on several initial achievements, the long term success of the Regional Program will depend on consolidating the early gains and demonstrating changes based on key measurable outcomes.

42 CFR 419.21 - Hospital services subject to the outpatient prospective payment system.

Code of Federal Regulations, 2013 CFR

2013-10-01

... exhausted their Part A benefits but are entitled to benefits under Part B of the program. (c) Partial... treatment or by a hospice program furnishing services to patients outside the hospice benefit: (1) Antigens. (2) Splints and casts. (3) Hepatitis B vaccine. (e)(1) Effective January 1, 2005 through December 31...

42 CFR 419.21 - Hospital services subject to the outpatient prospective payment system.

Code of Federal Regulations, 2014 CFR

2014-10-01

... exhausted their Part A benefits but are entitled to benefits under Part B of the program. (c) Partial... treatment or by a hospice program furnishing services to patients outside the hospice benefit: (1) Antigens. (2) Splints and casts. (3) Hepatitis B vaccine. (e)(1) Effective January 1, 2005 through December 31...

Factors in hospice patients' length of stay.

PubMed

Frantz, T T; Lawrence, J C; Somov, P G; Somova, M J

1999-01-01

Many hospice patients are referred comparatively late in the course of their disease progression, therefore minimizing the time of services to the patient, caregivers, and families. Untimely referrals can create organizational, clinical, and emotional problems for all involved; a better understanding of the factors related to length of stay (LOS) in hospice is necessary. This study investigated the relationship between LOS and selected variables. There were significant differences in LOS by diagnosis, physician type, and referral source. No significant differences were found in LOS by gender or insurance type. Factors related to LOS can assist hospices in identifying those particular patients more likely to have longer stays. Additionally, administrators may tailor their programs to meet the needs of the individual hospice.

Spiritual care in the training of hospice volunteers in Germany.

PubMed

Gratz, Margit; Paal, Piret; Emmelmann, Moritz; Roser, Traugott

2016-10-01

Hospice volunteers often encounter questions related to spirituality. It is unknown whether spiritual care receives a corresponding level of attention in their training. Our survey investigated the current practice of spiritual care training in Germany. An online survey sent to 1,332 hospice homecare services for adults in Germany was conducted during the summer of 2012. We employed the SPSS 21 software package for statistical evaluation. All training programs included self-reflection on personal spirituality as obligatory. The definitions of spirituality used in programs differ considerably. The task of defining training objectives is randomly delegated to a supervisor, a trainer, or to the governing organization. More than half the institutions work in conjunction with an external trainer. These external trainers frequently have professional backgrounds in pastoral care/theology and/or in hospice/palliative care. While spiritual care receives great attention, the specific tasks it entails are rarely discussed. The response rate for our study was 25.0% (n = 332). A need exists to develop training concepts that outline distinct contents, methods, and objectives. A prospective curriculum would have to provide assistance in the development of training programs. Moreover, it would need to be adaptable to the various concepts of spiritual care employed by the respective institutions and their hospice volunteers.

Medical students as hospice volunteers: reflections on an early experiential training program in end-of-life care education.

PubMed

Mott, Melissa L; Gorawara-Bhat, Rita; Marschke, Michael; Levine, Stacie

2014-06-01

Despite an increase in the content of palliative medicine curricula in medical schools, students are rarely exposed to end-of-life (EOL) care through real-patient experiences during their preclinical education. To evaluate the utility and impact of exposure to EOL care for first year medical students (MS-1s) through a hospice volunteer experience. Patients and Families First (PFF), a hospice volunteer training program in EOL care, was piloted on three cohorts of MS-1s as an elective. Fifty-five students received 3 hours of volunteer training, and were then required to conduct at least two consecutive hospice visits on assigned patients to obtain course credit. Students' reflective essays on their experiences were analyzed using qualitative methodology and salient themes were extracted by two investigators independently and then collaboratively. The following five themes were identified from students' reflective essays: perceptions regarding hospice patients; reactions regarding self; normalcy of EOL care at home; impact of witnessing death and dying; and suggestions for improving EOL care education for medical students. Hospice volunteering during preclinical years may provide valuable experiential training for MS-1s in caring for seriously ill patients and their families by fostering personal reflection and empathic skills, thereby providing a foundation for future patient encounters during clinical training.

Hospice Use and High-Intensity Care in Men Dying of Prostate Cancer

PubMed Central

Bergman, Jonathan; Saigal, Christopher S.; Lorenz, Karl A.; Hanley, Janet; Miller, David C.; Gore, John L.; Litwin, Mark S.

2012-01-01

Background Hospice programs improve the quality of life and quality of death for men dying of cancer. We sought to characterize hospice use by men dying of prostate cancer and to compare the use of high-intensity care between those who did or did not enroll in hospice. Methods We used linked Surveillance, Epidemiology, and End Results–Medicare data to identify a cohort of Medicare beneficiaries who died of prostate cancer between 1992 and 2005. We created 2 multivariable logistic regression models, one to identify factors associated with hospice use and one to determine the association of hospice use with the receipt of diagnostic and interventional procedures and physician visits at the end of life. Results Of 14 521 men dying of prostate cancer, 7646 (53%) used hospice for a median of 24 days. Multivariable modeling demonstrated that African American ethnicity (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.68–0.88) and higher Charlson comorbidity index (OR, 0.49; 95% CI, 0.44–0.55) were associated with lower odds of hospice use, while having a partner (OR, 1.23; 95% CI, 1.14–1.32) and more recent year of death (OR, 1.12; 95% CI, 1.11–1.14) were associated with higher odds of hospice use. Men dying of prostate cancer who enrolled in hospice were less likely (OR, 0.82; 95% CI, 0.74–0.91) to receive high-intensity care, including intensive care unit admissions, inpatient stays, and multiple emergency department visits. Conclusions The proportion of individuals using hospice is increasing, but the timing of hospice referral remains poor. Those who enroll in hospice are less likely to receive high-intensity end-of-life care. PMID:20937914

Feasibility and Preliminary Effects of an Intervention Targeting Schema Development for Caregivers of Newly Admitted Hospice Patients

PubMed Central

Mazurek Melnyk, Bernadette

2013-01-01

Abstract Background The transition to hospice care is a stressful experience for caregivers, who report high anxiety, unpreparedness, and lack of confidence. These sequelae are likely explained by the lack of an accurate cognitive schema, not knowing what to expect or how to help their loved one. Few interventions exist for this population and most do not measure preparedness, confidence, and anxiety using a schema building a conceptual framework for a new experience. Objective The purpose of this study was to test the feasibility and preliminary effects of an intervention program, Education and Skill building Intervention for Caregivers of Hospice patients (ESI-CH), using an innovative conceptual design that targets cognitive schema development and basic skill building for caregivers of loved ones newly admitted to hospice services. Design A pre-experimental one-group pre- and post-test study design was used. Eighteen caregivers caring for loved ones in their homes were recruited and twelve completed the pilot study. Depression, anxiety, activity restriction, preparedness, and beliefs/confidence were measured. Results Caregivers reported increased preparedness, more helpful beliefs, and more confidence about their ability to care for their loved one. Preliminary trends suggested decreased anxiety levels for the intervention group. Caregivers who completed the intervention program rated the program very good or excellent, thought the information was helpful and timely, and would recommend it to friends. Conclusions Results show promise that the ESI-CH program may assist as an evidence-based program to support caregivers in their role as a caregiver to a newly admitted hospice patient. PMID:23384244

Quality Measures for Hospice and Palliative Care: Piloting the PEACE Measures

PubMed Central

Rokoske, Franziska S.; Durham, Danielle; Cagle, John G.; Hanson, Laura C.

2014-01-01

Abstract Background: The Carolinas Center for Medical Excellence launched the PEACE project in 2006, under contract with the Centers for Medicare & Medicaid Services (CMS), to identify, develop, and pilot test quality measures for hospice and palliative care programs. Objectives: The project collected pilot data to test the usability and feasibility of potential quality measures and data collection processes for hospice and palliative care programs. Settings/subjects: Twenty-two hospices participating in a national Quality Improvement Collaborative (QIC) submitted data from 367 chart reviews for pain care and 45 chart reviews for nausea care. Fourteen additional hospices completed a one-time data submission of 126 chart reviews on 60 potential patient-level quality measures across eight domains of care and an organizational assessment evaluating structure and processes of care. Design: Usability was assessed by examining the range, variability and size of the populations targeted by each quality measure. Feasibility was assessed during the second pilot study by surveying data abstractors about the abstraction process and examining the rates of missing data. The impact of data collection processes was assessed by comparing results obtained using different processes. Results: Measures shown to be both usable and feasible included: screening for physical symptoms on admission and documentation of treatment preferences. Methods of data collection and measure construction appear to influence observed rates of quality of care. Conclusions: We successfully identified quality measures with potential for use in hospices and palliative care programs. Future research is needed to understand whether these measures are sensitive to quality improvement interventions. PMID:24921162

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.

The role of the hospice social worker in the nursing home setting.

PubMed

Amar, D F

1994-01-01

Data and case examples from two major metropolitan hospice programs are examined in order to arrive at a definition of the hospice social worker's role in the nursing home, and how it differs from that of the hospice social worker in home care. The nursing home population tends to be older, frailer, and with poorer mental status, making them less available to "talk therapies". The nursing home environment itself needs to be assessed as a significant part of the patient/family system. Social work interventions may focus on the patient, the family, the nursing home staff, or any combination of these elements. The hospice social worker on a nursing home team may do less counseling with patients, but the role draws on diverse other skills such as groupwork, negotiation, education, and advocacy.

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

[Development in the National Hospice Care Service in Korea].

PubMed

Lee, S W; Lee, E O; Ahn, H S; Heo, D S; Kim, D S; Kim, H S; Lee, H J

1997-01-01

The urgent needs to establish hospice care systems in Korea arise from the following reasons: (1) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e.g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accommodate other medical insurance beneficiaries: (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life: (6) medical and nursing care of AIDS patient in terminal stage: (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage, grouped in hospice and non-hospice care patients, reveal what they want visiting nursing care to help their pain control, psychological, social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains, the non-hospice care patients, in addition to their desire for pain control, demanded more psychological, social and spiritual helps as well. The results of this research could be utilized to (1) define the standard of hospice care, (2) provide the guidance for hospice medical care costs, (3) establish the database of hospice care systems, (4) develop softwares, (5) build communication network through Medinet, and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy, nursing care, and social welfare programs.

Proportion and Patterns of Hospice Discharges in Medicare Advantage Compared to Medicare Fee-for-Service.

PubMed

Teno, Joan M; Christian, Thomas J; Gozalo, Pedro; Plotzke, Michael

2018-03-01

When Medicare Advantage (MA) patients elect hospice, all covered services are reimbursed under the Medicare fee-for-service (FFS) program. This financial arrangement may incentivize MA plans to refer persons to hospice near end of life when costs of care typically rise. To characterize hospice discharge patterns for MA versus FFS patients and examine whether patterns differ by MA concentration across hospital referral regions (HRRs). The rate and pattern of live discharges and length of stay (LOS) between FFS and MA patients were examined. A multivariate mixed-effects model examined whether hospice patients in MA versus FFS had differential patterns of discharges. In addition, we tested whether concentrations of MA hospice patients in a patient's HRR were associated with different patterns of discharges. In fiscal year 2014, there were 1,199,533 hospice discharges with 331,142 MA patients having a slightly higher live discharge rate (15.8%) compared to 868,391 FFS hospice discharges (15.4%). After controlling for patient characteristics, the adjusted odds ratio (AOR) was 1.01 (95% CI 0.99-1.02). MA patients were less likely to have early live discharges (AOR 0.87 95% CI 0.84-0.91) and burdensome transitions (AOR 0.61 95% CI 0.58-0.64) but did not differ in live discharges post 210 days. Among hospice deaths, MA hospice patients were less likely to have a three-day or less LOS (AOR 0.95 95% 0.94-0.96) and a LOS exceeding 180 days (AOR 0.97 95% 0.96-0.99). The concentration of MA patients in a HRR had minimal impact. MA hospice patients' discharge patterns raised less concerns than FFS.

Training Physicians in Palliative Care.

ERIC Educational Resources Information Center

Muir, J. Cameron; Krammer, Lisa M.; von Gunten, Charles F.

1999-01-01

Describes the elements of a program in hospice and palliative medicine that may serve as a model of an effective system of physician education. Topics for the palliative-care curriculum include hospice medicine, breaking bad news, pain management, the process of dying, and managing personal stress. (JOW)

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…

76 FR 60720 - Wage Methodology for the Temporary Non-Agricultural Employment H-2B Program; Postponement of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-30

... wage determinations based on the new prevailing wage methodology set forth in the Wage Rule, as to the... comment, we published a Final Rule on August 1, 2011, which set the new effective date for the Wage Rule... date of the Wage Methodology for the Temporary Non- agricultural Employment H-2B Program Final Rule...

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

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules: ESRD and hospice patients. 417.423 Section 417.423 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND...

A cross-cultural comparison of hospice development in Japan, South Korea, and Taiwan.

PubMed

Glass, Anne P; Chen, Li-Kuang; Hwang, Eunju; Ono, Yuzuho; Nahapetyan, Lusine

2010-03-01

By 2050, one out of four people in Eastern Asia will be aged 65 and above. Thus, preparing to care for an older population is imperative. Addressing quality care for elders includes consideration of palliative and end-of-life care. A comparative study of the development of hospice and palliative care services in Japan, South Korea, and Taiwan, is presented, based on an extensive literature review. Both commonalities and differences were found. This article provides information on the origins and administration of hospice services in these three cases, as well as the degree of government involvement. Cultural and religious aspects are also considered, and obstacles to the spread of hospice services are discussed. This review compares experiences with hospice services and identifies factors that influence people's perceptions and adoption of hospice. Stronger financial support for hospice and palliative care through the government and insurance programs would help increase the availability and use of services. Also, the need for continuing education of healthcare providers, patients, families, and the community is urgent. However, promotion of understanding of better pain management and the worth of hospice and palliative care must be conducted in ways that are sensitive to the cultural values and traditions in Japan, South Korea, and Taiwan. Only when hospice and palliative care can be viewed as an admirable choice for one's loved ones, overcoming issues of truth telling, filial piety, worries about how one is judged, and religious considerations, will it become more widely accepted.

Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions.

PubMed

Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J

2016-01-01

People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

A cost-benefit analysis of music therapy in a home hospice.

PubMed

Romo, Rafael; Gifford, Lisa

2007-01-01

Medicare's fixed daily rates create an absolute cost constraint on hospices; consequently, the growth in hospice brings financial pressures. The patient efficacy of music therapy has been demonstrated in the literature and includes improving pain, agitation, disruptive behaviors, communication, depression, and quality of life. Music therapy is well suited to hospice as it addresses the four domains of palliative care (physiological, emotional, social, and spiritual care). In this small study, the total cost of patients in music therapy was $10,659 and $13,643 for standard care patients, resulting in a cost savings of $2984. The music therapy program cost $3615, yielding a cost benefit ratio of 0.83. When using cost per patient day, the cost benefit ratio is 0.95.

Information Framing Reduces Initial Negative Attitudes in Cancer Patients' Decisions About Hospice Care.

PubMed

Fridman, Ilona; Glare, Paul A; Stabler, Stacy M; Epstein, Andrew S; Wiesenthal, Alison; Leblanc, Thomas W; Higgins, E Tory

2018-06-01

Negative attitudes toward hospice care might prevent patients with cancer from discussing and choosing hospice as they approach end of life. When making a decision, people often naturally focus on either expected benefits or the avoidance of harm. Behavioral research has demonstrated that framing information in an incongruent manner with patients' underlying motivational focus reduces their negative attitudes toward a disliked option. Our study tests this communication technique with cancer patients, aiming to reduce negative attitudes toward a potentially beneficial but often-disliked option, that is, hospice care. Patients (n = 42) with active cancer of different types and/or stages completed a paper survey. Participants read a vignette about a patient with advanced cancer and a limited prognosis. In the vignette, the physician's advice to enroll in a hospice program was randomized, creating a congruent message or an incongruent message with patients' underlying motivational focus (e.g., a congruent message for someone most interested in benefits focuses on the benefits of hospice, whereas an incongruent message for this patient focuses on avoiding harm). Patients' attitudes toward hospice were measured before and after receiving the physician's advice. Regression analyses indicated that information framing significantly influenced patients with strong initial negative attitudes. Patients were more likely to reduce intensity of their initial negative attitude about hospice when receiving an incongruent message (b = -0.23; P < 0.01) than a congruent one (b = -0.13; P = 0.08). This finding suggests a new theory-driven approach to conversations with cancer patients who may harbor negative reactions toward hospice care. Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Prospective payment and the Medicare hospice benefit.

PubMed

Bloom, B S; Amenta, M O

1993-01-01

The objective of this study was to determine the effects of very high cost patients on hospice financial status. Ten Pennsylvania hospices dually certified by Medicare were randomly selected and agreed to participate. Patient age, sex, diagnosis, length of stay and payer were fairly uniform across hospices. Payments varied by diagnosis and payer. High cost patients were irregularly found in hospices; low cost patients were commonly and regularly distributed. Every hospice had at least one high cost patient. In one, the uncompensated payment for the 6.6 percent of patients defined as high cost ($7,300 and above) would have been 14.7 percent of total annual revenues. In another, uncompensated payments for high cost patients (9.8 percent) would have accounted for 17.2 percent of revenue. In 96.3 percent of the instances patients utilized less than the Medicare Hospice Benefit maximum allowable cost ($7,300); and, 98.8 percent of the time patients stayed less than the maximum allowable length of time of 210 days. A logistic regression model found long length of stay (p < 0.0001), Medicare hospice benefit as primary payer (p < 0.0001), any hospitalization during hospice stay (p < 0.003) and cerebrovascular disease diagnosis (p < 0.02) to be significantly related to high cost. Between the time the study was planned and completed, Medicare instituted a reinsurance program allowing unused funds below the maximum allowable limit from one patient to be used for patients who exhausted their benefits. Thus, no study hospice was adversely affected by high cost patients. However, it should serve as an object lesson to Medicare in using prospective payment.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

42 CFR 419.21 - Hospital outpatient services subject to the outpatient prospective payment system.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... (c) Partial hospitalization services furnished by community mental health centers (CMHCs). (d) The... under an HHA plan or treatment or by a hospice program furnishing services to patients outside the hospice benefit: (1) Antigens. (2) Splints and casts. (3) Hepatitis B vaccine. (e)(1) Effective January 1...

Patient safety incidents in hospice care: observations from interdisciplinary case conferences.

PubMed

Oliver, Debra Parker; Demiris, George; Wittenberg-Lyles, Elaine; Gage, Ashley; Dewsnap-Dreisinger, Mariah L; Luetkemeyer, Jamie

2013-12-01

In the home hospice environment, issues arise every day presenting challenges to the safety, care, and quality of the dying experience. The literature pertaining to the safety challenges in this environment is limited. The study explored two research questions; 1) What types of patient safety incidents occur in the home hospice setting? 2) How many of these incidents are recognized by the hospice staff and/or the patient or caregiver as a patient safety incident? Video-recordings of hospice interdisciplinary team case conferences were reviewed and coded for patient safety incidents. Patient safety incidents were defined as any event or circumstance that could have resulted or did result in unnecessary harm to the patient or caregiver, or that could have resulted or did result in a negative impact on the quality of the dying experience for the patient. Codes for categories of patient safety incidents were based on the International Classification for Patient Safety. The setting for the study included two rural hospice programs in one Midwestern state in the United States. One hospice team had two separately functioning teams, the second hospice had three teams. 54 video-recordings were reviewed and coded. Patient safety incidents were identified that involved issues in clinical process, medications, falls, family or caregiving, procedural problems, documentation, psychosocial issues, administrative challenges and accidents. This study distinguishes categories of patient safety events that occur in home hospice care. Although the scope and definition of potential patient safety incidents in hospice is unique, the events observed in this study are similar to those observed with in other settings. This study identifies an operating definition and a potential classification for further research on patient safety incidents in hospice. Further research and consensus building of the definition of patient safety incidents and patient safety incidents in this setting is recommended.

76 FR 59896 - Wage Methodology for the Temporary Non-Agricultural Employment H-2B Program; Postponement of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-28

... Wage Rule revised the methodology by which we calculate the prevailing wages to be paid to H-2B workers... methodology by which we calculate the prevailing wages to be paid to H-2B workers and United States (U.S... concerning the calculation of the prevailing wage rate in the H-2B program. CATA v. Solis, Dkt. No. 103-1...

The new hospice compliance plan: defining and addressing risk areas. Part 3.

PubMed

Jones, D H; Woods, K

2000-07-01

The recently released OIG guidelines to ensure compliance with federal and state statutes, rules, and regulations, and private-payor health care program requirements provide a blueprint for developing such programs. This is the last of three installments that focus specifically on the 28 risk areas identified in the guidance and offer strategies for incorporating them in a hospice compliance program. The authors have organized the 28 risk areas under 9 topic domains to simplify the task of tackling the guidance. This article covers the areas of nursing home care, marketing, and Conditions of Participation.

Nurse practitioner-based models of specialist palliative care at home: sustainability and evaluation of feasibility.

PubMed

Bookbinder, Marilyn; Glajchen, Myra; McHugh, Marlene; Higgins, Phil; Budis, James; Solomon, Neva; Homel, Peter; Cassin, Carolyn; Portenoy, Russell K

2011-01-01

Patients with serious medical problems who live at home may not be able to access specialist-level palliative care when the need develops. Nurse practitioner (NP)-based models may be able to increase the availability of specialist care in the community. The aim of this study was to evaluate the financial sustainability and feasibility of two NP-based models in an urban setting. In one model, an NP was linked with a social worker (SW) to create a new palliative home care team (PHCT-NP-SW), which would provide consultation and direct care to referred homebound elderly patients with advanced illnesses. In a second model, an NP was assigned to a hospice program (Hospice-NP) for the purpose of enhancing the reach and impact of a home care team. The revenue generated by each model was compared with direct costs; the PHCT-NP-SW model also was evaluated for its feasibility and impact on patient-level outcomes. Over a two-year period, the NP in the PHCT-NP-SW model made 350 visits and followed 114 patients at home. Annualized revenue through reimbursement from patient billing offset less than 50% of the NP's salary costs. In contrast, the Hospice-NP model led to a 360% increment in hospice referrals, yielding sufficient new revenue to support this position indefinitely after only seven months. The PHCT-NP-SW model provided numerous interventions that yielded a significant decline in symptom distress during the initial two weeks after referral (P=0.003), 100% compliance with advance care planning, 21% admission rate to hospice, access to other community services, and crisis management. Nonetheless, lack of funding led to closure of this model after the two years. This experience suggests that a PHCT-NP-SW model is not sustainable in this urban environment through reimbursement-based revenue, whereas a Hospice-NP model for hospice can be sustainable based on the growth of hospice census. The PHCT-NP-SW model appears to offer benefits, and additional efforts are needed to establish the funding mechanisms to sustain such programs, create mixed models of hospice and nonhospice funding, or provide a basis for sustainability through cost reduction. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

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.

Do Workplace Literacy Programs Promote High Skills or Low Wages? Suggestions for Future Evaluations of Workplace Literacy Programs.

ERIC Educational Resources Information Center

Sarmiento, Tony

Workplace literacy programs can support the path toward either low wages or high skills. Instead of the "high skill" path, most U.S. companies follow the "low wage" path. Depending on who is involved, which program goals are selected, and what planning process is followed, a workplace literacy program can maintain outdated workplaces or foster…

Holding on to what you have got: keeping hospice palliative care volunteers volunteering.

PubMed

Claxton-Oldfield, Stephen; Jones, Richard

2013-08-01

In all, 119 hospice palliative care volunteers from 3 community-based hospice programs completed the Volunteer Retention Questionnaire (VRQ), a 33-item survey designed for this study. The VRQ asks volunteers to rate the importance of each item to their decision to continue volunteering. The items that received the highest mean importance ratings included enjoying the work they do, feeling adequately prepared/trained to perform their role, and learning from their patients' experiences/listening to their patients' life stories. Being recognized (eg, pins for years of service or being profiled in the hospice newsletter), receiving phone calls/cards from their volunteer coordinator on special occasions, and being reimbursed for out-of-pocket expenses were among the items that received the lowest mean importance ratings. Suggestions for improving volunteer retention are provided.

The effect of Medicaid wage pass-through programs on the wages of direct care workers.

PubMed

Baughman, Reagan A; Smith, Kristin

2010-05-01

Despite growing demand for nursing and home health care as the US population ages, compensation levels in the low-skill nursing labor market that provides the bulk of long-term care remain quite low. The challenge facing providers of long-term care is that Medicaid reimbursement rates for nursing home and home health care severely restrict the wage growth that is necessary to attract workers, resulting in high turnover and labor shortages. Almost half of US states have responded by enacting "pass-through" provisions in their Medicaid programs, channeling additional long-term care funding directly to compensation of lower-skill nursing workers. We test the effect of Medicaid wage pass-through programs on hourly wages for direct care workers. We estimate several specifications of wage models using employment data from the 1996 and 2001 panels of the Survey of Income and Program Participation for nursing, home health, and personal care aides. The effect of pass-through programs is identified by an indicator variable for states with programs; 20 states adopted pass-throughs during the sample period. Workers in states with pass-through programs earn as much as 12% more per hour than workers in other states after those programs are implemented. Medicaid wage pass-through programs appear to be a viable policy option for raising compensation levels of direct care workers, with an eye toward improving recruitment and retention in long-term care settings.

In search of financial viability: hospital-based v. freestanding home care.

PubMed

Laff, Pat; Steding, Pam

2005-03-01

In the continually changing and perpetually unpredictable nature of Medicare and Medicaid reimbursement, many hospitals and health care systems are rethinking their relationships with their affiliated home care and hospice programs. As the books of many of these programs show an increasing amount of red ink, many hospitals are spinning off their home care and hospice services into independent entities with their own individual operating structures. This article provides insight into one health care system's transitioning of its home care services into a freestanding entity.

To be truly alive: motivation among prison inmate hospice volunteers and the transformative process of end-of-life peer care service.

PubMed

Cloyes, Kristin G; Rosenkranz, Susan J; Wold, Dawn; Berry, Patricia H; Supiano, Katherine P

2014-11-01

Some US prisons are meeting the growing need for end-of-life care through inmate volunteer programs, yet knowledge of the motivations of inmate caregivers is underdeveloped. This study explored the motivations of inmate hospice volunteers from across Louisiana State (n = 75) through an open-ended survey, a grounded theory approach to analysis, and comparison of responses by experience level and gender. Participants expressed complex motivations; Inter-related themes on personal growth, social responsibility and ethical service to vulnerable peers suggested that inmate caregivers experience an underlying process of personal and social transformation, from hospice as a source of positive self-identity to peer-caregiving as a foundation for community. Better understanding of inmate caregiver motivations and processes will help prisons devise effective and sustainable end of life peer-care programs. © The Author(s) 2013.

Impact of predictive model-directed end-of-life counseling for Medicare beneficiaries.

PubMed

Hamlet, Karen S; Hobgood, Adam; Hamar, Guy Brent; Dobbs, Angela C; Rula, Elizabeth Y; Pope, James E

2010-05-01

To validate a predictive model for identifying Medicare beneficiaries who need end-of-life care planning and to determine the impact on cost and hospice care of a telephonic counseling program utilizing this predictive model in 2 Medicare Health Support (MHS) pilots. Secondary analysis of data from 2 MHS pilot programs that used a randomized controlled design. A predictive model was developed using intervention group data (N = 43,497) to identify individuals at greatest risk of death. Model output guided delivery of a telephonic intervention designed to support educated end-of-life decisions and improve end-of-life provisions. Control group participants received usual care. As a primary outcome, Medicare costs in the last 6 months of life were compared between intervention group decedents (n = 3112) and control group decedents (n = 1630). Hospice admission rates and duration of hospice care were compared as secondary measures. The predictive model was highly accurate, and more than 80% of intervention group decedents were contacted during the 12 months before death. Average Medicare costs were $1913 lower for intervention group decedents compared with control group decedents in the last 6 months of life (P = .05), for a total savings of $5.95 million. There were no significant changes in hospice admissions or mean duration of hospice care. Telephonic end-of-life counseling provided as an ancillary Medicare service, guided by a predictive model, can reach a majority of individuals needing support and can reduce costs by facilitating voluntary election of less intensive care.

29 CFR 520.409 - When will authority to pay apprentices special minimum wages become effective and what is the...

Code of Federal Regulations, 2010 CFR

2010-07-01

... wages become effective and what is the special minimum wage rate? 520.409 Section 520.409 Labor... apprentices special minimum wages become effective and what is the special minimum wage rate? (a) An... Division. (b) The wage rate specified by the apprenticeship program becomes the special minimum wage rate...

Exploring Factors that Influence Informal Caregiving in Medication Management for Home Hospice Patients

PubMed Central

Berman, Rebecca; Halpern, Leslie; Pickard, A. Simon; Schrauf, Robert; Witt, Whitney

2010-01-01

Abstract Objective To explore factors that influence how informal caregivers manage medications as part of caring for hospice patients. Methods : Semistructured, open-ended interviews were conducted with 23 informal caregivers and 22 hospice providers from 4 hospice programs in the Chicago metropolitan areas. Qualitative analysis was conducted consistent with the grounded theory approach. Results : In general, informal caregivers and hospice providers identified similar key factors that facilitated or impeded caregivers' process in managing medications. Caregivers' life experience and self-confidence were considered assets that facilitated medication management. Limitations impeding the process included caregivers' negative emotional states, cognitive and physical impairments, low literacy, other competing responsibilities, as well as patients' negative emotional states and complex medication needs. Furthermore, the social context of medication management emerged as a salient theme: caregivers' good interpersonal relations with patients facilitated medication management, whereas poor communication/relations among caregivers within a support network impeded the process. While both study groups discussed the positive attributes of good caregiver–patient relations and support from multiple caregivers, hospice providers were cautious about the potential adverse influence of close relations with patients on caregivers' decision making about medications and discussed poor communication/relations among informal and privately hired caregivers that often resulted from family conflicts and/or a lack of long-standing leadership. Conclusion Our findings suggest additional intervention points, beyond knowledge and skill building, that could be addressed to support caregivers in executing medication responsibilities at home for hospice patients. PMID:20836633

Spiritual beliefs, practices, and needs at the end of life: Results from a New Zealand national hospice study.

PubMed

Egan, Richard; MacLeod, Rod; Jaye, Chrystal; McGee, Rob; Baxter, Joanne; Herbison, Peter; Wood, Sarah

2017-04-01

International studies have shown that patients want their spiritual needs attended to at the end of life. The present authors developed a project to investigate people's understanding of spirituality and spiritual care practices in New Zealand (NZ) hospices. A mixed-methods approach included 52 semistructured interviews and a survey of 642 patients, family members, and staff from 25 (78%) of NZ's hospices. We employed a generic qualitative design and analysis to capture the experiences and understandings of participants' spirituality and spiritual care, while a cross-sectional survey yielded population level information. Our findings suggest that spirituality is broadly understood and considered important for all three of the populations studied. The patient and family populations had high spiritual needs that included a search for (1) meaning, (2) peace of mind, and (3) a degree of certainty in an uncertain world. The healthcare professionals in the hospices surveyed seldom explicitly met the needs of patients and families. Staff had spiritual needs, but organizational support was sometimes lacking in attending to these needs. As a result of our study, which was the first nationwide study in NZ to examine spirituality in hospice care, Hospice New Zealand has developed a spirituality professional development program. Given that spirituality was found to be important to the majority of our participants, it is hoped that the adoption of such an approach will impact on spiritual care for patients and families in NZ hospices.

[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. © 2017 Korean Society of Nursing Science

Does hospital need more hospice beds? Hospital charges and length of stays by lung cancer inpatients at their end of life: A retrospective cohort design of 2002-2012.

PubMed

Kim, Sun Jung; Han, Kyu-Tae; Kim, Tae Hyun; Park, Eun-Cheol

2015-10-01

Previous studies found that hospice and palliative care reduces healthcare costs for end-of-life cancer patients. To investigate hospital inpatient charges and length-of-stay differences by availability of hospice care beds within hospitals using nationwide data from end-of-life inpatients with lung cancer. A retrospective cohort study was performed using nationwide lung cancer health insurance claims from 2002 to 2012 in Korea. Descriptive and multi-level (patient-level and hospital-level) mixed models were used to compare inpatient charges and lengths of stay. Using 673,122 inpatient health insurance claims, we obtained aggregated hospital inpatient charges and lengths of stay from a total of 114,828 inpatients and 866 hospital records. Hospital inpatient charges and length of stay drastically increased as patients approached death; a significant portion of hospital inpatient charges and lengths of stay occurred during the end-of-life period. According to our multi-level analysis, hospitals with hospice care beds tend to have significantly lower end-of-life hospital inpatient charges; however, length of stay did not differ. Hospitals with more hospice care beds were associated with reduction in hospital inpatient charges within 3 months before death. Higher end-of-life healthcare hospital charges were found for lung cancer inpatients who were admitted to hospitals without hospice care beds. This study suggests that health policy-makers and the National Health Insurance program need to consider expanding the use of hospice care beds within hospitals and hospice care facilities for end-of-life patients with lung cancer in South Korea, where very limited numbers of resources are currently available. © The Author(s) 2015.

Cultural competence: assessment and education resources for home care and hospice clinicians.

PubMed

Hines, Deborah

2014-05-01

Home healthcare and hospice clinicians face many challenges in the complex healthcare system caring for patients and their families in the home environment. One of those challenges is providing culturally competent care for an increasingly diverse population. This article will highlight free, easily accessible, online resources to assist clinicians and organizations to assess organizational and individual cultural competence and provide many resources for cultural competency education programs.

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.

76 FR 82115 - Wage Methodology for the Temporary Non-Agricultural Employment H-2B Program; Delay of Effective Date

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-30

... year (FY) 2012. The Wage Rule revised the methodology by which we calculate the prevailing wages to be... 19, 2011, 76 FR 3452. The Wage Rule revised the methodology by which we calculate the prevailing... November 30, 2011. When the Wage Rule goes into effect, it will supersede and make null the prevailing wage...

76 FR 78343 - HOME Investment Partnerships Program: Improving Performance and Accountability; and Updating...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-16

... their programs and in managing their growing portfolios of older HOME projects. These challenges include... program. Examples of such uses are hospice buildings, nursing homes, foster homes, halfway houses, and...

Hope Tree: An Interactive Art Installation to Facilitate the Expression of Hope in a Hospice Setting.

PubMed

Collins, Andrew; Bhathal, Darpanjot; Field, Tara; Larlee, Randene; Paje, Rachael; Young, Daneen

2018-01-01

Individuals confronting a terminal illness can experience intense psychological distress. Previous research has shown that hope can enhance one's ability to acknowledge, accept, and fight a terminal illness. Patients can continue to have hope or be hopeful, even in the face of a terminal illness. Can participation in a creative writing practice improve the expression of hope in a hospice setting? In this program evaluation, each expressed hope placed on the "Hope Tree" was independently coded by all research team members utilizing inductive content analysis. Overall themes were derived using a constant comparative approach and arranged into overarching themes based on consensus. Eight major themes emerged from the data: "Peace," "Dreams," "Total well-being," "Acknowledgment of loss," "Relationships," "Hospice care," "Spirituality," and "Dichotomies." The Hope Tree is a creative art project that can be used within a hospice environment to promote hope among family members and the health-care professionals who care for patients.

Comparison of the hospice systems in the United States, Japan and taiwan.

PubMed

Lee, Chung Yul; Komatsu, Hiroko; Zhang, Weihua; Chao, Yann-Fen; Kim, Ki Kyong; Kim, Gwang Suk; Cho, Yoon Hee; Ko, Ji Sook

2010-12-01

The aim of hospice care is to provide the best possible quality of life both for people approaching the end of life and for their families and carers. The Korean government has been implementing a pilot project for hospital hospice services and trying to develop the national hospice system. To assist in the development of the Korean hospice system, the Korean government supported the present study comparing the hospice systems of three countries, United States, Japan, and Taiwan, which currently have a developed hospice system. Data from three countries were collected in the following ways: reviewing hospice related literature, searching government documents on the Internet, collecting government hospice data, surveying six hospice institutions in each country, and conducting an international workshop. The hospice system was evaluated by comparing hospice management systems and hospice cost systems. The comparison of the hospice management system included five items of hospice infra structures and four items of hospice services. The hospice cost system included four items: funding source, hospital hospice cost, day care hospice cost, and home hospice cost. Based on the comparison of three countries, the most interesting thing was that home hospice care accounted for more than 90% of all hospice services in the United States and Taiwan. The results of this study will aid the countries that are in the process of developing a hospice system including Korea, which has been implementing a pilot project only for hospital hospice services. Copyright © 2010 Korean Society of Nursing Science. Published by . All rights reserved.

Development of Evaluation Indicators for Hospice and Palliative Care Professionals Training Programs in Korea.

PubMed

Kang, Jina; Park, Kyoung-Ok

2017-01-01

The importance of training for Hospice and Palliative Care (HPC) professionals has been increasing with the systemization of HPC in Korea. Hence, the need and importance of training quality for HPC professionals are growing. This study evaluated the construct validity and reliability of the Evaluation Indicators for standard Hospice and Palliative Care Training (EIHPCT) program. As a framework to develop evaluation indicators, an invented theoretical model combining Stufflebeam's CIPP (Context-Input-Process-Product) evaluation model with PRECEDE-PROCEED model was used. To verify the construct validity of the EIHPCT program, a structured survey was performed with 169 professionals who were the HPC training program administrators, trainers, and trainees. To examine the validity of the areas of the EIHPCT program, exploratory factor analysis and confirmatory factor analysis were conducted. First, in the exploratory factor analysis, the indicators with factor loadings above 0.4 were chosen as desirable items, and some cross-loaded items that loaded at 0.4 or higher on two or more factors were adjusted as the higher factor. Second, the model fit of the modified EIHPCT program was quite good in the confirmatory factor analysis (Goodness-of-Fit Index > 0.70, Comparative Fit Index > 0.80, Normed Fit Index > 0.80, Root Mean square of Residuals < 0.05). The modified model of the EIHPCT comprised 4 areas, 13 subdomains, and 61 indicators. The evaluation indicators of the modified model will be valuable references for improving the HPC professional training program.

The Impact of Fiscal Redistributive Policies on the Supply of Labor: Five Essays in Economic Theory and Program Design.

ERIC Educational Resources Information Center

Kesselman, Jonathan Rhys

Static and dynamic incentive effects of the following fiscal transfer forms are examined: income subsidy (negative income tax), wage subsidy, categorical income subsidy (work requirement), and overtime wage subsidy. Budgetary costs, aggregate labor-market impacts, and welfare effects are analyzed. A program for categorically combining wage and…

Association between the Availability of Hospital-Based Palliative Care and Treatment Intensity for Critically Ill Patients.

PubMed

Hua, May; Ma, Xiaoyue; Morrison, R Sean; Li, Guohua; Wunsch, Hannah

2018-05-29

In the intensive care unit (ICU), studies involving specialized palliative care services have shown decreases in the use of non-beneficial life-sustaining therapies and ICU length of stay for patients. However, whether widespread availability of hospital-based palliative care is associated with less frequent use of high intensity care is unknown. To determine whether availability of hospital-based palliative care is associated with decreased markers of treatment intensity for ICU patients. Retrospective cohort study of adult ICU patients in New York State hospitals, 2008-2014. Multilevel regression was used to assess the relationship between availability of hospital-based palliative care during the year of admission and hospital length of stay, use of mechanical ventilation, dialysis and artificial nutrition, placement of a tracheostomy or gastrostomy tube, days in ICU and discharge to hospice. Of 1,025,503 ICU patients in 151 hospitals, 814,794 (79.5%) received care in a hospital with a palliative care program. Hospital length of stay was similar for patients in hospitals with and without palliative care programs (6 days, interquartile range (IQR) 3-12 vs. 6 days, IQR 3-11, adjusted rate ratio 1.04 [1.03 to 1.05], p < 0.001), as were other healthcare utilization outcomes. However, patients in hospitals with palliative care programs were 46% more likely to be discharged to hospice than those in hospitals without palliative care programs (1.7% vs. 1.4%, adjusted odds ratio 1.46 [1.30 to 1.64], p<0.001). Availability of hospital-based palliative care was not associated with differences in in-hospital treatment intensity but was associated with significantly increased hospice utilization for ICU patients. At this time, the measurable benefit of palliative care programs for critically ill patients may be the increased use of hospice facilities, as opposed to decreased healthcare utilization during an ICU-associated hospitalization.

42 CFR 422.320 - Special rules for hospice care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations § 422... her enrollment in the MA plan and is entitled to receive, through the MA plan, any benefits other than...

Models of Care

ERIC Educational Resources Information Center

Wilson, Dottie C.; And Others

1978-01-01

This section describes hospice or palliative care programs for terminally ill patients and their families. The programs described are in Montreal, Quebec; Halifax, Nova Scotia; New Haven, Connecticut; Marin County, California; Tucson, Arizona; and Springfield, Illinois. (Author/JEL)

Why don't patients enroll in hospice? Can we do anything about it?

PubMed

Vig, Elizabeth K; Starks, Helene; Taylor, Janelle S; Hopley, Elizabeth K; Fryer-Edwards, Kelly

2010-10-01

United States hospice organizations aim to provide quality, patient-centered end-of-life care to patients in the last 6 months of life, yet some of these organizations observe that some hospice-eligible patients who are referred to hospice do not initially enroll. To identify reasons that eligible patients do not enroll in hospice (phase 1). To identify strategies used by hospice providers to address these reasons (phase 2). Semi-structured interviews analyzed using content analysis. In phase 1, we interviewed 30 patients and/or family members of patients who had a hospice admissions visit, but who did not enroll. In phase 2, we interviewed 19 hospice staff and national experts. In phase 1, we asked participants to describe the patient's illness, the hospice referral, and why they had not enrolled. We performed a content analysis to characterize their reasons for not enrolling in hospice. In phase 2, we enrolled hospice admissions staff and hospice experts. We asked them to describe how they would respond to each reason (from phase 1) during an admissions visit with a potential new hospice patient. We identified key phrases, and summarized their recommendations. Reasons that patients hadn't enrolled fell into three broad categories: patient/family perceptions (e.g., "not ready"), hospice specific issues (e.g., variable definitions of hospice-eligible patients), and systems issues (e.g., concerns about continuity of care). Hospice staff/experts had encountered each reason, and offered strategies at the individual and organizational level for responding. In hopes of increasing hospice enrollment among hospice-eligible patients, non-hospice and hospice clinicians may want to adopt some of the strategies used by hospice staff/experts for talking about hospice with patients/families and may want to familiarize themselves with the differences between hospice organizations in their area. Hospices may want to reconsider their admission policies and procedures in light of patients' and families' perceptions and concerns.

77 FR 60040 - Wage Methodology for the Temporary Non-Agricultural Employment H-2B Program; Delay of Effective Date

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-02

... Wage Rule revised the methodology by which the Department calculates the prevailing wages to be paid to... the Department calculates the prevailing wages to be paid to H-2B workers and United States (U.S... effect, it will supersede and make null the prevailing wage provisions at 20 CFR 655.10(b) of the...

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 ...

Examining variation in treatment costs: a cost function for outpatient methadone treatment programs.

PubMed

Dunlap, Laura J; Zarkin, Gary A; Cowell, Alexander J

2008-06-01

To estimate a hybrid cost function of the relationship between total annual cost for outpatient methadone treatment and output (annual patient days and selected services), input prices (wages and building space costs), and selected program and patient case-mix characteristics. Data are from a multistate study of 159 methadone treatment programs that participated in the Center for Substance Abuse Treatment's Evaluation of the Methadone/LAAM Treatment Program Accreditation Project between 1998 and 2000. Using least squares regression for weighted data, we estimate the relationship between total annual costs and selected output measures, wages, building space costs, and selected program and patient case-mix characteristics. Findings indicate that total annual cost is positively associated with program's annual patient days, with a 10 percent increase in patient days associated with an 8.2 percent increase in total cost. Total annual cost also increases with counselor wages (p<.01), but no significant association is found for nurse wages or monthly building costs. Surprisingly, program characteristics and patient case mix variables do not appear to explain variations in methadone treatment costs. Similar results are found for a model with services as outputs. This study provides important new insights into the determinants of methadone treatment costs. Our findings concur with economic theory in that total annual cost is positively related to counselor wages. However, among our factor inputs, counselor wages are the only significant driver of these costs. Furthermore, our findings suggest that methadone programs may realize economies of scale; however, other important factors, such as patient access, should be considered.

Social Workers' Perceptions of Job Satisfaction, Interdisciplinary Collaboration, and Organizational Leadership.

PubMed

Marmo, Suzanne; Berkman, Cathy

2018-01-01

To address job satisfaction, and therefore employment retention, of hospice social workers, this study examined how relationships with other members of the interdisciplinary hospice team and perceptions of hospice leadership may be associated with job satisfaction of hospice social workers. The sample of 203 hospice social workers was recruited by e-mailing invitations to hospice social workers identified by hospice directors in three states, use of online social media sites accessed by hospice social workers, and snowball sampling. Study measures included professional experience, hospice characteristics, interdisciplinary collaboration, perception of servant leadership, and intrinsic and extrinsic job satisfaction. Variables significant in the model for intrinsic satisfaction were perception of servant leadership, interdisciplinary collaboration, and feeling valued by the hospice physician. Variables significant in the model for extrinsic satisfaction were perception of servant leadership, interdisciplinary collaboration, feeling valued by the hospice physician, and number of social workers at the hospice. Interdisciplinary collaboration was more important for intrinsic job satisfaction and leadership style was more important for extrinsic job satisfaction. Profit status of the hospice, experience of the social worker, caseload size, and other variables were not significant in either model. These results support previous findings that leadership style of the hospice director and relationships with hospice colleagues are important for hospice social workers' job satisfaction. Such low-cost modifications to the hospice work environment, albeit not simple, may improve job satisfaction of hospice social workers.

A Feasibility Study of the Impact of Manpower Placement and Training Programs on Low-Wage Industries and Occupations.

ERIC Educational Resources Information Center

Diamond, Daniel E.; Bedrosian, Hrach

The expected expansion of Manpower Training and Placement Programs, particularly of the work incentive type, could have a significant impact on wage ratings and hiring standards in the low-wage sector of the economy. To answer this question an extensive three-phase project was formulated. This study (the first phase) was designed to ascertain if…

Workplace violence prevention policies in home health and hospice care agencies.

PubMed

Gross, Nathan; Peek-Asa, Corinne; Nocera, Maryalice; Casteel, Carri

2013-01-31

Workplace violence in the home health industry is a growing concern, but little is known about the content of existing workplace violence prevention programs. The authors present the methods for this study that examined workplace violence prevention programs in a sample of 40 California home health and hospice agencies. Data was collected through surveys that were completed by the branch managers of participating facilities. Programs were scored in six different areas, including general workplace violence prevention components; management commitment and employee involvement; worksite analysis; hazard prevention and control; safety and health training; and recordkeeping and program evaluation. The results and discussion sections consider these six areas and the important gaps that were found in existing programs. For example, although most agencies offered workplace violence training, not every worker performing patient care was required to receive the training. Similarly, not all programs were written or reviewed and updated regularly. Few program differences were observed between agency characteristics, but nonetheless several striking gaps were found.

Worksite Health Promotion for Low-Wage Workers: A Scoping Literature Review.

PubMed

Stiehl, Emily; Shivaprakash, Namrata; Thatcher, Esther; Ornelas, India J; Kneipp, Shawn; Baron, Sherry L; Muramatsu, Naoko

2018-02-01

To determine: (1) What research has been done on health promotion interventions for low-wage workers and (2) what factors are associated with effective low-wage workers' health promotion programs. This review includes articles from PubMed and PsychINFO published in or before July 2016. Study Inclusion/Exclusion Criteria: The search yielded 130 unique articles, 35 met the inclusion criteria: (1) being conducted in the United States, (2) including an intervention or empirical data around health promotion among adult low-wage workers, and (3) measuring changes in low-wage worker health. Central features of the selected studies were extracted, including the theoretical foundation; study design; health promotion intervention content and delivery format; intervention-targeted outcomes; sample characteristics; and work, occupational, and industry characteristics. Consistent with a scoping review, we used a descriptive, content analysis approach to analyze extracted data. All authors agreed upon emergent themes and 2 authors independently coded data extracted from each article. The results suggest that the research on low-wage workers' health promotion is limited, but increasing, and that low-wage workers have limited access to and utilization of worksite health promotion programs. Workplace health promotion programs could have a positive effect on low-wage workers, but more work is needed to understand how to expand access, what drives participation, and which delivery mechanisms are most effective.

Nursing Support of Home Hospice Caregivers on the Day of Patient Death.

PubMed

Clayton, Margaret F; Hulett, Jennifer; Kaur, Kirandeep; Reblin, Maija; Wilson, Andrew; Ellington, Lee

2017-07-01

To describe nurse-caregiver communication on the day of patient death.
. A descriptive secondary analysis of 44 audio-recorded home hospice nursing visits on day of death.
. Nine hospices in Utah, Oregon, and Massachusetts.
. 42 caregiver-patient dyads, 27 hospice nurses.
. Transcripts of audio recordings were coded for supportive nursing communication and relative time spent in physical, psychosocial, and spiritual discussion.
. Tangible, emotional, informational, esteem, and networking supportive communication; nurses' self-reported communication effectiveness; caregiver religious affiliation.
. Nurses reported that their communication skills were less effective when discussing difficult topics as compared to their overall communication effectiveness. Eleven patients died before the nursing visit, 3 died during the visit, and 30 died post-visit. Nurses primarily engaged in discussions facilitating caregiver emotional, tangible, and informational support. More informational support was observed when patient death occurred during the nursing visit. Time spent in general conversation showed that physical care conversations predominated (80% of the average overall amount of conversation time), compared to lifestyle/psychosocial discussions (14%) and spiritual discussions (6%). Spiritual discussions were observed in only 7 of 44 hospice visits. Spiritual discussions, although short and infrequent, were significantly longer, on average, for caregivers without a religious affiliation.
. Nurses support caregivers on the day of patient death using multiple supportive communication strategies. Spiritual discussions are minimal.
. Communication skills programs can potentially increase self-reported communication effectiveness. Emerging acute spiritual concerns, particularly for caregivers without a previous religious affiliation, should be anticipated. Spiritual support is included in the hospice model of holistic care.

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.

Culturally Competent Palliative and Hospice Care Training for Ethnically Diverse Staff in Long-Term Care Facilities.

PubMed

Kataoka-Yahiro, Merle R; McFarlane, Sandra; Koijane, Jeannette; Li, Dongmei

2017-05-01

Between 2013 and 2030, older adults 65 years and older of racial/ethnic populations in the U.S. is projected to increase by 123% in comparison to the Whites (Non-Hispanics). To meet this demand, training of ethnically diverse health staff in long-term care facilities in palliative and hospice care is imperative. The purpose of this study was to evaluate a palliative and hospice care training of staff in two nursing homes in Hawaii - (a) to evaluate knowledge and confidence over three time periods, and (b) to compare staff and family caregiver satisfaction at end of program. The educational frameworks were based on cultural and communication theories. Fifty-two ethnically diverse staff, a majority being Asian (89%), participated in a 10-week module training and one 4 hour communication skills workshop. Staff evaluation included knowledge and confidence surveys, pre- and post-test knowledge tests, and FAMCARE-2 satisfaction instrument. There were nine Asian (89%) and Pacific Islander (11%) family caregivers who completed the FAMCARE-2 satisfaction instrument. The overall staff knowledge and confidence results were promising. The staff rated overall satisfaction of palliative care services lower than the family caregivers. Implications for future research, practice, and education with palliative and hospice care training of ethnically diverse nursing home staff is to include patient and family caregiver satisfaction of palliative and hospice care services, evaluation of effectiveness of cross-cultural communication theories in palliative and hospice care staff training, and support from administration for mentorship and development of these services in long term care facilities.

Unique challenges of hospice for patients with heart failure: A qualitative study of hospice clinicians.

PubMed

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

2015-09-01

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. 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 semistructured interviews. Through team-based, iterative qualitative analysis, we identified 3 major themes. Hospice clinicians identified 3 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 prehospice health care providers. Third, hospice clinicians described opportunities to improve heart failure-specific hospice care, highlighting the desire for collaboration with referring cardiologists. From a hospice clinician perspective, caring for patients with heart failure is unique compared with 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. Published by Elsevier Inc.

Referral and timing of referral to hospice care in nursing homes: the significant role of staff members.

PubMed

Welch, Lisa C; Miller, Susan C; Martin, Edward W; Nanda, Aman

2008-08-01

Given concerns about end-of-life care for many nursing home (NH) residents, this study sought to understand factors influencing hospice referral or nonreferral as well as timing of referral. We conducted semistructured interviews with personnel from seven participating NHs and two hospices. We interviewed NH directors of nursing regarding facility referral practices and conducted interviews with 34 NH nurses, 30 NH aides, and 17 hospice nurses knowledgeable about the factors that led to the hospice status of 32 NH decedents. Selected decedents varied by diagnosis and hospice status (received hospice for >7 days,

34 CFR 369.44 - What wage and hour standards apply to community rehabilitation programs?

Code of Federal Regulations, 2010 CFR

2010-07-01

... VOCATIONAL REHABILITATION SERVICE PROJECTS What Conditions Must Be Met by a Grantee? § 369.44 What wage and... hour standards must be observed in projects carried out in community rehabilitation programs...

Nurses' perceptions of hospice palliative care volunteers.

PubMed

Claxton-Oldfield, Stephen; Hastings, Emily; Claxton-Oldfield, Jane

2008-01-01

A total of 50 nurses (hospital and home care) responded to a survey designed to measure: (1) their attitudes toward, and knowledge of, hospice palliative care volunteers; (2) the types of tasks they felt it was appropriate for volunteers to perform; and (3) how valuable they felt different members of the hospice palliative care team are. In addition, they were asked to respond to some open-ended questions (eg, "Do you feel that it is appropriate for hospice palliative care volunteers to know patient medical information?"). The nurses' responses to the "Attitude/Knowledge" part of the survey revealed that they generally held positive attitudes toward volunteers. The majority of the nurses felt that it was appropriate for volunteers to perform most of the tasks listed, except for hands-on patient care. Nurses rated the value of nurses, family members, doctors, and pharmacists significantly higher than volunteers. Fifty-three percent of the nurses felt that volunteers should know patient medical information, and 77% thought that volunteers should have the opportunity to provide input regarding patient care. Also, 75% of the nurses felt that volunteers made their jobs easier, and 56% felt that volunteers should be included in team meetings. When asked to list the topics covered in a hospice palliative care volunteer training program, 73% of the nurses indicated that they were not sure or did not know what topics were covered, indicating a lack of knowledge regarding volunteer training.

Advancing theory of family conflict at the end of life: a hospice case study.

PubMed

Boelk, Amy Z; Kramer, Betty J

2012-11-01

Although family conflict is a common occurrence for families involved in caregiving for a dying family member, it has not been examined in the hospice context. The purpose of this study was to advance theory of family conflict at the end of life through replication and expansion of a case study involving professional perspectives in the context of a managed care program for low-income elders with advanced chronic disease in their last six months of life, by exploring the perceptions of professionals and family caregivers experiencing conflict in the hospice context. Data were gathered through in-depth interviews with 15 hospice family caregivers experiencing substantial family conflict, and focus groups with 37 professionals employed in a large multicounty and nonprofit hospice in the Midwest U.S. Dimensional analysis, a method for the generation of grounded theory, was used to refine and expand an explanatory matrix of family conflict at the end of life. The initial matrix was expanded through the inclusion of eight new and two refined categories, strengthening our understanding of family conflict as a complex phenomenon influenced by salient contextual variables, conditions, and factors that may contribute to a number of negative outcomes for patients, family members, and professionals. The study findings are discussed in terms of implications for assessment and intervention. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

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

Pharmaceutical Education in Nigeria.

ERIC Educational Resources Information Center

Oyegbile, F. Rachel

1988-01-01

Nigeria has six pharmacy schools, most offering graduate programs. The undergraduate program is being expanded from four to five years. Although behavioral and clinical sciences are offered, emphasis is on the pharmaceutical sciences. Overall, pharmaceutical education is oriented toward hospice practice. (Author/MSE)

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.

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.

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

Development of Valid and Reliable Measures of Patient and Family Experiences of Hospice Care for Public Reporting.

PubMed

Anhang Price, Rebecca; Stucky, Brian; Parast, Layla; Elliott, Marc N; Haas, Ann; Bradley, Melissa; Teno, Joan M

2018-03-20

Increasingly, dying patients and their families have a choice of hospice providers. Care quality varies considerably across providers; informing consumers of these differences may help to improve their selection of hospices. To develop and evaluate standardized survey measures of hospice care experiences for the purpose of comparing and publicly reporting hospice performance. We assessed item performance and constructed composite measures by factor analysis, evaluating item-scale correlations and estimating reliability. To assess key drivers of overall experiences, we regressed overall rating and willingness to recommend the hospice on each composite. Data submitted by 2500 hospices participating in national implementation of the Consumer Assessment of Healthcare Providers and Systems (CAHPS ® ) Hospice Survey for April through September 2015. Composite measures of Hospice Team Communication, Getting Timely Care, Treating Family Member with Respect, Getting Emotional and Religious Support, Getting Help for Symptoms, and Getting Hospice Care Training. Cronbach's alpha estimates for the composite measures range from 0.61 to 0.85; hospice-level reliability for the measures range from 0.67 to 0.81 assuming 200 completed surveys per hospice. Together, the composites are responsible for 48% of the variance in caregivers' overall ratings of hospices. Hospice Team Communication is the strongest predictor of overall rating of care. Our analyses provide evidence of the reliability and validity of CAHPS Hospice Survey measure scores. Results also highlight important opportunities to improve the quality of hospice care, particularly with regard to addressing symptoms of anxiety and sadness, discussing side effects of pain medicine, and keeping family informed of the patient's condition.

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.

[New legal regulations for palliative care with implications for politics and practice].

PubMed

Melching, Heiner

2017-01-01

In December 2015 two different laws were adopted. Both are of importance for palliative care. One of the laws criminalizes commercial, "business-like" assisted suicide (§ 217 German Criminal Code), the other one aims to improve hospice and palliative care in Germany. Through the latter far-reaching changes in Social Code Books V and XI, as well as of the Hospital Finance Act have been made. This new Act to Improve Hospice and Palliative Care (HPG) focuses, amongst others, on: (a) Better funding of hospice services, by raising the minimum grant for patients in inpatient hospices paid per day by the health insurance funds by about 28.5%, and for outpatient hospice services by about 18%; (b) further development of general outpatient nursing and medical palliative care, and the networking of different service providers; (c) introduction of an arbitration procedure for service provider agreements to be concluded between the health insurance funds and the teams providing specialized home palliative care (SAPV); (d) the right to individual advice and support by the health insurance funds; (e) care homes may offer their residents advance care planning programs to be funded by the statutory health insurers; (f) palliative care units in hospitals can be remunerated outside the DRG system by per diem rates; (g) separate funding and criteria for multi-professional palliative care services within a hospital.While little concrete impact on hospice and palliative care can be expected following the new § 217 German Criminal Code, the HPG provides a good basis to improve care. For this purpose, however, which complementary and more concrete agreements are made to put the new legal regulations into practice will be crucial.

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. © The Author(s) 2014.

76 FR 73509 - Wage Methodology for the Temporary Non-Agricultural Employment H-2B Program; Delay of Effective...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-29

..., which set the new effective date of September 30, 2011 for the Wage Rule (the Effective Date Rule). In... Wage Rule and its new effective date, and the possibility that the litigation may be transferred to... performed before and after the new effective date of the Wage Rule. The first determination was based on the...

Productivity in Pediatric Palliative Care: Measuring and Monitoring an Elusive Metric.

PubMed

Kaye, Erica C; Abramson, Zachary R; Snaman, Jennifer M; Friebert, Sarah E; Baker, Justin N

2017-05-01

Workforce productivity is poorly defined in health care. Particularly in the field of pediatric palliative care (PPC), the absence of consensus metrics impedes aggregation and analysis of data to track workforce efficiency and effectiveness. Lack of uniformly measured data also compromises the development of innovative strategies to improve productivity and hinders investigation of the link between productivity and quality of care, which are interrelated but not interchangeable. To review the literature regarding the definition and measurement of productivity in PPC; to identify barriers to productivity within traditional PPC models; and to recommend novel metrics to study productivity as a component of quality care in PPC. PubMed ® and Cochrane Database of Systematic Reviews searches for scholarly literature were performed using key words (pediatric palliative care, palliative care, team, workforce, workflow, productivity, algorithm, quality care, quality improvement, quality metric, inpatient, hospital, consultation, model) for articles published between 2000 and 2016. Organizational searches of Center to Advance Palliative Care, National Hospice and Palliative Care Organization, National Association for Home Care & Hospice, American Academy of Hospice and Palliative Medicine, Hospice and Palliative Nurses Association, National Quality Forum, and National Consensus Project for Quality Palliative Care were also performed. Additional semistructured interviews were conducted with directors from seven prominent PPC programs across the U.S. to review standard operating procedures for PPC team workflow and productivity. Little consensus exists in the PPC field regarding optimal ways to define, measure, and analyze provider and program productivity. Barriers to accurate monitoring of productivity include difficulties with identification, measurement, and interpretation of metrics applicable to an interdisciplinary care paradigm. In the context of inefficiencies inherent to traditional consultation models, novel productivity metrics are proposed. Further research is needed to determine optimal metrics for monitoring productivity within PPC teams. Innovative approaches should be studied with the goal of improving efficiency of care without compromising value. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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.

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.

Association between the Medicare hospice benefit and health care utilization and costs for patients with poor-prognosis cancer.

PubMed

Obermeyer, Ziad; Makar, Maggie; Abujaber, Samer; Dominici, Francesca; Block, Susan; Cutler, David M

2014-11-12

More patients with cancer use hospice currently than ever before, but there are indications that care intensity outside of hospice is increasing, and length of hospice stay decreasing. Uncertainties regarding how hospice affects health care utilization and costs have hampered efforts to promote it. To compare utilization and costs of health care for patients with poor-prognosis cancers enrolled in hospice vs similar patients without hospice care. Matched cohort study of patients in hospice and nonhospice care using a nationally representative 20% sample of Medicare fee-for-service beneficiaries who died in 2011. Patients with poor-prognosis cancers (eg, brain, pancreatic, metastatic malignancies) enrolled in hospice before death were matched to similar patients who died without hospice care. Period between hospice enrollment and death for hospice beneficiaries, and the equivalent period of nonhospice care before death for matched nonhospice patients. Health care utilization including hospitalizations and procedures, place of death, cost trajectories before and after hospice start, and cumulative costs, all during the last year of life. Among 86,851 patients with poor-prognosis cancers, median time from first poor-prognosis diagnosis to death was 13 months (interquartile range [IQR], 3-34), and 51,924 patients (60%) entered hospice before death. Matching yielded a cohort balanced on age, sex, region, time from poor-prognosis diagnosis to death, and baseline care utilization, with 18,165 patients in the hospice group and 18,165 in the nonhospice group. After matching, 11% of nonhospice and 1% of hospice beneficiaries who had cancer-directed therapy after exposure were excluded. Median hospice duration was 11 days. After exposure, nonhospice beneficiaries had significantly more hospitalizations (65% [95% CI, 64%-66%], vs hospice with 42% [95% CI, 42%-43%]; risk ratio, 1.5 [95% CI, 1.5-1.6]), intensive care (36% [95% CI, 35%-37%], vs hospice with 15% [95% CI, 14%-15%]; risk ratio, 2.4 [95% CI, 2.3-2.5]), and invasive procedures (51% [95% CI, 50%-52%], vs hospice with 27% [95% CI, 26%-27%]; risk ratio, 1.9 [95% CI, 1.9-2.0]), largely for acute conditions not directly related to cancer; and 74% (95% CI, 74%-75%) of nonhospice beneficiaries died in hospitals and nursing facilities compared with 14% (95% CI, 14%-15%) of hospice beneficiaries. Costs for hospice and nonhospice beneficiaries were not significantly different at baseline, but diverged after hospice start. Total costs over the last year of life were $71,517 (95% CI, $70,543-72,490) for nonhospice and $62,819 (95% CI, $62,082-63,557) for hospice, a statistically significant difference of $8697 (95% CI, $7560-$9835). In this sample of Medicare fee-for-service beneficiaries with poor-prognosis cancer, those receiving hospice care vs not (control), had significantly lower rates of hospitalization, intensive care unit admission, and invasive procedures at the end of life, along with significantly lower total costs during the last year of life.

Transition towards end of life in palliative care: an exploration of its meaning for advanced cancer patients in Europe.

PubMed

Larkin, Philip J; Dierckx de Casterlé, Bernadette; Schotsmans, Paul

2007-01-01

Transition as a concept in healthcare has been explored, but there is limited empirical work which considers transition in the context of palliative care, specifically from the patient perspective. This article reports findings from a qualitative study designed to explore transition experiences of 100 advanced cancer patients in six European countries. Data were analyzed using the ATLAS.ti program. Findings suggest that transition is a confusing time of mixed messages, poor communication, and uncertainty, but the physical environment of the hospice offers a place of ontological security from which to address this. Transition concepts fail to capture the palliative care experience fully. Transience, as an alternative concept, is reported, although further research is needed to explore this. In clinical practice, the value given to hospice by patients suggests that clinicians must carefully balance the benefit of mainstream integration with sensitive assimilation of hospice philosophy.

Initial Experience with "Honoring Choices Wisconsin": Implementation of an Advance Care Planning Pilot in a Tertiary Care Setting.

PubMed

Peltier, Wendy L; Gani, Faiz; Blissitt, Jennifer; Walczak, Katherine; Opper, Kristi; Derse, Arthur R; Johnston, Fabian M

2017-09-01

Although previous research on advance care planning (ACP) has associated ACP with improved quality of care at the end of life, the appropriate use of ACP remains limited. To evaluate the impact of a pilot program using the "Honoring Choices Wisconsin" (HCW) model for ACP in a tertiary care setting, and to understand barriers to system-wide implementation. Retrospective review of prospectively collected data. Patients who received medical or surgical oncology care at Froedtert and the Medical College of Wisconsin. Patient demographics, disease characteristics, patient satisfaction, and clinical outcomes. Data from 69 patients who died following the implementation of the HCW program were reviewed; 24 patients were enrolled in the HCW program while 45 were not. Patients enrolled in HCW were proportionally less likely to be admitted to the ICU (12.5% vs. 17.8%) and were more likely to be "do not resuscitate" (87.5% vs. 80.0%), as well as have a completed ACP (83.3% vs. 79.1%). Furthermore, admission to a hospice was also higher among patients who were enrolled in the HCW program (79.2% vs. 25.6%), with patients enrolled in HCW more likely to die in hospice (70.8% vs. 53.3%). The HCW program was favorably viewed by patients, patient caregivers, and healthcare providers. Implementation of a facilitator-based ACP care model was associated with fewer ICU admissions, and a higher use of hospice care. System-level changes are required to overcome barriers to ACP that limit patients from receiving end-of-life care in accordance with their preferences.

A post-hoc analysis of music therapy services for residents in nursing homes receiving hospice care.

PubMed

Hilliard, Russell E

2004-01-01

This study analyzed the use of music therapy for residents in nursing homes receiving hospice care. An ex-post facto design was utilized to evaluate participants' length of life on the hospice program, time of death in relation to last visit by the social worker and music therapist, the number of sessions and total number of minutes spent in direct care by the social worker and music therapist, and care plan needs treated by the nurse, social worker, and music therapist. A total of 80 participants' medical records were randomly selected for this study. All participants were in nursing homes, 40 of whom had been referred to music therapy. Results showed no significant differences on the time of death in relation to last visit by hospice professional, but there were significant differences in the length of life for those receiving music therapy. Females in this study lived significantly longer than males. Participants received significantly more music therapy sessions than social work sessions, and music therapists spent significantly more time in direct care with participants than did social workers. Care plan needs were analyzed graphically and indicate that music therapists meet important needs of participants.

Extending computer technology to hospice research: interactive pentablet measurement of symptoms by hospice cancer patients in their homes.

PubMed

Wilkie, Diana J; Kim, Young Ok; Suarez, Marie L; Dauw, Colleen M; Stapleton, Stephen J; Gorman, Geraldine; Storfjell, Judith; Zhao, Zhongsheng

2009-07-01

We aimed to determine the acceptability and feasibility of a pentablet-based software program, PAINReportIt-Plus, as a means for patients with cancer in home hospice to report their symptoms and differences in acceptability by demographic variables. Of the 131 participants (mean age = 59 +/- 13, 58% women, 48.1% African American), 44% had never used a computer, but all participants easily used the computerized tool and reported an average computer acceptability score of 10.3 +/- 1.8, indicating high acceptability. Participants required an average of 19.1 +/- 9.5 minutes to complete the pain section, 9.8 +/- 6.5 minutes for the medication section, and 4.8 +/- 2.3 minutes for the symptom section. The acceptability scores were not statistically different by demographic variables but time to complete the tool differed by racial/ethnic groups. Our findings demonstrate that terminally ill patients with cancer are willing and able to utilize computer pentablet technology to record and describe their pain and other symptoms. Visibility of pain and distress is the first step necessary for the hospice team to develop a care plan for improving control of noxious symptoms.

Evidence of improved knowledge and skills after an elective rotation in a hospice and palliative care program for internal medicine residents.

PubMed

von Gunten, Charles F; Twaddle, Martha; Preodor, Michael; Neely, Kathy Johnson; Martinez, Jeanne; Lyons, John

2005-01-01

There is compelling evidence that residents training in primary care need education in palliative care. Evidence for effective curricula is needed. The objective of this study was to test whether a clinical elective improves measures of knowledge and skill. Residents from three categorical training programs in internal medicine were recruited to an elective including clinical experiences in an acute hospital palliative care consultation service, on an acute hospice and palliative care unit, and in-home hospice care. A 25-question pre- and post-test and a videotaped interview with a standardized patient were used to assess communication skills and measure outcomes. Residents demonstrated a 10 percent improvement in knowledge after the four-week elective (p < 0.05). All residents demonstrated basic competency in communication skills at the end of the rotation. These results indicate that clinical rotation shows promise as an educational intervention to improve palliative care knowledge and skills in primary care residents. An important limitation of the study is that it is an elective; further studies with a required rotation and/or a control group are needed to confirm the findings.

Designing Effective Interactions for Concordance around End-of-Life Care Decisions: Lessons from Hospice Admission Nurses

PubMed Central

Candrian, Carey; Tate, Channing; Broadfoot, Kirsten; Tsantes, Alexandra; Matlock, Daniel; Kutner, Jean

2017-01-01

Near the end of life, hospice care reduces symptom-related distress and hospitalizations while improving caregiving outcomes. However, it takes time for a person to gain a sufficient understanding of hospice and decide to enroll. This decision is influenced by knowledge of hospice and its services, emotion and fear, cultural and religious beliefs, and an individual’s acceptance of diagnosis. Hospice admission interactions, a key influence in shaping decisions regarding hospice care, happen particularly late in the illness trajectory and are often complex, unpredictable, and highly variable. One goal of these interactions is ensuring patients and families have accurate and clear information about hospice care to facilitate informed decisions. So inconsistent are practices across hospices in consenting patients that a 2016 report from the Office of Inspector General (OIG) entitled “Hospices should improve their election statements and certifications of terminal illness” called for complete and accurate election statements to ensure that hospice patients and their caregivers can make informed decisions and understand the costs and benefits of choosing hospice care. Whether complete and accurate information at initial admission visits improves interactions and outcomes is unknown. Our recent qualitative work investigating interactions between patients, caregivers, and hospice nurses has uncovered diverse and often diverging stakeholder-specific expectations and perceptions which if not addressed can create discordance and inhibit decision-making. This paper focuses on better understanding the communication dynamics and practices involved in hospice admission interactions in order to design more effective interactions and support the mandate from the OIG to provide hospice patients and their caregivers with accurate and complete information. This clarity is particularly important when discussing the non-curative nature of hospice care, and the choice patients make to forego aggressive treatment measures when they enroll in hospice. In a literal sense, to enroll in hospice means to bring in support for end-of-life care. It means to identify the need for expertise around symptom management at end-of-life, and agree to having a care team come and manage someone’s physical, psychosocial, and/or spiritual needs. As with all care, hospice can be stopped if it is no longer considered appropriate. To uncover the communication tensions undergirding a hospice admission interaction, we use Street’s ecological theory of patient-centered communication to analyze a case exemplar of a hospice admission interaction. This analysis reveals diverse points of struggle within hospice decision-making processes around hospice care and the need for communication techniques that promote trust and acceptance of end-of-life care. Lessons learned from talking about hospice care can inform other quality initiatives around communication and informed decision-making in the context of advance care planning, palliative care, and end-of-life care. PMID:28420191

We are our brother's keeper.

PubMed

Ufema, J

1993-11-01

York House Hospice is another hospice started on a small scale and making great accomplishments in hospice care. This author worked for some time as a thanatologist with a hospital. When the hospital closed, the author determined to open a hospice for AIDS patients. York House Hospice is a paradigm of the hard work and spirit of hospice. Here is the story of its beginning.

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.

Children With Intellectual Disability and Hospice Utilization: The Moderating Effect of Residential Care.

PubMed

Lindley, Lisa C

2017-01-01

Children with intellectual disability commonly lack access to pediatric hospice care services. Residential care may be a critical component in providing access to hospice care for children with intellectual disability. This research tested whether residential care intensifies the relationship between intellectual disability and hospice utilization (ie, hospice enrollment, hospice length of stay), while controlling for demographic characteristics. Multivariate regression analyses were conducted using 2008 to 2010 California Medicaid claims data. The odds of children with intellectual disability in residential care enrolling in hospice care were 3 times higher than their counterparts in their last year of life, when controlling for demographics. Residential care promoted hospice enrollment among children with intellectual disability. The interaction between intellectual disability and residential care was not related to hospice length of stay. Residential care did not attenuate or intensify the relationship between intellectual disability and hospice length of stay. The findings highlight the important role of residential care in facilitating hospice enrollment for children with intellectual disability. More research is needed to understand the capability of residential care staff to identify children with intellectual disability earlier in their end-of-life trajectory and initiate longer hospice length of stays.

Hospice Exposure Is Associated With Lower Health Care Expenditures in Taiwanese Cancer Decedents' Last Year of Life: A Population-Based Retrospective Cohort Study.

PubMed

Hung, Yen-Ni; Wen, Fur-Hsing; Liu, Tsang-Wu; Chen, Jen-Shi; Tang, Siew Tzuh

2018-03-01

Evidence for the association of hospice exposure with lower health care expenditures at end of life (EOL) remains inconclusive and neglects EOL care being concentrated in patients' last few months. The association between hospice exposure and health care expenditures in cancer patients' last one, three, six, and 12 months was evaluated. In this population-based, retrospective cohort study, Taiwanese cancer decedents in 2001-2010 (N = 195,228) were matched 1:1, with proportions of matched hospice users reaching 87.8%, by a hospice-utilization propensity score. For each matched pair, exposure to hospice (time from hospice enrollment to death) was matched to equivalent periods for hospice nonusers before death. Hospice-care associations with health care expenditures were evaluated by hospice use/exposure interactions with multilevel linear regression modeling using generalized estimating equations. The unadjusted main effect showed lower total mean health care expenditures for hospice users than for hospice nonusers only in the last one and three months (rate ratio [95% CI]: 0.86 [0.81, 0.90] and 0.93 [0.89, 0.96], respectively). However, after accounting for exposure time, hospice care was significantly associated with lower health care expenditures at exposures of ≤30, ≤60, and ≤180 days for health care expenditures measured in the last one and three months, six months, and 12 months, respectively. Savings for patients with lengthy hospice stays were neutralized or even disappeared. Hospice care was associated with lower health care expenditures when it could actively intervene in EOL care. Hospice philosophy should be applied not only shortly before death but also throughout the dying trajectory to achieve maximum cost savings. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Great Careers in Two Years: The Associate Degree Option. High Skill and High Wage Jobs Available through Two-Year Programs.

ERIC Educational Resources Information Center

Phifer, Paul

This book explores high-skill and high-wage jobs available through two-year programs. It identifies 100 high-need occupational areas, and discusses "hot" programs and starting salaries for graduates of dental hygiene, manufacturing, process technology, telecommunications, physical therapy assisting, and registered nursing. Each career article…

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.

Ownership status and patterns of care in hospice: results from the National Home and Hospice Care Survey.

PubMed

Carlson, Melissa D A; Gallo, William T; Bradley, Elizabeth H

2004-05-01

The number of for-profit hospices increased nearly 4-fold over the past decade, more than 6 times the growth of nonprofit hospices. Despite this growth, the impact of ownership on hospice care is largely unknown. We sought to assess differences in the provision of services to patients of for-profit and nonprofit hospices. Using the 1998 National Home and Hospice Care Survey, we examined services used by patients (N = 2080) cared for by 422 hospices nationwide. We used multivariable ordered logistic and logistic regression to assess the effect of profit status on service use, adjusting for potentially confounding patient and organizational characteristics. We calculated point estimates adjusted for sampling weights and standard errors adjusted for the clustering of patients within hospices. In ordered logistic models controlling for organizational and patient factors, patients of for-profit hospices received a significantly narrower range of services (adjusted odds ratio [OR], 0.45; 95% confidence interval [CI], 0.22-0.92) than patients of nonprofit hospices. This result is driven by patients of for-profit hospices receiving significantly fewer types of hospice services that federal regulations term "noncore" or more discretionary services (adjusted OR, 0.34; 95% CI, 0.15-0.75). The pattern of care differs in for-profit and nonprofit hospices. As the industry develops a substantial for-profit presence, it is critical for clinicians and other healthcare professionals to be alert to the potential impact of profit status on the care their patients receive.

Focus on Wage and Salary Programs.

ERIC Educational Resources Information Center

Risher, Howard W.

1989-01-01

Budget pressures, tightening labor markets, and increasing public interest should prompt colleges and universities to review their wage and salary programs. Many administrators have never been exposed to practices other than those common to higher education, and trustees with corporate experience may provide some insight. (Author/MSE)

42 CFR 418.60 - Condition of participation: Infection control.

Code of Federal Regulations, 2010 CFR

2010-10-01

... control education to employees, contracted providers, patients, and family members and other caregivers. ... infection control program that protects patients, families, visitors, and hospice personnel by preventing...

FAQ about Recreational Therapy (RT)

MedlinePlus

... increasing number are being hired in residential facilities, community mental health centers, adult day care programs, substance abuse centers, hospice care, community centers, and in school systems. There is a ...

76 FR 19365 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-07

... Fiscal Year 2011 Final Wage Indices Implementing the Medicare and Medicaid Extenders Act AGENCY: Centers... fiscal year (FY) 2011 wage indices and hospital reclassifications and other related tables which reflect... reclassifications and special exception wage indices through September 30, 2011. DATES: Applicability Date: The...

Simulating the impact of case-mix adjusted hospice rates.

PubMed

Mor, V; Laliberte, L

1986-01-01

The Medicare hospice benefit prospectively reimburses hospices based on the inpatient status of the patient, whether or not the patient is at home, and whether the patient is receiving round-the-clock nursing. Using national Hospice Study data, two case-mix adjusters based on patient functioning and living arrangement were found to be significantly related to per diem cost. These were tested by simulating their impact on hospice revenues. Increasing per diem reimbursements 35 percent for nonambulatory patients living alone only increases hospice revenues by 4 percent; hospices with sicker patients benefit the most.

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.

75 FR 81138 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-27

... [CMS-1510-CN2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home Health Agencies and Hospices AGENCY... ``Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in...

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.

Effectiveness of a Hospice Community Bereavement Program.

ERIC Educational Resources Information Center

Longman, Alice J.

1993-01-01

Assessed extent of unresolved grief in bereaved individuals attending two programs, their spiritual perspectives, and the relationship between them. Fifty-six individuals completed questionnaires, and 42 completed same questionnaires 3 months later. Results indicated that individuals manifested initial reactions to death, and these reactions were…

75 FR 11935 - Technical Change to the Filing Location of Prevailing Wage Determinations for Use in the H-1B, H...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-12

... of Prevailing Wage Determinations for Use in the H-1B, H-1B1 (Chile/Singapore), H-1C, H- 2B, E-3 (Australia), and Permanent Labor Certification Programs; Prevailing Wage Determinations for Use in the... address where prevailing wage determination requests for H-1B, H-1B1 (Chile/Singapore), H-1C, H- 2B, E-3...

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…

Simulating the impact of case-mix adjusted hospice rates

PubMed Central

Mor, Vincent; Laliberte, Linda

1986-01-01

The Medicare hospice benefit prospectively reimburses hospices based on the inpatient status of the patient, whether or not the patient is at home, and whether the patient is receiving round-the-clock nursing. Using National Hospice Study data, two case-mix adjusters based on patient functioning and living arrangement were found to be significantly related to per diem cost. These were tested by simulating their impact on hospice revenues. Increasing per diem reimbursements 35 percent for nonambulatory patients living alone only increases hospice revenues by 4 percent; hospices with sicker patients benefit the most. PMID:10312012

Racial disparity in hospice use in the United States in 2002.

PubMed

Connor, S R; Elwert, F; Spence, C; Christakis, N A

2008-04-01

We used complete Centers for Disease Control death certificate records and the Centers for Medicare and Medicaid Services 100% Standard Analytic File for hospice claims for 2002 to examine differences in hospice utilization between African-American and white decedents living in the United States. White decedents were more likely to use hospice in the year before their death than African-American decedents (29% vs 22%). Cause-specific hospice utilization rates among women were consistently higher than among men within a given race. African-American decedents were consistently less likely to use hospice than white decedents for almost all conditions. Hospice utilization was lower among African-American than among white decedents in 31 of 40 states. The higher the overall hospice utilization in a state, the less the positive difference between white and African-American usage rates; that is, the more accepted hospice is, as measured by 'market share', the lower the racial disparity in its use.

Informal Caregiving of Hospice Patients

PubMed Central

Pottie, Colin G.; Burch, Karen A.; Irwin, Scott A.

2014-01-01

Abstract Background: Informal caregivers play a critical role in the provision of care to hospice patients. The care they provide often impacts their physical and psychological well-being. Objective: This study synthesized 58 articles pertaining to informal hospice caregiving, focusing on caregivers' satisfaction with hospice services, the physical and psychological well-being of caregivers, the predictors of caregivers' well-being, the direct impact of hospice services on caregivers, and the effectiveness of targeted interventions for hospice caregivers. Method: A systematic literature review of journal articles published between 1985 and 2012 was conducted. Results: The studies reviewed found hospice caregivers to experience clinically significant levels of anxiety, depression, and stress; however, results for caregiver burden and quality of life were mixed. Caregivers' perceptions regarding the meaningfulness of care as well as their levels of social support were associated with enhanced psychological outcomes. Conclusions: Beyond satisfaction with hospice services, the direct impact of standard hospice care on caregivers remains uncertain. Caregiver intervention studies have demonstrated promising outcomes signifying a need for additional investigations into hospice-specific interventions that improve caregiver outcomes. Additional research and resources are needed to assist hospice caregivers, with the ultimate goal of minimizing their psychiatric and physical morbidity and enhancing their caregiving and subsequent bereavement processes. PMID:24992371

Marketing and Distribution: New Minimum Wage Legislation: Impact on Co-Op DE Programs.

ERIC Educational Resources Information Center

Husted, Stewart W.

1978-01-01

Impact on distributive education cooperative programs due to the legislation increasing the minimum wage effective January 1, 1978, indicates that the change could greatly restrict future cooperative placements, thereby reducing distributive education enrollments. Employer strategies (for example, reducing student work hours) to overcome wage…

Legal Status and Wage Disparities for Mexican Immigrants

ERIC Educational Resources Information Center

Hall, Matthew; Greenman, Emily; Farkas, George

2010-01-01

This article employs a unique method of inferring the legal status of Mexican immigrants in the Survey of Income and Program Participation to offer new evidence of the role of legal authorization in the United States on workers' wages. We estimate wage trajectories for four groups: documented Mexican immigrants, undocumented Mexican immigrants,…

78 FR 46373 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Domestic...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-31

... minimum wage an agricultural employer utilizing the H-2A program, allowing temporary employment of alien... for OMB Review; Comment Request; Domestic Agricultural In-Season Wage Report ACTION: Notice. SUMMARY...- Season Wage Report,'' to the Office of Management and Budget (OMB) for review and approval for use in...

5 CFR 351.203 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... for a position covered by a wage-board or similar wage-determining procedure, such as provided in the definition of representative rate for Federal Wage System positions in 5 CFR 532.401 of this chapter; (3) For... low priority program or to a vacant position. [51 FR 319, Jan. 3, 1986, as amended at 58 FR 65533, Dec...

78 FR 66364 - Medicare & Medicaid Programs: Application From the Accreditation Commission for Health Care for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-05

...] Medicare & Medicaid Programs: Application From the Accreditation Commission for Health Care for Continued... Accreditation Commission for Health Care (ACHC) for continued recognition as a national accrediting organization...) announcing Accreditation Commission for Health Care's request for approval of its hospice accreditation...

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. © 2014 American Society of Law, Medicine & Ethics, Inc.

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.

Meritocracy without Rising Inequality? Wage Rate Differences Are Widening by Education and Narrowing by Gender and Race. Economic Restructuring and the Job Market No. 2.

ERIC Educational Resources Information Center

Lerman, Robert I.

This brief, part of a series on labor trends and their policy implications, uses data on wage rates and hours worked from the Survey of Income and Program Participation (SIPP) to look at two questions about wage inequality since the mid-1980s. One question is whether wage differentials are becoming more related to education and less to gender and…

Worksite Health Promotion for Low-wage Workers: A Scoping Literature Review

PubMed Central

Stiehl, Emily; Shivaprakash, Namrata; Thatcher, Esther; Ornelas, India J.; Kneipp, Shawn; Baron, Sherry L.; Muramatsu, Naoko

2018-01-01

Objective To determine: (1) What research has been done on health promotion interventions for low-wage workers and (2) What factors are associated with effective low-wage workers’ health promotion. Data Source This review includes articles from PubMed and PsychINFO published in or before July 2016 Study Inclusion/Exclusion Criteria The search yielded 130 unique articles, 35 met the inclusion criteria: (1) being conducted in the US, (2) including an intervention or empirical data around health promotion among adult low-wage workers, and (3) measuring changes in low-wage worker health. Data Extraction Central features of the selected studies were extracted, including the theoretical foundation, study design, health promotion intervention content and delivery format, intervention targeted outcomes, sample characteristics, and work, occupational, and industry characteristics. Data Analysis Consistent with a scoping review, we used a descriptive, content analysis approach to analyze extracted data. All authors agreed upon emergent themes and two authors independently coded data extracted from each article. Results The results suggest that the research on low-wage workers’ health promotion is limited, but increasing, and that low-wage workers have limited access to and utilization of worksite health promotion programs. Conclusions Workplace health promotion programs could have a positive effect on low-wage workers, but more work is needed to understand how to expand access, what drives participation and which delivery mechanisms are most effective. PMID:28893085

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.

75 FR 65282 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-22

... to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or as a nursing facility (NF) in the Medicaid program. We are proposing these requirements to ensure that long... According to CMS data, at any point in time, approximately 1.4 million elderly and disabled nursing home...

Hospice Care

MedlinePlus

... Hospice is covered by Medicare, Medicaid and most insurance companies, and will cover medications related to the primary ... hospice care; however, payment levels vary for private insurance companies. References: National Hospice and Palliative Organization Learn more: ...

End of Life (Hospice Care)

MedlinePlus

... days of life. Meier DE, et al. Hospice: Philosophy of care and appropriate utilization in the United ... Care Organization. http://www.nhpco.org/hospice-statistics-research-press-room/facts-hospice-and-palliative-care. Accessed ...

Professional and educational needs of hospice and palliative care social workers.

PubMed

Weisenfluh, Sherri M; Csikai, Ellen L

2013-01-01

In the past decade much growth has occurred in the numbers of patients and families served by hospices and palliative care services. Thus, not surprisingly, these services have also been subject to increasing regulation by governmental and accrediting entities. In order to stay up-to-date in this ever-changing environment and to continue to provide effective interventions, social workers must stay engaged in the professional community and continuing education. In this quantitative study, 1,169 practicing hospice and palliative care social workers provided information about their practice activities and agency characteristics, professional affiliations and certification, and ongoing educational needs. About one-half of respondents carried a caseload of 21-50 and were most engaged in communicating the psychosocial needs of the patient and family to other members of the team and assessing for grief and bereavement issues. The most important educational needs pertained to the psychological and social needs of patients and families and psychosocial interventions. Most were members of professional organizations and three-quarters were members of NASW. Although many were aware of the joint NASW-NHPCO social work hospice specialty certification, few held this certification yet. The results of this survey can be utilized in the design of continuing education programs and advocacy for programmatic and policy change within agencies and the industry.

Hospice care delivered at home, in nursing homes and in dedicated hospice facilities: A systematic review of quantitative and qualitative evidence.

PubMed

Candy, B; Holman, A; Leurent, B; Davis, S; Jones, L

2011-01-01

Hospice care supports patients and their families physically and emotionally through the dying phase. In many countries a substantial portion of specialised end-of-life care is provided through hospices. Such care has developed outside of general healthcare and is commonly provided in a patient's home or in dedicated facilities. Hospice provision may need to increase in the future due to an ageing population with a greater need for access to end-of-life care. In this systematic review we sought to identify the current evidence on (1) the effectiveness, including cost-effectiveness, of hospices, and hospice care in a patient's home and in nursing homes and (2) the experiences of those who use and of those who provide such services. We included quantitative and qualitative studies on hospice care that was provided in a patient's home, nursing home or hospice. We did not include studies on end-of-life care that was provided as part of general healthcare provision, such as by general practitioners in primary care, community nurses or within general hospitals. For quantitative evaluations we included only those that compared hospice care with usual generalist healthcare. The databases CINAHL, MEDLINE, EMBASE, and The Cochrane Library were searched from 2003 to 2009. Evidence was assessed for quality and data extractions double-checked. For quantitative studies we present the outcome data comparing hospice versus usual care. For qualitative evaluations we organise findings thematically. Eighteen comparative evaluations and four thematic papers were identified. Quantitative evidence, mostly of limited quality in design, showed that hospice care at home reduced general health care use and increased family and patient satisfaction with care. Main themes in the qualitative literature revealed that home hospice services support families to sustain patient care at home and hospice day care services generate for the patient a renewed sense of meaning and purpose. Although studies had methodological limitations, in this review we found much evidence to support the benefits of hospice care. There were limited evaluations found on the impact of hospice care on psychological well-being, such as symptoms of depression, and on inpatient hospice care and non-hospital related costs. Copyright © 2010 Elsevier Ltd. All rights reserved.

42 CFR 418.58 - Condition of participation: Quality assessment and performance improvement.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... The hospice must develop, implement, and maintain an effective, ongoing, hospice-wide data-driven... learning throughout the hospice. (3) The hospice must take actions aimed at performance improvement and...

42 CFR 418.58 - Condition of participation: Quality assessment and performance improvement.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... The hospice must develop, implement, and maintain an effective, ongoing, hospice-wide data-driven... learning throughout the hospice. (3) The hospice must take actions aimed at performance improvement and...

42 CFR 418.58 - Condition of participation: Quality assessment and performance improvement.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... The hospice must develop, implement, and maintain an effective, ongoing, hospice-wide data-driven... learning throughout the hospice. (3) The hospice must take actions aimed at performance improvement and...

Community Jobs Outcomes Assessment & Program Evaluation.

ERIC Educational Resources Information Center

Case, Annette; Burchfield, Erin; Sommers, Paul

Unemployment wage data were evaluated to assess employment, job retention, and wage progression for graduates of Community Jobs (CJ), a short-term public job creation program for the hard to employ in the state of Washington. The following were among the findings: (1) 66% of all participants were employed after graduating from CJ; (2) 53% were…

Preclinical Medical Students' Diverse Educational and Emotional Responses to a Required Hospice Experience.

PubMed

Tse, Chung Sang; Morrison, Laura J; Ellman, Matthew S

2017-09-01

Physicians' lack of comfort and skill in communicating about hospice care results in deficits and delays in hospice referrals. Preclinical exposure to hospice may lay a foundation to improve medical students' knowledge and comfort with hospice care. To understand how preclinical medical student (MS)-2s respond both educationally and emotionally to a required hospice care experience (HCE). Accompanied by hospice clinicians, MS-2s spent 3 hours seeing inpatient or home hospice patients followed by a 1-hour debriefing. Students submitted written reflections to e-mailed educational and emotional prompts. Two hundred and two MS-2s from 2 academic cohorts completed the HCE at 1 of 2 hospice sites. Written reflective responses were analyzed qualitatively, where salient themes extracted and responses were coded. Ninety-two students submitted 175 responses to Prompt #1 (educational impact) and 85 students entered 85 responses to prompt #2 (emotional impact) of the HCE. Eleven themes were identified for prompt #1, most frequently focusing on hospice services and goals and hospice providers' attitudes and skills. Prompt #2 elicited a diverse spectrum of emotional responses, spanning positive and negative emotions. Most often, students reported "no specified emotional reaction," "sad/depressed," "difficult /challenging," "heartened/encouraged," and "mixed emotions." In an HCE, preclinical students reported learning core aspects of hospice care and experiencing a broad spectrum of emotional responses. These findings may assist educators in the planning of HCEs for preclinical students, including debriefing sessions with skilled clinicians and opportunities for triggered reflection.

Hospice Knowledge and Intentions among Latinos Using Safety-Net Clinics

PubMed Central

Selsky, Claire; Kreling, Barbara; Luta, Gheorghe; Makgoeng, Solomon B.; Gomez-Duarte, Jessika; Barbo, Andrea Gabriela A.

2012-01-01

Abstract Background Hospice use is low in Latinos but we know little about explanations for this pattern. Objective To describe factors associated with knowledge of and intention to use hospice for cancer care. Methods We conducted a Spanish-language, interviewer-administered cross-sectional survey of 331 Latino immigrants from Central and South America in safety-net clinics. Hospice intentions were measured using a hypothetical scenario. We used logistic regression and multiple imputations to test associations between cultural values, social acculturation, and other variables and knowledge and intentions. Results Only 29% knew about hospice and 35% would choose hospice care (once it was defined). Collectivist (group-focused) views (odds ratio [OR] 1.06 per 1-point increase, 95% confidence interval [CI] 1.01-1.12, p=.05), endorsing family-centric values (OR 1.03 per 1-point increase, 95% CI 1.01-1.04, p=.004), and higher education were associated with greater hospice knowledge after considering covariates. Greater social ties were also independently associated with greater knowledge, but knowledge was not related to hospice intentions. Individuals who believed in maintaining secrecy about prognosis were 19% less likely to choose hospice than those who did not endorse secrecy (OR 0.81, 95% CI 0.67-0.99, p=.038). The most socially acculturated individuals were significantly more likely to choose hospice than those with less acculturation (OR 1.19 for each 1-unit increase, 95% CI 10.6-1.34, p=.004). Conclusions Hospice knowledge may be necessary but is not sufficient to increase hospice use among immigrant Latinos. Latino social networks and organizations may provide a natural leverage point for interventions. Interventions to increase hospice use may need to consider culturally related values. PMID:22731515

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.

Legal Status and Wage Disparities for Mexican Immigrants.

PubMed

Hall, Matthew; Greenman, Emily; Farkas, George

2010-12-01

This paper employs a unique method of imputing the legal status of Mexican immigrants in the 1996-1999 and 2001-2003 panels of the Survey of Income and Program Participation to provide new evidence of the role of legal authorization in the U.S. on workers' wages. Using growth curve techniques, we estimate wage trajectories for four groups: documented Mexican immigrants, undocumented Mexican immigrants, U.S-born Mexican Americans, and native non-Latino whites. Our estimates reveal a 17 percent wage disparity between documented and undocumented Mexican immigrant men, and a 9 percent documented-undocumented wage disparity for Mexican immigrant women. We also find that in comparison to authorized Mexicans, undocumented Mexican immigrants have lower returns to human capital and slower wage growth.

Legal Status and Wage Disparities for Mexican Immigrants

PubMed Central

Hall, Matthew; Greenman, Emily; Farkas, George

2014-01-01

This paper employs a unique method of imputing the legal status of Mexican immigrants in the 1996-1999 and 2001-2003 panels of the Survey of Income and Program Participation to provide new evidence of the role of legal authorization in the U.S. on workers’ wages. Using growth curve techniques, we estimate wage trajectories for four groups: documented Mexican immigrants, undocumented Mexican immigrants, U.S-born Mexican Americans, and native non-Latino whites. Our estimates reveal a 17 percent wage disparity between documented and undocumented Mexican immigrant men, and a 9 percent documented-undocumented wage disparity for Mexican immigrant women. We also find that in comparison to authorized Mexicans, undocumented Mexican immigrants have lower returns to human capital and slower wage growth. PMID:25414526

The Role of Hospice Care in the Nursing Home Setting

PubMed Central

Miller, Susan C.; Mor, Vince N.T.

2013-01-01

The last days of life for a substantial proportion of dying older adults are spent in nursing homes. Considering this, the provision of Medicare hospice care in nursing homes would appear to be an equitable use of Medicare expenditures as well as a valid investment in improving the quality of life for dying nursing home residents. However, government concerns regarding possible abuse of the hospice benefit in nursing homes, as well as suggestion that the payment for the benefit in nursing homes may be excessive, has perhaps slowed the adoption of hospice services into the nursing home setting. Currently, access to hospice care in nursing homes is inequitable across facilities, and across geographic areas. In nursing homes where hospice is available and present, however, recent research documents superior outcomes for residents enrolled in hospice, and perhaps for nonhospice residents. Still, more research is needed, particularly research focusing on the government costs associated with the provision of hospice care in nursing homes. If subsequent research continues to support the “added value” of hospice care in nursing homes and at the same or less total costs, the issue of foremost concern becomes how equitable access to Medicare hospice care in nursing homes can be achieved. Access may be increased to some extent by changing government policies, and conflicting regulations and interpretive guidelines, so they support and encourage the nursing home/hospice collaboration. PMID:12006229

Investigations of the pediatric hospice care in Taiwan: 2005 to 2010.

PubMed

Kang, Shih-Chao; Hwang, Shinn-Jang; Wang, Wei-Shu

2014-08-01

The utilization of pediatric hospice care remains unclear in Taiwan. Data were analyzed from the claims of hospice admissions in patients aged 18 years or younger using the National Health Insurance Research Database from 2005 to 2010. A total of 91 patients and 136 admissions were enrolled (male-female = 50:41; mean 11.6 years old). In all, 62 patients were admitted once, including 47 patients who died. All the patients had cancer, with brain cancer (40.7%) accounting the most . Among acute comorbidities, neurological complications (16.2%) were mostly accounted. Family physicians provided most (64.7%) of the hospice services. Hospice stay ≤3 days correlated positively with death in hospices (odds ratio = 2.922, 95% confidence interval = 1.268-6.730). Pediatric hospice care revealed characteristics different from adults. Underlying late referrals were prevalent. There is space to promote the utilization of hospices for terminally ill pediatric patients. © The Author(s) 2013.

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

76 FR 82116 - Wage Methodology for the Temporary Non-Agricultural Employment H-2B Program; Delay of Effective...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-30

....D. Pa. June 16, 2011). In anticipation of the revised effective date of the Wage Rule, the... effective date to November 30, 2011, and in anticipation of the new effective date, the Office of Foreign... issued in anticipation of the effective date of, and in accordance with, the Wage Rule will not be...

76 FR 45667 - Wage Methodology for the Temporary Non-Agricultural Employment H-2B Program; Amendment of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-01

... effective date because ``many employers already may have planned for their labor needs and operations for... operations, the Department is delaying implementation of this Final Rule so that the prevailing wage... seeking to hire H-2B workers for its restaurant could be presented with SCA wage rates for a ``Cook I...

76 FR 73508 - Wage Methodology for the Temporary Non-Agricultural Employment H-2B Program; Delay of Effective Date

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-29

..., 2011, which set the new effective date for the Wage Rule of September 30, 2011 (the Effective Date Rule... implementation. In consideration of the two pending challenges to the Wage Rule and its new effective date, and...: Employment and Training Administration, Department of Labor. ACTION: Final rule; delay of effective date...

78 FR 24047 - Wage Methodology for the Temporary Non-Agricultural Employment H-2B Program, Part 2

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-24

... Employment and Training Administration 20 CFR Part 655 RIN 1205-AB69 Wage Methodology for the Temporary Non-Agricultural Employment H- 2B Program, Part 2 AGENCY: Employment and Training Administration, Labor; U.S. Citizenship and Immigration Services, DHS. ACTION: Interim final rule; request for comments. SUMMARY: The...

Mid-Career Outcomes of Graduates of Virginia Institutions of Higher Education

ERIC Educational Resources Information Center

State Council of Higher Education for Virginia, 2014

2014-01-01

The State Council of Higher Education for Virginia (SCHEV) has produced new reporting tools of graduate wage outcomes out to twenty years post completion. These reports are available at the statewide level by program discipline (two-digit level of the Classification of Instructional Programs). It was found that reported wages increase by level of…

78 FR 19098 - Wage Methodology for the Temporary Non-Agricultural Employment H-2B Program; Delay of Effective Date

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-29

... by dividing the Bureau of Labor Statistics Occupational Employment Statistics Survey (OES survey... DEPARTMENT OF LABOR Employment and Training Administration 20 CFR Part 655 RIN 1205-AB61 Wage Methodology for the Temporary Non-Agricultural Employment H- 2B Program; Delay of Effective Date AGENCY...

Federal and State Employment Laws. Module Number 11. Work Experience Program Modules. Coordination Techniques Series.

ERIC Educational Resources Information Center

Kidney, John

This self-instructional module, the eleventh in a series of 16 on techniques for coordinating work experience programs, deals with federal and state employment laws. Addressed in the module are federal and state employment laws pertaining to minimum wage for student learners, minimum wage for full-time students, unemployment insurance, child labor…

Socialization of hospice volunteers: members of the family.

PubMed

Sadler, C; Marty, F

1998-01-01

The purpose of this study is to examine the turning points volunteers found important in their hospice training and volunteer experiences. Seventeen individuals who had recently completed hospice training were asked about the turning points in their training and volunteering that were important in their becoming and remaining a hospice volunteer. The study finds that volunteers have a wide variety of intrapersonal, interpersonal, and group reasons for becoming and remaining a hospice volunteer. The findings suggest that hospice staff need to create a wide variety of events which volunteers can identify with to help people want to become and remain volunteers.

Willingness to Pay for Hospice Care Using the Contingent Valuation Method

PubMed Central

Kim, Mee-Ok; Kim, Jung-Hoe; Joo, Ji-Soo

2011-01-01

Purpose It is necessary to develop a proper payment system for more health care facilities to provide hospice and palliative cares. In deciding the proper level of payment for hospice per diem fee, willingness to pay (WTP) may provide one of the critical information. This study was conducted to determine WTP for hospice care and to analyze those factors affecting WTP. Materials and Methods A contingent valuation method with a double-bounded dichotomous-choice model was used. Interview survey was organized and conducted by a survey company from April 4 to 18, 2008. The mean WTP was calculated through an infinite integration of survival functions. Results The average willingness to pay was found to be 42,240 Korean won (KRW) (USD 35), with the amount becoming higher as hospice services were deemed more necessary or where average monthly household income was higher. The amount was also higher among male respondents than females. Conclusion To compare this WTP with actual cost (32,500 KRW) (USD 27) for hospice care. To facilitate hospice service, hospice specific payment system should be developed. This study provides information regarding the general public's preference of hospice service and their WTP for hospice care, and it may be useful in the decision-making process. PMID:21488196

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. Project HOPE—The People-to-People Health Foundation, Inc.

78 FR 5458 - Medicare Program; Request for Information To Aid in the Design and Development of a Survey...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-25

...] Medicare Program; Request for Information To Aid in the Design and Development of a Survey Regarding..., well-designed Hospice Survey will allow us to understand: (1) Patient experiences throughout their... accordance with CAHPS[supreg] Survey Design Principles and implementation instructions will be based on those...

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

How might Levinas' concept of the other's priority and Derrida's unconditional hospitality contribute to the philosophy of the modern hospice movement?

PubMed

Floriani, Ciro Augusto; Schramm, Fermin Roland

2010-06-01

Hospitality is commonly referred as one of the meanings of hospes, the Latin word which is also the root of hospice. This article explores the semantics of the word hospice - the seal of identity of modern hospice movement - and attempts to integrate the meaning of hospitality into the modern hospice movement, understood as unconditional reception. Therefore, the article analyzes the concept of unconditional hospitality, developed by Jacques Derrida and that of ethical responsibility proposed by Emmanuel Levinas based on the phenomenological experience of the other. From this point of view, these two concepts tie in with the meaning of hospice, bringing substantial grounding elements to the hospice movement for the construction of a protective ethos.

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.

Impact of hospice care on end-of-life hospitalization of elderly patients with lung cancer in Taiwan.

PubMed

Kang, Shih-Chao; Lin, Ming-Hwai; Hwang, I-Hsuan; Lin, Ming-Hsien; Chang, Hsiao-Ting; Hwang, Shinn-Jang

2012-05-01

This study investigated the impact of hospice care on end-of-life elderly patients with lung cancer in Taiwan. Data were collected from deceased inpatients with lung cancer who were at least 65 years old, using the National Health Insurance Research Database of 2004. A total of 1282 patients were enrolled, of whom 277 (21.6%) received hospice care (hospice-care group) and the other 1005 (78.4%) received general acute ward care (control group). The patients' age, gender, and institution of hospitalization did not differ significantly between the two groups, and most of the patients had chosen medical centers and their affiliated hospices for terminal care. The hospice-care group had a significantly shorter hospital stay and lower costs of hospitalization than the control group, with patients cared for primarily by family physicians and radiation oncologists (all p<0.05). The hospice-care group had an elevated incidence of co-morbid diabetes mellitus, higher scores on the Charlson Comorbidity Index, fewer acute lower respiratory conditions, and fewer invasive procedures than the control group (all p<0.05). Natural opium alkaloids were the most commonly prescribed drugs in the hospice-care group, whereas parenteral solutions were most frequently requested in the control group. Hospice care has provided a humane and cost-efficient pathway for end-of-life elderly patients with lung cancer. Parenteral nutrition/hydration should be limited for terminal care patients. Opioids should be promoted for the relief of pain and dyspnea in acute ward care. Family physicians and radiation oncologists play important roles in hospice care. Compared with the prevalence of hospice care in the United Kingdom and other developed countries, hospice care in Taiwan is in the position to be expanded. Copyright © 2012. Published by Elsevier B.V.

Developing design principles for a Virtual Hospice: improving access to care.

PubMed

Taylor, Andrea; French, Tara; Raman, Sneha

2018-03-01

Providing access to hospice services will become increasingly difficult due to the pressures of an ageing population and limited resources. To help address this challenge, a small number of services called Virtual Hospice have been established. This paper presents early-stage design work on a Virtual Hospice to improve access to services provided by a hospice (Highland Hospice) serving a largely remote and rural population in Scotland, UK. The study was structured as a series of Experience Labs with Highland Hospice staff, healthcare professionals and patients. Experience Labs employ a participatory design approach where participants are placed at the centre of the design process, helping to ensure that the resultant service meets their needs. Data from the Experience Labs were analysed using qualitative thematic analysis and design analysis. A number of themes and barriers to accessing Highland Hospice services were identified. In response, an initial set of seven design principles was developed. Design principles are high-level guidelines that are used to improve prioritisation and decision making during the design process by ensuring alignment with research insights. The design principles were piloted with a group of stakeholders and gained positive feedback. The design principles are intended to guide the ongoing development of the Highland Hospice Virtual Hospice. However, the challenges faced by Highland Hospice in delivering services in a largely remote and rural setting are not unique. The design principles, encompassing digital and non-digital guidelines, or the design approach could be applied by other hospices in the UK or overseas. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

Variation in Hospice Services by Location of Care: Nursing Home Versus Assisted Living Facility Versus Home.

PubMed

Unroe, Kathleen T; Bernard, Brittany; Stump, Timothy E; Tu, Wanzhu; Callahan, Christopher M

2017-07-01

To describe differences in hospice services for patients living at home, in nursing homes or in assisted living facilities, including the overall number and duration of visits by different hospice care providers across varying lengths of stay. Retrospective cohort study using hospice patient electronic medical record data. Large, national hospice provider. Data from 32,605 hospice patients who received routine hospice care from 2009 to 2014 were analyzed. Descriptive statistics were calculated for utilization measures for each type of provider and by location of care. Frequency and duration of service contacts were standardized to a 1 week period and pairwise comparisons were used to detect differences in care provided between the three settings. Minimal differences were found in overall intensity of service contacts across settings, however, the mix of services were different for patients living at home versus nursing home versus assisted living facility. Overall, more nurse care was provided at the beginning and end of the hospice episode; intensity of aide care services was higher in the middle portion of the hospice episode. Nearly 43% of the sample had hospice stays less than 2 weeks and up to 20% had stays greater than 6 months. There are significant differences between characteristics of hospice patients in different settings, as well as the mix of services they receive. Medicare hospice payment methodology was revised starting in 2016. While the new payment structure is in greater alignment with the U shape distribution of services, it will be important to evaluate the impact of the new payment methodology on length of stay and mix of services by different providers across settings of care. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Hospice Enrollment in Patients with Advanced Heart Failure Decreases Acute Medical Service Utilization

PubMed Central

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

2017-01-01

Background Patients with advanced heart failure (HF) enroll in hospice at low rates and data on their acute medical service utilization following hospice enrollment is limited. Methods and Results We performed a descriptive analysis of Medicare fee-for-service beneficiaries, with at least one home health claim between 07/01/2009 and 06/30/2010, and at least two HF hospitalizations between 07/01/2009 and 12/31/2009, who subsequently enrolled in hospice between 07/01/2009 and 12/31/2009. 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 5,073 beneficiaries: 55% were female, 45% were ≥ 85 years of age, 13% were non-white, and the mean comorbidity count was 2.38 (STD 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, ICU, and ER admissions decreased from 2.56, 0.87, and 1.17 before hospice enrollment to 0.53, 0.19, and 0.76 after hospice enrollment. Conclusions Home health care Medicare beneficiaries with advanced HF who enrolled in hospice had lower acute medical service utilization following 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. PMID:28292824

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

Hospice Use and Pain Management in Elderly Nursing Home Residents With Cancer.

PubMed

Hunnicutt, Jacob N; Tjia, Jennifer; Lapane, Kate L

2017-03-01

Pain management is suboptimal in nursing homes. To estimate the extent to which receipt of hospice in nursing homes (NHs) increases the receipt of pain management for residents with cancer at the end of life. Study participants included Medicare beneficiaries with cancer who were NH residents in the last 90 days of life in 2011-2012 (n = 78,160). Residents in pain on hospice were matched to like residents without hospice by facility, type of pain assessment (self-report/staff assessment), and weeks until death (9064 matched strata, 16,968 unique residents). Minimum Data Set 3.0 provided information on residents' pain prevalence and receipt of pain management (scheduled analgesics, as needed [pro re nata {PRN}] medication, nonpharmacologic interventions). We developed conditional logistic models to estimate the association between hospice use and pain management, stratified by self-reported and staff-assessed pain. We found that pain prevalence was higher in residents using hospice versus those without hospice (e.g., residents who self-reported pain: hospice: 59.9%, 95% CIs = 59.3%-60.5%; nonhospice: 50.0%, 95% CI = 49.4%-50.6%). In matched analyses, untreated pain was uncommon (self-reported pain: 2.9% and 5.6% in hospice users and nonusers, respectively). Hospice use was associated with receipt of scheduled analgesics (self-reported: adjusted odds ratio = 1.85, 95% CI = 1.73-1.971) and PRN medication (self-reported: adjusted odds ratio = 1.31, 95% CI = 1.20-1.43). Pain prevalence and the association between hospice and pain management were similar in residents with staff-assessed pain. Untreated pain at the end of life among residents with cancer in NHs is unusual. Hospice is associated with increased pain management among those with documented pain. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Comparison of home health and hospice care agencies by organizational characteristics and services provided: United States, 2007.

PubMed

Park-Lee, Eunice Y; Decker, Frederic H

2010-11-09

This report presents national estimates of the organizational characteristics of home health and hospice care agencies in 2007. Comparisons of organizational characteristics and provision of selected services are made by agency type. A comparison of selected characteristics between 1996 and 2007 is also provided to highlight changes that have occurred leading to the current composition of the home health and hospice care sector. Estimates are based on data collected on agencies from the 1996, 2000, and 2007 National Home and Hospice Care Survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Estimates are derived from data collected during interviews with administrators and staff designated by the administrators. In 2007, there were 14,500 home health and hospice care agencies in the United States, an increase from 11,400 in 2000. Three-quarters of these agencies provided home health care only, 15% provided hospice care only, and 10% provided both home health and hospice care (mixed). The percentage of proprietary home health care only and hospice care only agencies increased during 1996-2007, whereas the percentage of proprietary mixed agencies remained relatively stable. The average number of home health care patients that home health care only and mixed agencies served decreased, while the average number of hospice care patients that hospice care only agencies served increased across years. Among mixed agencies, no significant changes were observed in the average number of hospice care patients being served. The percentage of home health care only agencies offering certain therapeutic and nonmedical services declined over the years. There was an increase in the proportion of hospice care only agencies' providing many core and noncore hospice care services during 1996-2007. Also during this time, the proportion of mixed agencies providing selected nonmedical services decreased.

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.

On euthanasia, resistance, and redemption: the moralities and politics of a hospice.

PubMed

Broom, Alex

2012-02-01

Euthanasia/assisted dying, the desire to hasten death, and religious supportive care at the end of life are controversial issues that have been heavily debated within the academic and medical communities. Little research has been done on hospice patients' views, despite hospices being political spaces, espousing a range of perspectives on assisted dying, religiosity, and "good deaths." In this article I document the presence, articulation, and significance of these issues as perceived and experienced by 20 hospice inpatients in the last 4 weeks of their lives. Key themes to emerge included polarization in desire for hastened death and assisted dying in the hospice; the hospice as a morally bound space situated within particular notions of "dying well"; and the divisive character of religion as part of formalized hospice care. Theoretically, the participants' perspectives on euthanasia/assisted dying and religiosity in the hospice provide a means of unpacking and revealing the moral economy of modern dying practices and the institutional governance and production of "timely deaths."

Nearly Half Of All Medicare Hospice Enrollees Received Care From Agencies Owned By Regional Or National Chains

PubMed Central

Stevenson, David G.; Dalton, Jesse B.; Grabowski, David C.; Huskamp, Haiden A.

2016-01-01

To date, analyses of ownership in the US hospice sector have focused on the growth of for-profit hospice and on aggregate differences in patient populations and service use patterns between for-profit and not-for-profit agencies. Although such comparisons are useful, they do not offer insights about the types of organizations that comprise the hospice sector, including the emergence of multi-agency chains. Using Medicare Cost Reports from 2000 to 2011, we track the evolution of the US hospice industry, not only to describe the market's composition by profit status but also to provide new information about the roles of regional and national chains. Almost half of all Medicare hospice enrollees received these services from a multi-agency chain in 2011. Although a handful of companies play a prominent role, the presence of smaller for-profit and not-for-profit hospice chains also has grown in recent years. By focusing on the role of the diverse organizations that provide hospice care, our analyses can help inform efforts to monitor and assure quality of care, to assess payment adequacy and options for reform, and to facilitate greater transparency and accountability within the hospice marketplace. PMID:25561641

German Version of the Inventory of Motivations for Hospice Palliative Care Volunteerism: Are There Gender Differences?

PubMed

Stelzer, Eva-Maria; Lang, Frieder R; Hörl, Melanie; Kamin, Stefan T; Claxton-Oldfield, Stephen

2018-02-01

The present study examined gender differences in motivations for volunteering for hospice using a German version of the Inventory of Motivations for Hospice Palliative Care Volunteerism (IMHPCV). The IMHPCV was translated into German and back-translated into English following the World Health Organization's guidelines for the translation and adaptation of instruments. In an online survey, 599 female and 127 male hospice volunteers from hospice organizations throughout Germany completed the translated version of the IMHPCV, the Scales of the Attitude Structure of Volunteers as well as questions pertaining to their volunteer experience. Based on an exploratory structural equation modeling approach, adequate model fit was found for the expected factor structure of the German version of the IMHPCV. The IMHPCV showed adequate internal consistency and construct validity. Both female and male hospice volunteers found altruistic motives and humanitarian concerns most influential in their decision to volunteer for hospice. Personal gain was least influential. Men rated self-promotion, civic responsibility, and leisure as more important than women. Analyses provided support for the use of the IMHPCV as a measurement tool to assess motivations to volunteer for hospice. Implications for recruitment and retention of hospice volunteers, in particular males, are given.

Seminar on Subminimum Wage for Youth. Executive Summary (New York, New York, April 21, 1981).

ERIC Educational Resources Information Center

1981

A seminar was held to examine the merits and feasibility of a subminimum wage for youth. Throughout the seminar panelists expressed general agreement on the fact that most youth want to work as well as on the value or potential value of employment and training programs, including the Comprehensive Employment and Training Act (CETA) programs. In…

76 FR 21036 - Application of the Prevailing Wage Methodology in the H-2B Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-14

...: Notice. SUMMARY: On January 19, 2011, the Department of Labor (Department) published a final rule, Wage... work performed on or after January 1, 2012. Employers whose work commences in 2011 and continues into...-agricultural Employment H-2B Program, 76 FR 3452, Jan. 19, 2011. DATES: This Notice is effective on April 14...

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. © The Author(s) 2014.

A Multimethod Analysis of Shared Decision-Making in Hospice Interdisciplinary Team Meetings Including Family Caregivers

PubMed Central

Washington, Karla T.; Oliver, Debra Parker; Gage, L. Ashley; Albright, David L.; Demiris, George

2015-01-01

Background Much of the existing research on shared decision-making in hospice and palliative care focuses on the provider-patient dyad; little is known about shared decision-making that is inclusive of family members of patients with advanced disease. Aim We sought to describe shared decision-making as it occurred in hospice interdisciplinary team meetings that included family caregivers as participants using video-conferencing technology. Design We conducted a multimethod study in which we used content and thematic analysis techniques to analyze video-recordings of hospice interdisciplinary team meetings (n = 100), individual interviews of family caregivers (n = 73) and hospice staff members (n = 78), and research field notes. Setting/participants Participants in the original studies from which data for this analysis were drawn were hospice family caregivers and staff members employed by one of five different community-based hospice agencies located in the Midwestern United States. Results Shared decision-making occurred infrequently in hospice interdisciplinary team meetings that included family caregivers. Barriers to shared decision-making included time constraints, communication skill deficits, unaddressed emotional needs, staff absences, and unclear role expectations. The hospice philosophy of care, current trends in health care delivery, the interdisciplinary nature of hospice teams, and the designation of a team leader/facilitator supported shared decision-making. Conclusions The involvement of family caregivers in hospice interdisciplinary team meetings using video-conferencing technology creates a useful platform for shared decision-making; however, steps must be taken to transform family caregivers from meeting attendees to shared decision-makers. PMID:26281854

A multimethod analysis of shared decision-making in hospice interdisciplinary team meetings including family caregivers.

PubMed

Washington, Karla T; Oliver, Debra Parker; Gage, L Ashley; Albright, David L; Demiris, George

2016-03-01

Much of the existing research on shared decision-making in hospice and palliative care focuses on the provider-patient dyad; little is known about shared decision-making that is inclusive of family members of patients with advanced disease. We sought to describe shared decision-making as it occurred in hospice interdisciplinary team meetings that included family caregivers as participants using video-conferencing technology. We conducted a multimethod study in which we used content and thematic analysis techniques to analyze video-recordings of hospice interdisciplinary team meetings (n = 100), individual interviews of family caregivers (n = 73) and hospice staff members (n = 78), and research field notes. Participants in the original studies from which data for this analysis were drawn were hospice family caregivers and staff members employed by one of five different community-based hospice agencies located in the Midwestern United States. Shared decision-making occurred infrequently in hospice interdisciplinary team meetings that included family caregivers. Barriers to shared decision-making included time constraints, communication skill deficits, unaddressed emotional needs, staff absences, and unclear role expectations. The hospice philosophy of care, current trends in healthcare delivery, the interdisciplinary nature of hospice teams, and the designation of a team leader/facilitator supported shared decision-making. The involvement of family caregivers in hospice interdisciplinary team meetings using video-conferencing technology creates a useful platform for shared decision-making; however, steps must be taken to transform family caregivers from meeting attendees to shared decision-makers. © The Author(s) 2015.

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.

Association Between the Medicare Hospice Benefit and Health Care Utilization and Costs for Patients With Poor-Prognosis Cancer

PubMed Central

Obermeyer, Ziad; Makar, Maggie; Abujaber, Samer; Dominici, Francesca; Block, Susan; Cutler, David M.

2014-01-01

IMPORTANCE More patients with cancer use hospice currently than ever before, but there are indications that care intensity outside of hospice is increasing, and length of hospice stay decreasing. Uncertainties regarding how hospice affects health care utilization and costs have hampered efforts to promote it. OBJECTIVE To compare utilization and costs of health care for patients with poor-prognosis cancers enrolled in hospice vs similar patients without hospice care. DESIGN, SETTING, AND PARTICIPANTS Matched cohort study of patients in hospice and nonhospice care using a nationally representative 20% sample of Medicare fee-for-service beneficiaries who died in 2011. Patients with poor-prognosis cancers (eg, brain, pancreatic, metastatic malignancies) enrolled in hospice before death were matched to similar patients who died without hospice care. EXPOSURES Period between hospice enrollment and death for hospice beneficiaries, and the equivalent period of nonhospice care before death for matched nonhospice patients. MAIN OUTCOMES AND MEASURES Health care utilization including hospitalizations and procedures, place of death, cost trajectories before and after hospice start, and cumulative costs, all during the last year of life. RESULTS Among 86 851 patients with poor-prognosis cancers, median time from first poor-prognosis diagnosis to death was 13 months (interquartile range [IQR], 3–34), and 51 924 (60%) entered hospice before death. Matching yielded a cohort balanced on age, sex, region, time from poor-prognosis diagnosis to death, and baseline care utilization, with 18 165 patients in the hospice group and 18 165 in the nonhospice group. Nonhospice Group (n = 18 165) Hospice Group (n = 18 165) Risk Ratio (95% CI) Hospitalizations, % (95% CI) 65.1 (64.4–65.8) 42.3 (41.5–43.0) 1.5 (1.5–1.6) Intensive care unit admission, % (95% CI) 35.8 (35.1–36.5) 14.8 (14.3–15.3) 2.4 (2.3–2.5) Invasive procedures, % (95% CI) 51.0 (50.3–51.7) 26.7 (26.1–27.4) 1.9 (1.9–2.0) Death in hospital or nursing facility 74.1 (73.5–74.8) 14 (13.5–14.5) 5.3 (5.1–5.5) Costs in last year of life, $ (95% CI) 71 517 (70 543–72 490) 62 819 (62 082–63 557) Difference, 8697 (7560–9835) After matching, 11% of nonhospice and 1% of hospice beneficiaries who had cancer-directed therapy after exposure were excluded. Median hospice duration was 11 days. Nonhospice beneficiaries had significantly greater health care utilization, largely for acute conditions not directly related to cancer and higher overall costs. CONCLUSIONS AND RELEVANCE In this sample of Medicare fee-for-service beneficiaries with poor-prognosis cancer, those receiving hospice care vs not (control), had significantly lower rates of hospitalization, intensive care unit admission, and invasive procedures at the end of life, along with significantly lower total costs during the last year of life. PMID:25387186

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,…

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

Code of Federal Regulations, 2010 CFR

2010-10-01

... direct patient care. (c) Standard: Physical environment. The hospice must maintain a safe physical environment free of hazards for patients, staff, and visitors. (1) Safety management. (i) The hospice must...: Organizational Environment § 418.110 Condition of participation: Hospices that provide inpatient care directly. A...

75 FR 67905 - National Hospice Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-04

... National Hospice Month, 2010 By the President of the United States of America A Proclamation During National Hospice Month, we recognize the dignity hospice care can provide to patients who need it most, and... their lives, in spite of a terminal illness. During this month, let us recognize those who allow the...

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

PubMed Central

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

2016-01-01

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

"I'm not trying to be cured, so there's not much he can do for me": hospice patients' constructions of hospice's holistic care approach in a biomedical culture.

PubMed

Pederson, Sarah Nebel; Emmers-Sommer, Tara M

2012-01-01

The hospice philosophy was founded on a mission to provide comprehensive and holistic services to individuals at the end of life. Hospice interdisciplinary teams work together to offer therapies such as spiritual services, comfort care, and massage therapy to meet patients' physical, psychological, emotional, and spiritual needs. Although the hospice philosophy is guided toward patient-centered care, limited research has examined how patients understand holistic care services. Through a social constructionist lens and qualitative interviews, we examined hospice patients' understandings of holistic care and argue that these perceptions of care are constructed through the biomedical model of medicine.

Effects of a new medical insurance payment system for hospice patients in palliative care programs in Korea.

PubMed

Lee, Youngin; Lee, Seung Hun; Kim, Yun Jin; Lee, Sang Yeoup; Lee, Jeong Gyu; Jeong, Dong Wook; Yi, Yu Hyeon; Tak, Young Jin; Hwang, Hye Rim; Gwon, Mieun

2018-03-07

This study investigates the effects of a new medical insurance payment system for hospice patients in palliative care programs and analyzes length of survival (LoS) determinants. At the Pusan National University Hospital hospice center, between January 2015 and April 2016, 276 patients were hospitalized with several diagnosed types of terminal stage cancer. This study separated patients into two groups, "old" and "new," by admission date, considering the new system has been applied from July 15, 2015. The study subsequently compared LoS, total cost, and out-of-pocket expenses for the two groups. Overall, 142 patients applied to the new medical insurance payment system group, while the old medical insurance payment system included 134 patients. The results do not show a significantly negative difference in LoS for the new system group (p = 0.054). Total cost is higher within the new group (p <  0.001); however, the new system registers lower patient out-of-pocket expenses (p <  0.001). The novelty of this study is proving that the new medical insurance payment system is not inferior to the classic one in terms of LoS. The total cost of the new system increased due to a multidisciplinary approach toward palliative care. However, out-of-pocket expenses for patients overall decreased, easing their financial burden.

Jobs Taken by Mothers Moving from Welfare to Work and the Effects of Minimum Wages on This Transition.

ERIC Educational Resources Information Center

Brandon, Peter D.

The potential effects of raising the minimum wage on the earnings of mothers moving from welfare to work were examined by analyzing the differences that existed in the late 1980s in the various states' minimum wage rates and data from three waves of the Survey of Income and Program Participation for the years 1985-1990 (during which time 13 states…

"Keep All Thee 'Til the End": Reclaiming the Lifeworld for Patients in the Hospice Setting.

PubMed

West, Emily; Onwuteaka-Philipsen, Bregje; Philipsen, Hans; Higginson, Irene J; Pasman, H R W

2017-01-01

St Christopher's Hospice, London, was founded to provide specialist care to the incurably ill. We studied the dimensions of difference that set St Christopher's Hospice apart from hospital care of the dying, focusing on physical space and social organization. Material from 1953 to 1980 from the Cicely Saunders Archive was analyzed qualitatively. Through thematic analysis, quotes were found and analyzed using open coding. Five themes were developed. Themes identified were home/homelike, community, consideration of others, link with outside world, and privacy. The hospice philosophy functioned as the catalyst for the development of the physical environment of St Christopher's Hospice. Taking Habermas' concept of lifeworld, it seems that, in contrast to acute care, the need for hospice to formulate their own lifeworld to support and fully engage patients was central. As lifeworlds are culture sensitive, this underlines the need for variation in design and organization of hospices around the world.

76 FR 9502 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-18

... [CMS-1510-F2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home Health Agencies and Hospices; Correction... set forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: The...

78 FR 38594 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-27

..., and in view of the slight differences between these rules, we requested public comment on whether the...: This final rule will revise the requirements that an institution will have to meet in order to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or as a nursing facility...

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…

Children with intellectual disability and hospice utilization

PubMed Central

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

2016-01-01

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. PMID:28260997

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.

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

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

PubMed

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

2012-10-01

The goal of this study was to explore empathic communication opportunities presented by family caregivers and responses from interdisciplinary hospice team members. Empathic opportunities and hospice team responses were analyzed from bi-weekly 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. 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 acknowledgements of caregiver statements and only one-third of the team responses were explicit recognitions of caregiver empathic opportunities. 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. 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. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The experiences of Batswana families regarding hospice care of AIDS patients in the Bophirima district, North West province, South Africa.

PubMed

Makhele, M F; Mulaudzi, F M

2012-01-01

The HIV/AIDS pandemic put significant strain on healthcare services in the country. Hospitals were no longer coping with the escalating number of AIDS patients. This resulted in the early discharge of patients, with some patients, too ill to be nursed at home, being sent to hospices for continued care. The Batswana had mixed feelings about hospice care, because their beliefs on patient care are based on the ubuntu philosophy, which emphasises the principle of caring for one another. The purpose of this study was to explore and describe the experiences of Batswana families regarding hospice care for patients in the Thlabane township in the province of the North West as well as to make recommendations to policy-makers to ensure that hospices are accepted by community members and utilised effectively. A qualitative, explorative, descriptive research design was applied. Purposive sampling was applied to select study participants with whom in-depth unstructured interviews were conducted. A qualitative data analysis was done by categorising, ordering, and summarising the data, and describing the findings. The findings indicated that families of patients in hospice care experienced such care as foreign to their culture. These families also experienced stigmatisation, firstly owing to the stigma associated with AIDS and secondly because they opted for hospice care. However, they also observed the high quality of care provided by the hospice and understood its benefits for AIDS patients. The study concluded that hospice care relieved families of terminally ill AIDS patients of the burden of care and enabled them to keep on working and earning a living. Recommendations to policy-makers included enhancing hospice care and ensuring the provisioning of culturally safe hospice care.

'Where do I go from here'? A cultural perspective on challenges to the use of hospice services.

PubMed

Frey, Rosemary; Gott, Merryn; Raphael, Deborah; Black, Stella; Teleo-Hope, Linda; Lee, Hyeonjoo; Wang, Zonghua

2013-09-01

Do hospice services as shaped by a western perspective adequately fulfil the needs of persons from non-Western cultures? Based on a Western view of palliative care, the vision outlined in the New Zealand Palliative Care Strategy (2001) is to deliver palliative care services, including hospice services, to all patients and their families requiring them in the context of an increasingly pluralistic and multicultural society. It is predicted that over the next two decades the proportion of people identifying as Māori, Pacific and Asian will dramatically increase within New Zealand. Ministry of Health information provided through a GAP analysis identified hospices as facing access-to-care pressures for Māori, Pacific and Asian patients. It is therefore critical to identify the challenges to hospice service access for Māori, Asian and Pacific patients. This project involved qualitative interviews with 37 cancer patients (Māori, Pacific and Asian self-identified ethnicities), whānau/family and bereaved whanua/family, as well as 15 health professionals (e.g. referring GPs, oncologists, allied health professionals) within one District Health Board. Patients and their families included both those who utilised hospice services, as well as those non-users of hospice services identified by a health professional as having palliative care needs. Challenges to hospice service utilisation reported in the findings include a lack of awareness in the communities of available services, as well as continuing misconceptions concerning the nature of hospice services. Language barriers were particularly reported for Asian patients and their families. Issues concerning the ethnic representativeness of the hospice services staff were raised. The findings highlight the importance of patient and family knowledge of hospice care for utilisation of services. This information can be used for future planning to enable hospices to both provide high quality evidence based palliative care services for patients and families and provide consultative services to primary healthcare providers in the community. © 2013 John Wiley & Sons Ltd.

Impact of a Home Hospice Visit Program on Third-Year Medical Students: A qualitative analysis of student reflections.

PubMed

Strano-Paul, Lisa; Lane, Susan; Lu, Wei-Hsin; Chandran, Latha

2015-01-01

This study evaluates the impact of an interprofessional home hospice visit (HHV) on third-year medical students' attitudes toward, and understanding of, end-of-life care and the visit's effect on students' views of their emerging professional roles and identities. All third-year medical students at Stony Brook School of Medicine in Stony Brook, New York, USA, participated in an HHV. A didactic session preceded the HHV. Subsequently, students were required to submit a piece of reflective writing detailing the impact of the visit. We conducted a qualitative analysis of a random sample drawn from the 467 submitted reflections. Six themes emerged from the student reflections: three were related to the students' direct observations during the HHV, and three were related to the reflective learning of the students based on their HHV experience. The qualitative analysis of the reflective writings showed that the students gained a deep appreciation of the human identity of hospice patients and a humanistic understanding of their own role as future physicians.

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…

Proposal for a university-community-hospice partnership to address organizational barriers to cultural competence.

PubMed

Reese, Dona J

2011-02-01

Models of culturally competent hospice services have been developed, but they are not generally being used. This article describes a participatory action research project which is addressing organizational barriers to cultural competence through a university-community-hospice partnership. The intervention plan is to develop a connection with the African American community, increasing community knowledge, and hospice staff cultural competence through a social work student field placement. It is hoped that, if successful, this model will be replicated to address the problem of African American utilization and access to hospice.

Death representation of caregivers in hospice.

PubMed

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

2012-11-01

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

Hospital Wage and Price Controls: Lessons From the Economic Stabilization Program

PubMed Central

Ozminkowski, Ronald J.; Gaumer, Gary; Coit, Anne Jenny; Gabay, Mary

1994-01-01

The Clinton Administration has implied that short-run failures to control health care costs may cause a reexamination of wage and price controls as elements of comprehensive health care reform. The most recent imposition of mandatory wage and price controls was the Economic Stabilization Program (ESP) of the early 1970s. We analyze trends in hospitals' economic behavior and utilization before, during, and after ESP. We also review the relevant literature to estimate ESP's impact, considering other factors that influence hospital behavior. Noting important changes in the hospital industry since the 1970s, we conclude that ESP had limited effect and that similar controls would have little effect today. PMID:10142369

Palliative Care Enrichment in Geropsychology Fellowships.

ERIC Educational Resources Information Center

Strauss, Gerald; Nelson, Barbara J.

1996-01-01

Interviews with 6 of 10 Veterans' Affairs programs offering postdoctoral fellowships in geropsychology indicated that only 30% included palliative care or hospice training, despite the fact that the veteran population is likely to have an increasing need for terminal illness care. (SK)

Supported Employment in Connecticut: An Examination of Integration and Wage Outcomes.

ERIC Educational Resources Information Center

Helms, Barbara L.; And Others

1991-01-01

Study of a sample of 93 individuals with disabilities participating in supported employment programs in Connecticut found that monthly wages and levels of integration increased significantly when compared to working situations prior to supported employment placement. (JDD)

Examining the Role of Primary Care Physicians and Challenges Faced When Their Patients Transition to Home Hospice Care.

PubMed

Shalev, Ariel; Phongtankuel, Veerawat; Lampa, Katherine; Reid, M C; Eiss, Brian M; Bhatia, Sonica; Adelman, Ronald D

2018-04-01

The transition into home hospice care is often a critical time in a patient's medical care. Studies have shown patients and caregivers desire continuity with their physicians at the end of life (EoL). However, it is unclear what roles primary care physicians (PCPs) play and what challenges they face caring for patients transitioning into home hospice care. To understand PCPs' experiences, challenges, and preferences when their patients transition to home hospice care. Nineteen semi-structured phone interviews with PCPs were conducted. Study data were analyzed using standard qualitative methods. Participants included PCPs from 3 academic group practices in New York City. Measured: Physician recordings were transcribed and analyzed using content analysis. Most PCPs noted that there was a discrepancy between their actual role and ideal role when their patients transitioned to home hospice care. Primary care physicians expressed a desire to maintain continuity, provide psychosocial support, and collaborate actively with the hospice team. Better establishment of roles, more frequent communication with the hospice team, and use of technology to communicate with patients were mentioned as possible ways to help PCPs achieve their ideal role caring for their patients receiving home hospice care. Primary care physicians expressed varying degrees of involvement during a patient's transition to home hospice care, but many desired to be more involved in their patient's care. As with patients, physicians desire to maintain continuity with their patients at the EoL and solutions to improve communication between PCPs, hospice providers, and patients need to be explored.

Perspective of patients, patients' families, and healthcare providers towards designing and delivering hospice care services in a middle income Country.

PubMed

Azami-Aghdash, Saber; Ghojazadeh, Morteza; Aghaei, Mir Hossein; Naghavi-Behzad, Mohammad; Asgarlo, Zoleikha

2015-01-01

In view of the recent surge in chronic disease rates and elderly population in the developing countries, there is an urgent felt need for palliative and hospice care services. The present study investigates the views and attitudes of patients and their families, physicians, nurses, healthcare administrators, and insurers regarding designing and delivering hospice care service in a middle income country. In this qualitative study, the required data was collected using semi structured interviews and was analyzed using thematic analysis. Totally 65 participants from hospitals and Tabriz University of Medical Sciences were selected purposively to achieve data saturation. Analyzing the data, five main themes (barriers, facilitators, strategies, attitudes, and service provider) were extracted. Barriers included financial issues, cultural-religious beliefs, patient and family-related obstacles, and barriers related to healthcare system. Facilitators included family-related issues, cultural-religious beliefs, as well as facilitators associated with patients, healthcare status, and benefits of hospice service. Most participants (79%) had positive attitude towards hospice care service. Participant suggested 10 ways to design and deliver effective and efficient hospice care service. They thought the presence of physicians, nurses, and psychologists and other specialists and clergy were necessary in the hospice care team. Due to lack of experience in hospice care in developing countries, research for identifying probable barriers and appropriate management for reducing unsuccessfulness in designing and delivering hospice care service seems necessary. Input from the facilitators and their suggested solutions can be useful in planning the policy for hospice care system.

Access to palliative care and hospice in nursing homes.

PubMed

Zerzan, J; Stearns, S; Hanson, L

2000-11-15

Nursing homes are the site of death for many elderly patients with incurable chronic illness, yet dying nursing home residents have limited access to palliative care and hospice. The probability that a nursing home will be the site of death increased from 18.7% in 1986 to 20.0% by 1993. Dying residents experience high rates of untreated pain and other symptoms. They and their family members are isolated from social and spiritual support. Hospice improves end-of-life care for dying nursing home residents by improving pain control, reducing hospitalization, and reducing use of tube feeding, but it is rarely used. For example, in 1997 only 13% of hospice enrollees were in nursing homes while 87% were in private homes, and 70% of nursing homes had no hospice patients. Hospice use varies by region, and rates of use are associated with nursing home administrators' attitudes toward hospice and contractual obligations. Current health policy discourages use of palliative care and hospice for dying nursing home residents. Quality standards and reimbursement rules provide incentives for restorative care and technologically intensive treatments rather than labor-intensive palliative care. Reimbursement incentives, contractual requirements, and concerns about health care fraud also limit its use. Changes in health policy, quality standards, and reimbursement incentives are essential to improve access to palliative care and hospice for dying nursing home residents. JAMA. 2000;284:2489-2494.

A Promising Tool for Helping Vulnerable Workers? An Exploration of the Use of Employee Assistance Programs (EAPs) to Help Low-Wage Workers on College Campuses

ERIC Educational Resources Information Center

Hahn, Andrew B.

2005-01-01

Employee assistance programs, or EAPs, are an employee benefit designed to help workers meet their work and family needs. However, questions have been raised about the design, utilization, and scale of services that EAPs make possible for low-wage workers. This article explores whether on college campuses an EAP benefit can simultaneously meet the…

Work experience, work environment, and blood exposure among home care and hospice nurses.

PubMed

Leiss, Jack K

2012-01-01

Blood exposure rates among home care and hospice nurses (RNs) in the United States are markedly lower for nurses with more home care/hospice experience, whether or not they have more total years of nursing experience (i.e., in other work environments). This study examined whether the protective effect of home care/hospice experience was greater for nurses who worked under three types of circumstances that are typical of the home care/hospice work environment and conducive to blood exposure. A mail survey was conducted in 2006 among home care/hospice nurses in North Carolina, a largely rural state in the southeastern U.S. The adjusted response rate was 69% (n=833). Blood exposure rates were higher among nurses with ≤5 years' experience in home care/hospice. Contrary to expectations, the protective effect of more experience was greater among nurses who did not have limited access to safety devices/personal protective equipment, did not have to rush during home visits, and did not often visit homes with unrestrained pets, unruly children, poor lighting, or extreme clutter. These results suggest that characteristics of the home care/hospice work environment limit nurses' ability to use their experience to prevent blood exposure.

Promoting volunteer capacity in hospice palliative care: a narrative review.

PubMed

Pesut, Barbara; Hooper, Brenda; Lehbauer, Suzanne; Dalhuisen, Miranda

2014-02-01

Hospice volunteers play an essential role in the primary care network for end of life. The purpose of this review was to examine the evidence on hospice volunteers published between 2002 and July 2012. An electronic search of PubMed, CINAHL and PsychINFO using controlled vocabulary, and a reference scan, yielded 54 studies focusing on hospice volunteers. Studies were primarily descriptive using quantitative, qualitative and mixed methods. Findings from studies were grouped thematically into descriptions of the work of hospice volunteers; recruitment, preparation and retention of hospice volunteers; and perspectives and outcomes of the volunteer role. A substantial body of evidence exists describing the roles, stresses and rewards of hospice volunteering. Less is known about how to adequately recruit, prepare and retain volunteers. A small but intriguing body of evidence exists around volunteers' contributions to family satisfaction and patient longevity. Although the evidence around hospice volunteers continues to grow, there is an urgent need for further research. Findings indicate that volunteers make important contributions to high quality end of life care. However, more focused research attention is required to better understand how to maximize this contribution while providing better support for volunteers.

Caregiving in a patient's place of residence: turnover of direct care workers in home care and hospice agencies.

PubMed

Dill, Janette S; Cagle, John

2010-09-01

High turnover and staff shortages among home care and hospice workers may compromise the quality and availability of in-home care. This study explores turnover rates of direct care workers for home care and hospice agencies. OLS (ordinary least square) regression models are run using organizational data from 93 home care agencies and 29 hospice agencies in North Carolina. Home care agencies have higher total turnover rates than hospice agencies, but profit status may be an important covariate. Higher unemployment rates are associated with lower voluntary turnover. Agencies that do not offer health benefits experience higher involuntary turnover. Differences in turnover between hospice and home health agencies suggest that organizational characteristics of hospice care contribute to lower turnover rates. However, the variation in turnover rates is not fully explained by the proposed multivariate models. Future research should explore individual and structural-level variables that affect voluntary and involuntary turnover in these settings.

Development of a Spanish-Language Hospice Video.

PubMed

Chung, Kyusuk; Augustin, Frankline; Esparza, Salvador

2017-09-01

The nation faces a persistent issue of delayed access to hospice care. Even though hospice enrollment is considered to be one of the most difficult medical decisions, physician clinics and hospitals lack tools for helping patients/families faced with making decisions about enrollment. Health-care literature lacks discussion of development of decision-making aids in the context of hospice decisions for minority ethnic groups, even though those groups have decisional needs that may differ from those of non-Hispanic whites. To fill the gap, we developed a video of a Latino hospice patient with footages showing how the patient was being taken care of by her family with support from a hospice disciplinary team. A primary objective of this article is to describe how focus groups, existing decision aids, and individual interviews were used to develop and improve a Spanish-language hospice educational video targeting Latino subgroups with linguistic, cultural, and educational barriers. These steps may provide guidelines for developing and revising health-related videos targeting other minority ethnic groups.

Negotiating the boundary between paid and unpaid hospice workers: a qualitative study of how hospice volunteers understand their work.

PubMed

Field-Richards, Sarah E; Arthur, Antony

2012-12-01

To explore the nurse-volunteer relationship in a day hospice. Underpinned by an interpretive approach, face-to-face semistructured interviews were conducted with 12 day hospice volunteers. The nature and dynamics of the relationship between nursing staff and volunteers within the day hospice were characterized by increasing formality and changes in the division of labor, which challenged smooth working relationships. Volunteers see their role as becoming increasingly formalized partly as a response to increasing administrative demands on hospice nurses. The willingness of volunteers to take on new roles is variable. For volunteers to feel secure and valued and working relationships to remain strong, the process of how boundaries between paid and unpaid workers are negotiated needs to be transparent.

Changes in inequality and unemployment over the 1980s: comparative cross-national responses.

PubMed

Blank, R M

1995-01-01

The steep recession in the early 1980s was followed by a recovery in nations of the Organization for Economic Cooperation and Development (OECD), but in western European countries unemployment rates remained high. On the other hand, the United States economy after 1983 revived and unemployment dropped rapidly. However, a new problem arose in the late 1980s: rising inequality in the wage rates of more and less skilled workers. The widening wage inequality in the US is proven by the fact that among male high school dropouts real wages fell by 13% between 1979-1989, while among male college graduates real wages rose by 11%. The wage inequality was modest in the Netherlands, no noticeable change occurred in France, Germany, and Italy; there was a modest rise in Canada, Japan, and Sweden; and a large rise in the United Kingdom and US in the 1980s. One hypothesis suggests the growing international competition faced by US firms; another credits the changing demand for more skilled workers driven by the technological shift in computer-intensive industries. The consequences of this wage inequality in the US has been increasing poverty: from 15.6% of households in 1979 to 18.1% in 1986, especially in younger households. In contrast, the respective percentages for Germany were 5.5 in 1979 and 6.8 in 1986. It is likely that both in the US and Europe this rising inequality is caused by international shifts in trade, employment, and technology. Policy responses are utilized by OECD countries: 1) income transfer programs, unemployment benefits, and welfare payments, which have become means-tested because of tight public budgets; 2) public sector job creation programs, with the disadvantage of high cost; 3) job placement and training programs, which are also expensive to operate; 4) wage subsidies, as tried in 1993 in the US by expanding the Earned Income Tax Credit; and 5) hiring subsidies, which encourage the private sector to increase employment.

Personality characteristics of hospice volunteers as measured by Myers-Briggs Type Indicator.

PubMed

Mitchell, C W; Shuff, I M

1995-12-01

A sample of hospice volunteers (n = 99) was administered the Myers-Briggs Type Indicator (Myers & McCaulley, 1985). Frequencies of types observed were compared to population sample (n = 1,105) frequencies. Results indicated that, as a whole, hospice volunteers preferred extraversion over introversion, intuition over sensing, and feeling over thinking. Analysis of four-and two-letter preference combinations also yielded statistically significant differences. Most notably, the sensing-intuitive function appeared pivotal in determining of hospice volunteering. Suggestions are offered as to why the sensing-intuition function appeared central to hospice volunteering. Results appeared consistent with Jungian personality theory.

The evolution of hospice in America: nursing's role in the movement.

PubMed

Hoffmann, Rosemary L

2005-07-01

In the current society, many individuals fear death and the feelings of suffering and loneliness that often accompany death. Two visionaries in the United States, Florence Wald and Dr. Elisabeth Kubler-Ross, recognized these fears and planned the nation's first hospice movement in the 1970s. The hospice philosophy continues to prosper in the new millennium. In this article, the founding American hospice's philosophy, types of facilities, standards, health team composition, patient demographics, organizations, reimbursement, and research are compared and contrasted with those of the current hospice movement. Existing issues with the modern movement are also discussed.

Trends of Do-Not-Resuscitate consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan between 2010 and 2014

PubMed Central

Chang, Hsiao-Ting; Lin, Ming-Hwai; Chen, Chun-Ku; Chou, Pesus; Chen, Tzeng-Ji; Hwang, Shinn-Jang

2016-01-01

Abstract Do-Not-Resuscitate (DNR) and hospice care are not only applied to cancer patients but also to patients with noncancer progressive illness. However, the trends of DNR consent and hospice utilization are not well explored for noncancer patients. This study aimed to explore the trends of DNR consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan. We analyzed the Death and Hospice Palliative Care Database from the Taipei Veterans General Hospital in Taiwan. The Death and Hospice Palliative Care Database contains information including patient sex, major diagnosis, admission date, date of death, age at death, department at discharge, status of DNR consent, and status of hospice care of patients who died in the Taipei Veterans General Hospital. Data on patients aged 20 years old or more who died of major terminal noncancer diseases, including brain diseases, amyotrophic lateral sclerosis, dementia, chronic obstructive pulmonary disease (COPD) and other lung diseases, heart failure, chronic liver diseases and cirrhosis, and renal failure between 2010 and 2014 were extracted for analysis. A total of 1416 patients aged 20 years or more died of major noncancer diseases in Taipei Veterans General Hospital during the study period. The most common diagnosis was brain diseases, amyotrophic lateral sclerosis, and dementias (n = 510, 36%) followed by chronic obstructive pulmonary disease and other lung diseases (n = 322, 22.7%). Among these noncancer decedents, 1045 (73.8%) had DNR consents, while 134 (9.5%) received hospice care. Patients diagnosed with renal failure had the highest percentage of DNR consent (80%), followed by chronic liver diseases and cirrhosis (77.7%). Patients diagnosed with chronic liver diseases and cirrhosis had the highest percentage of hospice utilization (17.4%), followed by renal failure (15.8%). The percentages of DNR consent and hospice utilization were significantly different across different disease diagnosis, hospitalization department, and year of death. There were increased trends of DNR consent in patients with major noncancer diagnoses, and increased hospice care utilization in patients diagnosed with lung diseases and renal failure from 2010 to 2014. However, the hospice care utilization could be improved. Further study to evaluate factors associated hospice care to improve the utilization is suggested. PMID:27861375

Trends of Do-Not-Resuscitate consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan between 2010 and 2014: A Hospital-based observational study.

PubMed

Chang, Hsiao-Ting; Lin, Ming-Hwai; Chen, Chun-Ku; Chou, Pesus; Chen, Tzeng-Ji; Hwang, Shinn-Jang

2016-11-01

Do-Not-Resuscitate (DNR) and hospice care are not only applied to cancer patients but also to patients with noncancer progressive illness. However, the trends of DNR consent and hospice utilization are not well explored for noncancer patients. This study aimed to explore the trends of DNR consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan. We analyzed the Death and Hospice Palliative Care Database from the Taipei Veterans General Hospital in Taiwan. The Death and Hospice Palliative Care Database contains information including patient sex, major diagnosis, admission date, date of death, age at death, department at discharge, status of DNR consent, and status of hospice care of patients who died in the Taipei Veterans General Hospital. Data on patients aged 20 years old or more who died of major terminal noncancer diseases, including brain diseases, amyotrophic lateral sclerosis, dementia, chronic obstructive pulmonary disease (COPD) and other lung diseases, heart failure, chronic liver diseases and cirrhosis, and renal failure between 2010 and 2014 were extracted for analysis. A total of 1416 patients aged 20 years or more died of major noncancer diseases in Taipei Veterans General Hospital during the study period. The most common diagnosis was brain diseases, amyotrophic lateral sclerosis, and dementias (n = 510, 36%) followed by chronic obstructive pulmonary disease and other lung diseases (n = 322, 22.7%). Among these noncancer decedents, 1045 (73.8%) had DNR consents, while 134 (9.5%) received hospice care. Patients diagnosed with renal failure had the highest percentage of DNR consent (80%), followed by chronic liver diseases and cirrhosis (77.7%). Patients diagnosed with chronic liver diseases and cirrhosis had the highest percentage of hospice utilization (17.4%), followed by renal failure (15.8%). The percentages of DNR consent and hospice utilization were significantly different across different disease diagnosis, hospitalization department, and year of death. There were increased trends of DNR consent in patients with major noncancer diagnoses, and increased hospice care utilization in patients diagnosed with lung diseases and renal failure from 2010 to 2014. However, the hospice care utilization could be improved. Further study to evaluate factors associated hospice care to improve the utilization is suggested.

Philosophical and ethical perspectives on cardiovascular disease risk in low-wage workers.

PubMed

Hwang, Won Ju

2011-01-01

One of the overriding goals of Healthy People 2010 is to reduce the health disparities observed among Americans. Because workers in small businesses tend to have little or no access to health screening or preventive health education programs, they may be unaware of their unique risk factors and are thus more at risk of cardiovascular disease (CVD). Furthermore, occupational health nurses are more likely to be available in health programs to employees in large rather than small businesses. The purpose of this paper is to illustrate how nursing values and philosophy might influence public health nurses' thinking about nursing science and ethical issues relating to the risk of CVD among low-wage workers. The following questions will guide the exploration of health disparities among low-wage workers: (a) What are the health disparities observed among low-wage workers with CVD risk? (b) What are the philosophical and ethical perspectives on the issues presented? (c) Based on these findings, how should limited resources be allocated? and (d) How does this affect nursing? These approaches will provide the foundation for developing a culturally sensitive ethical and philosophical perspective to prevent CVD and promote cardiovascular health among low-wage workers. © 2011 Wiley Periodicals, Inc.

The health impact of health care on families: a matched cohort study of hospice use by decedents and mortality outcomes in surviving, widowed spouses.

PubMed

Christakis, Nicholas A; Iwashyna, Theodore J

2003-08-01

Alternative ways of caring for seriously ill patients might have implications not only for patients' own outcomes, but also, indirectly, for the health outcomes of their family members. Clinical observation suggests that patients who die "good deaths" may impose less stress on their spouses. Consequently, we sought to assess whether hospice use by a decedent is associated with decreased risk of death in surviving, bereaved spouses. We conducted a matched retrospective cohort study involving a population-based sample of 195,553 elderly couples in the USA. A total of 30,838 couples where the decedent used hospice care were matched using the propensity score method to 30,838 couples where the decedent did not use hospice care. Our principal outcome of interest was the duration of survival of bereaved widow/ers. After adjustment for other measured variables, 5.4% of bereaved wives died by 18 months after the death of their husband when their deceased husband did not use hospice and 4.9% died when their deceased husband did use hospice, yielding an odds ratio (OR) of 0.92 (95% CI: 0.84-0.99) in favor of hospice use. Similarly, whereas 13.7% of bereaved husbands died by 18 months when their deceased wife did not use hospice, 13.2% died when their deceased wife did use hospice, yielding an OR of 0.95 (95% CI: 0.84-1.06) in favor of hospice use. Our findings suggest a possible beneficial impact of hospice--as a particularly supportive type of end-of-life care--on the spouses of patients who succumb to their disease. Hospice care might attenuate the ordinarily increased mortality associated with becoming widowed. This effect is present in both men and women, but it is statistically significant and possibly larger in bereaved wives. The size of this effect is comparable to the reductions in the risk of death seen in a variety of other modifiable risk factors in women. Health care may have positive, group-level health "externalities": it may affect the health not only of patients but also of patients' family members.

42 CFR 418.114 - Condition of participation: Personnel qualifications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Condition of participation: Personnel qualifications. 418.114 Section 418.114 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of participation...

42 CFR 418.114 - Condition of participation: Personnel qualifications.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Condition of participation: Personnel qualifications. 418.114 Section 418.114 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of...

42 CFR 418.114 - Condition of participation: Personnel qualifications.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Condition of participation: Personnel qualifications. 418.114 Section 418.114 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of...

42 CFR 418.114 - Condition of participation: Personnel qualifications.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Condition of participation: Personnel qualifications. 418.114 Section 418.114 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of...

A Nationwide Survey of Quality of End-of-Life Cancer Care in Designated Cancer Centers, Inpatient Palliative Care Units, and Home Hospices in Japan: The J-HOPE Study.

PubMed

Miyashita, Mitsunori; Morita, Tatsuya; Sato, Kazuki; Tsuneto, Satoru; Shima, Yasuo

2015-07-01

End-of-life (EOL) cancer care in general hospitals and home care has not previously been evaluated in Japan. This study aimed to evaluate EOL cancer care from the perspective of bereaved family members in nationwide designated cancer centers, inpatient palliative care units (PCUs), and home hospices in Japan. We conducted a cross-sectional, anonymous, self-report questionnaire survey for bereaved family members of cancer patients in March 2008 for 56 designated cancer centers and in June 2007 for 100 PCUs and 14 home hospices. Outcomes were overall care satisfaction, structure and process of care (Care Evaluation Scale), and achievement of a good death (Good Death Inventory). In designated cancer centers, PCUs, and home hospices, 2794 (response rate 59%), 5312 (response rate 69%), and 292 (response rate 67%) bereaved family members participated, respectively. Mean scores for overall care satisfaction were high for all places of death, at 4.3 ± 1.2 for designated cancer centers, 5.0 ± 1.2 for PCUs, and 5.0 ± 1.0 for home hospices. Designated cancer centers showed significantly lower ratings than PCUs and home hospices for structure and process of care and achievement of a good death (P = 0.0001 each). Home hospices were rated significantly higher than PCUs for achievement of a good death (P = 0.0001). The main findings of this study were: (1) overall, bereaved family members were satisfied with end-of-life care in all three places of death; (2) designated cancer centers were inferior to PCUs and home hospices and had more room for improvement; and 3) home hospices were rated higher than PCUs for achieving a good death, although home hospices remain uncommon in Japan. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

The effects of hospice-shared care for gastric cancer patients.

PubMed

Huang, Kun-Siang; Wang, Shih-Ho; Chuah, Seng-Kee; Rau, Kun-Ming; Lin, Yu-Hung; Hsieh, Meng-Che; Shih, Li-Hsueh; Chen, Yen-Hao

2017-01-01

Hospice care has been proved to result in changes to the medical behaviors of terminally ill patients. The aim of this study was to evaluate the effects and medical behavior changes of hospice-shared care intervention among terminally ill gastric cancer patients. A total of 174 patients who died of gastric cancer between 2012 and 2014 were identified. These patients were divided into two groups: a hospice-shared care group (n = 93) and a control group (n = 81). Among the 174 patients, 84% had advanced stage (stage III or stage IV) cancer. The females and the patients cared by medical oncologists had a higher percentage of hospice-shared care than the males (71% vs 44%, p = 0.001) and those cared by other physicians (63% vs 41%, p = 0.004). Compared to the control group, the hospice-shared care group underwent lower incidence of life sustaining or aggressive medical treatments, including intensive care unit admission (2% vs 26%, p<0.001), intubation (1% vs 27%, p<0.001), cardiopulmonary-cerebral resuscitation (0% vs 11%, p = 0.001), ventilator use (1% vs 27%, p<0.001), inotropic agent use (8% vs 46%, p<0.001), total or partial parenteral nutrition use (38% vs. 58%, p = 0.029), and blood transfusion (45% vs 74%, p<0.001). Besides, the hospice-shared care group had a higher percentage of palliative treatments than the control group, including signed Do-Not-Resuscitate (DNR) orders (95% vs 37%, p<0.001), receiving home hospice care (16% vs 1%, p<0.001), and indicating home as the realistically preferred place of death (41% vs 19%, p = 0.001). The hospice ward admission rate in the hospice-shared care group increased from 30% to 53% from 2012 to 2014. The use of hospice-shared care for gastric cancer patients could increase the rate of signed DNR orders, decrease the use of life sustaining and aggressive/palliative treatments, and improve quality of life.

Low-wage workers and health insurance coverage: can policymakers target them through their employers?

PubMed

Long, S H; Marquis, M S

2001-01-01

Many policy initiatives to increase health insurance coverage would subsidize employers to offer coverage or subsidize employees to participate in their employers' health plans. Using data from the 1997 Robert Wood Johnson Foundation Employer Health Insurance Survey, we contrast "low-wage employers" with all other employers. Employees in low-wage businesses have significantly worse access to employment-based insurance than other employees do; they are less likely to work for an employer that offers insurance, less likely to be eligible if working in a business that offers insurance, and less likely to be enrolled if eligible. Low-wage employers contribute lower shares of premiums and offer less generous benefits than other employers do. Policies that would target subsidies to selected employers to increase insurance offers to low-wage workers are difficult to design, however, because several commonly mentioned employer characteristics (including firm size) are found to be poor indicators of low-wage worker concentration. Programs that would set minimum standards for employer plans to be eligible for "buy-ins" need to base these standards on the less generous terms offered by low-wage employers in order to effectively reach low-wage workers and their dependents.

42 CFR 418.24 - Election of hospice care.

Code of Federal Regulations, 2013 CFR

2013-10-01

... curative nature of hospice care, as it relates to the individual's terminal illness. (3) Acknowledgement... hospice). (2) Any Medicare services that are related to the treatment of the terminal condition for which...

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... designated hospice). (2) Any Medicare services that are related to the treatment of the terminal condition...

42 CFR 418.24 - Election of hospice care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... curative nature of hospice care, as it relates to the individual's terminal illness. (3) Acknowledgement... hospice). (2) Any Medicare services that are related to the treatment of the terminal condition for which...

42 CFR 418.24 - Election of hospice care.

Code of Federal Regulations, 2012 CFR

2012-10-01

... curative nature of hospice care, as it relates to the individual's terminal illness. (3) Acknowledgement... hospice). (2) Any Medicare services that are related to the treatment of the terminal condition for which...

Stress in hospice at home nurses: a qualitative study of their experiences of their work and wellbeing.

PubMed

Tunnah, Karen; Jones, Angela; Johnstone, Rosalynde

2012-06-01

The literature has evaluated studies of hospice nurses and stress but very few studies have focused on community hospice nurses. This study explored hospice at home nurses' experiences of caring for palliative and dying patients. Hospice at home nurses working in the community across North West Wales were interviewed and a grounded theory approach was used to categorise the data into the following themes: job satisfaction, stressors, coping strategies, and support. Recommendations arising from the study include encouraging the use of clinical supervision, attendance at multidisciplinary meetings, and the provision of stress-awareness training, and raising awareness of the role of hospice at home nurses in primary care. Implementation of these recommendations might be beneficial for staff wellbeing. Further work would identify whether such recommendations can help to prevent sickness and promote staff retention.

The impact of the first gay AIDS patient on hospice staff.

PubMed

Geis, S; Fuller, R L

1985-01-01

AIDS, a recently discovered, contagious, potentially fatal disease has created alarm in some segments of our society. Policy makers in hospices and all facilities that care for dying patients can benefit from the experience of others who have already cared for AIDS patients. This article is a report about the experiences of care givers in hospice settings that have received only a few AIDS patients, all of whom were young, gay males. The psychosocial impact of AIDS patient care on hospice staff is one of the issues that must be addressed if the experience is going to be a positive one for both the hospice and the patient/patient family. Three suggestions are made about hospice procedures that may decrease problems: successful acknowledgement of institutional and personal fear and anxiety; adequate inservice training; development of strong support networks.

Nutrition Intervention through Interdisciplinary Medical Treatment in Hospice Patients: From Admission to Death.

PubMed

Kang, Hyelim; Yang, Yu Jin; Park, Juyeon; Heo, Gyu Jin; Hong, Jeong-Im; Kim, Hye-Jin

2018-04-01

The demand for hospice services as well as for 'well-dying' of terminal patients is increasing as patient financial burden is decreasing due to National Health Insurance coverage for hospice care. Hospice institutions utilize interdisciplinary teams comprising doctors, nurses, dietitians, and other health staffs to provide comprehensive patient management. This report examined the nutritional status of a hospice patient from admission to death as well as the nutrition management of this patient in the hospice ward through nutrition interventions performed by a dietitian in the interdisciplinary team. The patient in the present case was a 74-year-old man diagnosed with pancreatic head cancer who died after 26 days of hospice care following transfer from the general ward. During hospice care, the dietitian monitored the patient's nutritional status and performed 8 nutrition interventions, but his oral intake decreased as the patient's symptoms worsened. The average energy intake rates were 30% and 17% of required rates for oral and artificial nutrition, respectively. In line with a report suggesting that the main focus of nutrition in palliative care should be on improving the quality of life and reducing worry in patients, rather than aggressive nutritional management, there is a need for nutrition interventions that are personalized to individual patients by monitoring progress and offering continuous counseling from the time of admission. In addition, further studies such as comparative analysis of nutritional management in Korean hospice ward will be needed for better nutrition management for terminally ill patients.

Implementation of a salaried compensation program for registered nurses.

PubMed

Sills, L R

1993-01-01

Compensation is a key variable in recruitment and retention of registered nurses. A 6-month trial of an exempt/salaried wage program for registered nurses, based on normative change theory, was implemented in the adult critical care division of a 491-bed community hospital. A total of 58 registered nurses participated in the trial. At the end of 6 months on salary, 94% (53) of the nurses voted to remain salaried. The staff perceived that the new wage program increased flexibility in work schedules and promoted teamwork and professional autonomy.

48 CFR 622.404 - Davis-Bacon Act wage determinations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Davis-Bacon Act wage determinations. 622.404 Section 622.404 Federal Acquisition Regulations System DEPARTMENT OF STATE SOCIOECONOMIC PROGRAMS APPLICATION OF LABOR LAWS TO GOVERNMENT ACQUISITIONS Labor Standards for Contracts Involving...

48 CFR 422.404 - Davis-Bacon Act wage determinations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Davis-Bacon Act wage determinations. 422.404 Section 422.404 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE SOCIOECONOMIC PROGRAMS APPLICATION OF LABOR LAWS TO GOVERNMENT ACQUISITIONS Labor Standards for Contracts...

34 CFR 361.84 - Performance indicators.

Code of Federal Regulations, 2012 CFR

2012-07-01

... competitive, self-, or BEP employment with earnings equivalent to at least the minimum wage. (iv) Performance... earnings equivalent to at least the minimum wage, the percentage who are individuals with significant... program in competitive, self-, or BEP employment with earnings levels equivalent to at least the minimum...

34 CFR 361.84 - Performance indicators.

Code of Federal Regulations, 2014 CFR

2014-07-01

... competitive, self-, or BEP employment with earnings equivalent to at least the minimum wage. (iv) Performance... earnings equivalent to at least the minimum wage, the percentage who are individuals with significant... program in competitive, self-, or BEP employment with earnings levels equivalent to at least the minimum...

34 CFR 361.84 - Performance indicators.

Code of Federal Regulations, 2013 CFR

2013-07-01

... competitive, self-, or BEP employment with earnings equivalent to at least the minimum wage. (iv) Performance... earnings equivalent to at least the minimum wage, the percentage who are individuals with significant... program in competitive, self-, or BEP employment with earnings levels equivalent to at least the minimum...

34 CFR 361.84 - Performance indicators.

Code of Federal Regulations, 2011 CFR

2011-07-01

... competitive, self-, or BEP employment with earnings equivalent to at least the minimum wage. (iv) Performance... earnings equivalent to at least the minimum wage, the percentage who are individuals with significant... program in competitive, self-, or BEP employment with earnings levels equivalent to at least the minimum...

34 CFR 361.84 - Performance indicators.

Code of Federal Regulations, 2010 CFR

2010-07-01

... competitive, self-, or BEP employment with earnings equivalent to at least the minimum wage. (iv) Performance... earnings equivalent to at least the minimum wage, the percentage who are individuals with significant... program in competitive, self-, or BEP employment with earnings levels equivalent to at least the minimum...

WAGE INCENTIVES FOR SOLID WASTE COLLECTION PERSONNEL

EPA Science Inventory

An assessment was made of a time and wage incentive program for solid waste collection and supervisory personnel in the test city, Covington, Kentucky. On an annualized basis, cost savings amounting to $113,000 (19 percent of budget) resulted from implementation of the new progra...

78 FR 32460 - Comment Request for Information Collection for ETA Form 232, Domestic Agricultural In-Season Wage...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-30

...The Department of Labor (Department), as part of its continuing effort to reduce paperwork and respondent burden, conducts a preclearance consultation program to provide the public and Federal agencies with an opportunity to comment on proposed and/or continuing collections of information in accordance with the Paperwork Reduction Act of 1995 [44 U.S.C. 3506(c)(2)(A)]. This program helps ensure that requested data can be provided in the desired format, reporting burden (time and financial resources) is minimized, collection instruments are clearly understood, and the impact of collection requirements on respondents can be properly assessed. Currently, ETA is soliciting comments concerning the collection of data about ETA Form 232, Domestic Agricultural In-Season Wage Report and ETA Form 232-A, Wage Survey Interview Record, OMB Control No. 1205- 0017, both of which expire July 31, 2013. These forms are used by the State Workforce Agencies to collect wage information from agricultural employers.

"I'm Not Trying to Be Cured, so There's Not Much He Can Do for Me": Hospice Patients' Constructions of Hospice's Holistic Care Approach in a Biomedical Culture

ERIC Educational Resources Information Center

Nebel Pederson, Sarah; Emmers-Sommer, Tara M.

2012-01-01

The hospice philosophy was founded on a mission to provide comprehensive and holistic services to individuals at the end of life. Hospice interdisciplinary teams work together to offer therapies such as spiritual services, comfort care, and massage therapy to meet patients' physical, psychological, emotional, and spiritual needs. Although the…

Seizing the Opportunity: Exploring Barriers to Use of Transmucosal Midazolam in Hospice Patients.

PubMed

Perna, Samuel J; Rhinewalt, James M; Currie, Erin R

2018-05-01

Status epilepticus seizures are distressing events for hospice and palliative care patients. Currently, rectal diazepam is the only abortive therapy approved by the U.S. Food and Drug Administration for seizures occurring out of hospital. However, transmucosal (buccal and intranasal) midazolam hydrochloride is a less expensive, equally effective, and a more socially acceptable alternative. To explore the use of transmucosal midazolam in out-of-hospital hospice patients in the State of Alabama. A cross-sectional survey was used explore hospice providers' knowledge and use of transmucosal midazolam in clinical practice within Alabama. Setting Subjects: Hospice providers (physicians, nurses, and administrators) in the State of Alabama (n = 27). An electronic survey was used to elicit transmucosal midazolam use among hospice providers. Transmucosal midazolam has been documented throughout the literature and reported by expert clinicians as an efficacious, safe, and appropriate pharmaceutical intervention for the abortive treatment of seizures in adult and pediatric out-of-hospital patients. However, barriers to the use of transmucosal midazolam with hospice patients included unfamiliarity with transmucosal route and lack of provider orders. None of the participants reported transmucosal midazolam use in out-of-hospital hospice settings. Evidence in the literature supports the use of transmucosal midazolam; however, further research is necessary to understand and address barriers in a more diverse and generalizable population.

Rapid EHR development and implementation using web and cloud-based architecture in a large home health and hospice organization.

PubMed

Weaver, Charlotte A; Teenier, Pamela

2014-01-01

Health care organizations have long been limited to a small number of major vendors in their selection of an electronic health record (EHR) system in the national and international marketplace. These major EHR vendors have in common base systems that are decades old, are built in antiquated programming languages, use outdated server architecture, and are based on inflexible data models [1,2]. The option to upgrade their technology to keep pace with the power of new web-based architecture, programming tools and cloud servers is not easily undertaken due to large client bases, development costs and risk [3]. This paper presents the decade-long efforts of a large national provider of home health and hospice care to select an EHR product, failing that to build their own and failing that initiative to go back into the market in 2012. The decade time delay had allowed new technologies and more nimble vendors to enter the market. Partnering with a new start-up company doing web and cloud based architecture for the home health and hospice market, made it possible to build, test and implement an operational and point of care system in 264 home health locations across 40 states and three time zones in the United States. This option of "starting over" with the new web and cloud technologies may be posing a next generation of new EHR vendors that retells the Blackberry replacement by iPhone story in healthcare.

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

Longer Hospice Stays Associated With Decreased End-Of-Life Spending For Patients In Regions With High Expenditures

PubMed Central

Wang, Shi-Yi; Hsu, Sylvia H.; Huang, Siwan; Soulos, Pamela R.; Gross, Cary P.

2018-01-01

Hospice is expected to decrease end-of-life care expenditures yet evidence for its financial impact remains inconclusive. One potential explanation is that hospice enrollment may produce differential cost saving effects by region, due to geographic variation in end-of-life care spending patterns. Accordingly, we examined 103,745 elderly Medicare fee-for-service beneficiaries in the Surveillance, Epidemiology, and End Results-Medicare database who died from cancer in 2004–2011. We created quintiles by the mean end-of-life expenditure per hospital referral region (HRR), and examined HRR-level variation in the associations between length of hospice enrollment and expenditures among quintiles. Results showed that longer hospice stays were associated with decreased end-of-life expenditures for patients residing in regions of high average expenditures, but not for those in regions with low average expenditures. Hospice use accounted for 8.0% of the expenditure variation between the highest and lowest quintile areas, demonstrating the powers and limitations of hospice use for cost saving. PMID:28167723

Variation in geographic access to specialist inpatient hospices in England and Wales.

PubMed

Gatrell, Anthony C; Wood, D Justin

2012-07-01

We seek to map and describe variation in geographic access to the set of 189 specialist adult inpatient hospices in England and Wales. Using almost 35,000 small Census areas (Local Super Output Areas: LSOAs) as our units of analysis, the locations of hospices, and estimated drive times from LSOAs to hospices we construct an accessibility 'score' for each LSOA, for England and Wales as a whole. Data on cancer mortality are used as a proxy for the 'demand' for hospice care and we then identify that subset of small areas in which accessibility (service supply) is relatively poor yet the potential 'demand' for hospice services is above average. That subset is then filtered according to the deprivation score for each LSOA, in order to identify those LSOAs which are also above average in terms of deprivation. While urban areas are relatively well served, large parts of England and Wales have poor access to hospices, and there is a risk that the needs of those living in relatively deprived areas may be unmet. Copyright © 2012 Elsevier Ltd. All rights reserved.

42 CFR 418.104 - Condition of participation: Clinical records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Condition of participation: Clinical records. 418.104 Section 418.104 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of participation: Organizational...

42 CFR 418.104 - Condition of participation: Clinical records.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Condition of participation: Clinical records. 418.104 Section 418.104 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of participation: Organizational...

42 CFR 418.102 - Condition of participation: Medical director.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Condition of participation: Medical director. 418.102 Section 418.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of participation: Organizational...

42 CFR 418.102 - Condition of participation: Medical director.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Condition of participation: Medical director. 418.102 Section 418.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of participation: Organizational...

42 CFR 418.78 - Conditions of participation-Volunteers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Conditions of participation-Volunteers. 418.78 Section 418.78 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of Participation: Patient Care Non-Core...

Evaluating an end-of-life curriculum in a medical residency program.

PubMed

Yacht, Andrew C; Suglia, Shakira Franco; Orlander, Jay D

The ability to meet patient needs at the end of life is important. Boston University Residency Program in Medicine initiated a 1-week-long end-of-life curriculum that included a hospice care orientation, core articles, and home hospice visits. Evaluated was the impact of the rotation on participant knowledge and attitude. Knowledge was assessed by pretest and posttest questionnaires and compared with more senior resident controls, naïve to the curriculum. Attitudes toward issues relating to end-of-life care and subjective change in knowledge were assessed comparing subjects' retrospective preintervention and postintervention responses included in the postintervention questionnaire. Forty-five second-year participants completed both questionnaires. Participants demonstrated significant improvements in attitude and self-assessed knowledge of end-of-life care in 23 of 24 Likert-type scale questions. The end-of-life curriculum led to significant improvements in participant knowledge and attitudes about the conceptual and practical aspects of end-of-life care. The structure of the rotation should be reproducible in many locales.

5 CFR 532.265 - Special wage schedules for apprentices and shop trainees.

Code of Federal Regulations, 2012 CFR

2012-01-01

... and shop trainees. 532.265 Section 532.265 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... schedules for apprentices and shop trainees. (a) Agencies may establish special wage schedules for apprentices and shop trainees who are included in: (1) Formal apprenticeship programs involving training for...

5 CFR 532.265 - Special wage schedules for apprentices and shop trainees.

Code of Federal Regulations, 2013 CFR

2013-01-01

... and shop trainees. 532.265 Section 532.265 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... schedules for apprentices and shop trainees. (a) Agencies may establish special wage schedules for apprentices and shop trainees who are included in: (1) Formal apprenticeship programs involving training for...

5 CFR 532.265 - Special wage schedules for apprentices and shop trainees.

Code of Federal Regulations, 2014 CFR

2014-01-01

... and shop trainees. 532.265 Section 532.265 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... schedules for apprentices and shop trainees. (a) Agencies may establish special wage schedules for apprentices and shop trainees who are included in: (1) Formal apprenticeship programs involving training for...

5 CFR 532.265 - Special wage schedules for apprentices and shop trainees.

Code of Federal Regulations, 2011 CFR

2011-01-01

... and shop trainees. 532.265 Section 532.265 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... schedules for apprentices and shop trainees. (a) Agencies may establish special wage schedules for apprentices and shop trainees who are included in: (1) Formal apprenticeship programs involving training for...

5 CFR 532.265 - Special wage schedules for apprentices and shop trainees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... and shop trainees. 532.265 Section 532.265 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... schedules for apprentices and shop trainees. (a) Agencies may establish special wage schedules for apprentices and shop trainees who are included in: (1) Formal apprenticeship programs involving training for...

48 CFR 622.404-7 - Correction of wage determinations containing clerical errors.

Code of Federal Regulations, 2010 CFR

2010-10-01

... DEPARTMENT OF STATE SOCIOECONOMIC PROGRAMS APPLICATION OF LABOR LAWS TO GOVERNMENT ACQUISITIONS Labor Standards for Contracts Involving Construction 622.404-7 Correction of wage determinations containing clerical errors. The cognizant contracting activity is the contracting agency for the purposes of FAR 22...

Exploring the relationship between volunteering and hospice sustainability in the UK: a theoretical model.

PubMed

Scott, Ros; Jindal-Snape, Divya; Manwaring, Gaye

2018-05-02

To explore the relationship between volunteering and the sustainability of UK voluntary hospices. A narrative literature review was conducted to inform the development of a theoretical model. Eight databases were searched: CINAHL (EBSCO), British Nursing Index, Intute: Health and Life Sciences, ERIC, SCOPUS, ASSIA (CSA), Cochrane Library and Google Scholar. A total of 90 documents were analysed. Emerging themes included the importance of volunteering to the hospice economy and workforce, the quality of services, and public and community support. Findings suggest that hospice sustainability is dependent on volunteers; however, the supply and retention of volunteers is affected by internal and external factors. A theoretical model was developed to illustrate the relationship between volunteering and hospice sustainability. It demonstrates the factors necessary for hospice sustainability and the reciprocal impact that these factors and volunteering have on each other. The model has a practical application as an assessment framework and strategic planning tool.

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

A team approach to recruitment in hospice research: engaging patients, close people and health professionals.

PubMed

L Campbell, Cathy; Bailey, Cara; Armour, Kathy; Perry, Rachel; Orlando, Rosanna; Kinghorn, Philip; Jones, Louise; Coast, Joanna

2016-07-02

Research is vital to the future development of hospice care. However, research in hospice settings is very challenging. This paper describes a case study of a successful multidisciplinary research team approach (MDRT) to the recruitment of participants (hospice patients, family members and health professionals) for a study in a hospice setting on the economic evaluation of end-of-life care. A successful recruitment plan includes three key strategies: identifying key members of the MDRT early in the research process; having a clear and constant communication stream; and creating an environment where all team members have a shared commitment to the research, all voices are heard and valued, and everyone contributes to the research aims. An MDRT approach will be helpful to guide the development of successful recruitment plans for academic-community research partnerships in the hospice setting.

The Terrible Choice: Re-Evaluating Hospice Eligibility Criteria for Cancer

PubMed Central

Casarett, David J.; Fishman, Jessica M.; Lu, Hien L.; O'Dwyer, Peter J.; Barg, Frances K.; Naylor, Mary D.; Asch, David A.

2009-01-01

Purpose To be eligible for the Medicare Hospice Benefit, cancer patients with a life expectancy of 6 months or less must give up curative treatment. Our goal was to determine whether willingness to make this choice identifies patients with greater need for hospice services. Patients and Methods Three hundred patients with cancer and 171 family members were recruited from six oncology practices. Respondents completed conjoint interviews in which their perceived need for five hospice services was calculated from the choices they made among combinations of services. Patients' preferences for treatment were measured, and patients were followed for 6 months or until death. Results Thirty-eight patients (13%) said they would not want cancer treatment even if it offered an almost 100% chance of 6-month survival. These patients, who would have been eligible for hospice, did not have greater perceived need for hospice services compared with other patients (n = 262; mean, 1.75 v 1.98; Wilcoxon rank sum test, P = .46), nor did their family members (mean, 1.95 v 2.04; Wilcoxon rank sum test, P = .80). Instead, independent predictors of patients' perceived need for hospice services included African American ethnicity, less social support, worse functional status, and a greater burden of psychological symptoms. For families, predictors included caregiver burden, worse self-reported health, working outside the home, and caring for a patient with worse functional status. Conclusion The requirement that patients forgo life-sustaining treatment does not identify patients with greater perceived need for hospice services. Other characteristics offer a better way to identify the patients who are most likely to benefit from hospice. PMID:19114698

Long and short hospice stays among nursing home residents at the end of life.

PubMed

Huskamp, Haiden A; Stevenson, David G; Grabowski, David C; Brennan, Eric; Keating, Nancy L

2010-08-01

To identify characteristics of nursing homes and residents associated with particularly long or short hospice stays. Observational study using administrative data on resident characteristics and hospice utilization from a large regional hospice linked with publicly available data on nursing home characteristics. A total of 13,479 residents who enrolled in hospice during 2001-2008. Logistic regression models of the probability of a long (>180 days) or very short (

Association of hospice utilization and publicly reported outcomes following hospitalization for pneumonia or heart failure: a retrospective cohort study.

PubMed

Lah, Soowhan; Wilson, Emily L; Beesley, Sarah; Sagy, Iftach; Orme, James; Novack, Victor; Brown, Samuel M

2018-01-09

The Center for Medicare and Medicaid Services (CMS) and the Hospital Quality Alliance began collecting and reporting United States hospital performance in the treatment of pneumonia and heart failure in 2008. Whether the utilization of hospice might affect CMS-reported mortality and readmission rates is not known. Hospice utilization (mean days on hospice per decedent) for 2012 from the Dartmouth Atlas (a project of the Dartmouth Institute that reports a variety of public health and policy-related statistics) was merged with hospital-level 30-day mortality and readmission rates for pneumonia and heart failure from CMS. The association between hospice use and outcomes was analyzed with multivariate quantile regression controlling for quality of care metrics, acute care bed availability, regional variability and other measures. 2196 hospitals reported data to both CMS and the Dartmouth Atlas in 2012. Higher rates of hospice utilization were associated with lower rates of 30-day mortality and readmission for pneumonia but not for heart failure. Higher quality of care was associated with lower rates of mortality for both pneumonia and heart failure. Greater acute care bed availability was associated with increased readmission rates for both conditions (p < 0.05 for all). Higher rates of hospice utilization were associated with lower rates of 30-day mortality and readmission for pneumonia as reported by CMS. While causality is not established, it is possible that hospice referrals might directly affect CMS outcome metrics. Further clarification of the relationship between hospice referral patterns and publicly reported CMS outcomes appears warranted.

Race, treatment preferences, and hospice enrollment. Eligibility criteria may exclude patients with the greatest needs for care

PubMed Central

Fishman, Jessica; O'Dwyer, Peter; Lu, Hien L.; Henderson, Hope; Asch, David A.; Casarett, David J.

2009-01-01

Background The requirement that patients give up curative treatment makes hospice enrollment unappealing for some patients, and may particularly limit use among African American patients. Objectives To determine whether African-American patients with cancer are more likely than white patients are to have preferences for cancer treatment that exclude them from hospice, and whether they are less likely to want specific hospice services. Methods 283 patients receiving treatment for cancer at six oncology clinics within the University of Pennsylvania Cancer Network completed conjoint interviews measuring their perceived need for five hospice services and their preferences for continuing cancer treatment. Patients were followed for six months or until death. Results African American patients had stronger preferences for continuing their cancer treatments on a 7-point scale even after adjusting for age, sex, finances, education, ECOG performance status, quality of life, and physical and psychological symptom burden (adjusted means 4.75 vs. 3.96; β coefficient 0.82; 95% confidence interval 0.22-1.41; p=0.007). African-American patients also had greater perceived needs for hospice services after adjusting for these characteristics (adjusted means 2.31 vs. 1.83) (β coefficient 0.51; 95% confidence interval 0.11-0.92; p=0.01). However, this effect disappeared after adjusting for household finances. Conclusions Hospice eligibility criteria may exclude African-American patients disproportionately despite greater perceived needs for hospice services in this population. The mechanisms driving this health disparity likely include both cultural differences and economic characteristics, and consideration should be given to redesigning hospice eligibility criteria. PMID:19107761

Inpatient Palliative Care Consultation and 30-Day Readmissions in Oncology.

PubMed

DiMartino, Lisa D; Weiner, Bryan J; Hanson, Laura C; Weinberger, Morris; Birken, Sarah A; Reeder-Hayes, Katherine; Trogdon, Justin G

2018-01-01

Prior research indicates that hospice and palliative care delivered in outpatient settings are associated with reduced hospital readmissions for cancer patients. However, little is known about how inpatient palliative care affects readmissions in oncology. To examine associations among inpatient palliative care consultation, hospice use (discharge), and 30-day readmissions among patients with solid tumor cancers. We identified all live discharges from a large tertiary cancer hospital between 2010 and 2016. Palliative care consult data were abstracted from medical charts and linked to hospital encounter data. Propensity scores were used to match palliative care consult to usual care encounters. Modified Poisson regression models estimated adjusted relative risk (aRR) and 95% confidence intervals (CI) of 30-day readmissions and hospice discharge. We compared predicted probabilities of readmission for palliative care consultation with hospice discharge, without hospice discharge, and usual care. Of 8085 eligible encounters, 753 involved a palliative care consult. The likelihood of having a 30-day readmission did not differ between palliative care consult and usual care groups (p > 0.05). However, the palliative care consult group was more likely than usual care to have a hospice discharge (aRR = 4.09, 95% CI: 3.07-5.44). The predicted probability of 30-day readmission was lower when palliative care consultation was combined with hospice discharge compared to usual care or consultation with discharge to nonhospice postacute care (p < 0.001). The effect of inpatient palliative care on readmissions in oncology is largely driven by hospice enrollment. Strategies that combine palliative care consultation with hospice discharge may decrease hospital readmissions and improve cancer care quality.

Helping You Choose Quality Hospice Care

MedlinePlus

Helping you choose: Quality hospice care When you need hospice care, you should find out some information to help you choose the best ... the service follows rules for patient safety and quality. Go to Quality Check ® at www. qualitycheck. org ...

24 CFR 266.225 - Labor standards.

Code of Federal Regulations, 2010 CFR

2010-04-01

... following conditions: (i) Advances for the project are insured under this part; (ii) The project involves... mortgage insurance program to which Davis-Bacon wage rates are made applicable by statute. (d) Advances. (1) No advance under a mortgage on a project subject to Davis-Bacon wage rates under paragraph (a) of...

77 FR 65715 - Agency Information Collection Activities; Submissions for OMB Review; Comment Request; H-2A...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-30

... Prevailing Wage Determination ACTION: Notice. SUMMARY: The Department of Labor (DOL) is submitting four... Certification Program, and Application for Prevailing Wage Determination. DATES: Submit comments on or before... DOL is submitting has been assigned ICR Reference Number 201210-1205-002, Application for Prevailing...

Predicting the Effects of Comparable Worth Programs on Female Labor Supply.

ERIC Educational Resources Information Center

Nakamura, Alice; Nakamura, Masao

1989-01-01

Surveys theories in labor economics about how the female labor supply is affected by the wage offers that women receive. Summarizes the implications concerning expected effects of comparable worth wage adjustments on female labor supply. Examines empirical evidence pertaining to the theory of female labor supply. (JS)

48 CFR 622.404-3 - Procedures for requesting wage determinations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... STATE SOCIOECONOMIC PROGRAMS APPLICATION OF LABOR LAWS TO GOVERNMENT ACQUISITIONS Labor Standards for Contracts Involving Construction 622.404-3 Procedures for requesting wage determinations. The cognizant contracting activity (see 601.603-70) is the contracting agency for the purposes of 22.404-3(b) and (d). [53...

[Volunteering in end-of-life care : Challenges, problems and perspectives].

PubMed

Schneider, Werner

2017-01-01

Volunteering in the hospice movement has had a profound impact on generating awareness of hospice work and palliative care in the context of supporting dying persons and their relatives as well as on integrating respective services in the existing health care system. This paper focuses on two specific questions: First, it asks how society is changing with respect to dealing with dying and death, and more precisely with dying persons, which is recognizable by the integration of hospice work and palliative care in the healthcare system and related to the relevance of volunteering in the sense of a citizens' movement. Second, this paper asks what the specific roles of volunteers are as well as the possibilities and limits of voluntary practice in end-of-life care and accompaniment. To answer these questions, the pivotal objectives of the hospice movement - the transformation of the social awareness regarding dying and death, as well as the reorganization of "institutions of dying" - will first be outlined by reference to the concept of "good dying", a specific hospice attitude together with hospice culture and palliative competence. In a second step, the relevance of volunteering and the specific role of volunteers in the actual practice of hospice work and palliative care will be outlined alongside current indicators and recognizable alteration tendencies, before concluding with a discussion of the perspectives of hospices as a citizens' movement.

How can I help you? A study of the perceived importance of different kinds of hospice palliative care volunteer support.

PubMed

Claxton-Oldfield, Stephen; Gosselin, Natasha

2011-06-01

A total of 143 adults were asked to imagine that they had recently been diagnosed with a life-threatening illness. After reading about the roles of hospice palliative care volunteers, participants were asked whether they would use the services of a volunteer to help them and their loved ones get through this difficult time. The vast majority (94.4%) of the participants said they would choose to have a volunteer. These participants were then asked to rate the importance of 23 different supportive tasks that volunteers can perform. These tasks reflected the different kinds of support--emotional, social, practical, informational, and religious/spiritual--that hospice palliative care volunteers typically provide. Overall, the practical support category (eg, ''Having the volunteer run errands for me'') received the highest mean importance rating. Significant gender differences were found for the categories of emotional support (eg, ''Having the volunteer hold my hand'') and social support (eg, ''Having the volunteer share hobbies and interests with me''), with females rating both of these kinds of support as being more important to them than males did. The findings of this study may have practical implications for volunteer program coordinators.

Use of Compounded Dextromethorphan-Quinidine Suspension for Pseudobulbar Affect in Hospice Patients.

PubMed

Wahler, Robert G; Reiman, Alfred T; Schrader, Joshua V

2017-03-01

Pseudobulbar affect (PBA) consists of unprovoked and uncontrollable episodes of laughing and/or crying. In end-of-life situations, PBA symptoms can be especially distressing to family and friends during an already heightened emotional time. Although a commercial product combining dextromethorphan and quinidine (DMQ) is FDA approved for use in PBA, many hospice patients are unable to swallow any solids or semisolids. An alternative formulation for these patients is needed. We present here two cases in which we used a compounded DMQ suspension successfully to treat PBA symptoms in the weeks before the patients' death. A retrospective chart review was completed on the two cases where the DMQ suspension was used. A description of the DMQ suspension formula is described. Both patients were under the care of a hospice program; one in home care and one in a skilled nursing facility. Episodes of PBA symptoms were summarized in a narrative of the patients' symptom relief. Both patients tolerated the administration of the DMQ suspension and there were noted improvements in PBA symptoms. DMQ suspension is an effective alternative for PBA symptoms in patients who cannot swallow oral solid medication.

Hospice family members' perceptions of and experiences with end-of-life care in the nursing home.

PubMed

Oliver, Debra Parker; Washington, Karla; Kruse, Robin L; Albright, David L; Lewis, Alexandria; Demiris, George

2014-10-01

Even though more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had 2 research questions; (1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared with family members of community dwelling hospice patients? (2) What are family members' perceptions of and experiences with end-of-life care in the nursing home setting? This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family members of hospice patients residing in the community. Outcome measures for family members of nursing home residents were compared (n = 176) with family members of community-dwelling hospice patients (n = 267). The family members of nursing home residents reported higher quality of life; however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents, concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting. These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for residents. This study suggests that nursing homes should embrace the opportunity to demonstrate the value of family participation in the care-planning process. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Hospice family members’ perceptions and experiences with end-of-life care in the nursing home

PubMed Central

Washington, Karla; Kruse, Robin L.; Albright, David L; Lewis, Alexandria; Demiris, George

2014-01-01

Objective Despite the fact that more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had two research questions; 1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared to family members of community dwelling hospice patients? 2) What are family members’ perceptions of and experiences with end-of-life care in the nursing home setting? Methods This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family member of hospice patients residing in the community. Results Outcome measures for family members of nursing home residents were compared (n=176) with family members of community dwelling hospice patients (n=267). The family members of nursing home residents reported higher quality of life however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting. Conclusion These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for residents. This study suggests that nursing homes should embrace the opportunity to demonstrate the value of family participation in the care planning process. PMID:25017391

42 CFR 418.108 - Condition of participation: Short-term inpatient care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Condition of participation: Short-term inpatient care. 418.108 Section 418.108 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of participation...

42 CFR 418.108 - Condition of participation: Short-term inpatient care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Condition of participation: Short-term inpatient care. 418.108 Section 418.108 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of participation...

42 CFR 418.108 - Condition of participation: Short-term inpatient care.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Condition of participation: Short-term inpatient care. 418.108 Section 418.108 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of...

42 CFR 418.108 - Condition of participation: Short-term inpatient care.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Condition of participation: Short-term inpatient care. 418.108 Section 418.108 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of...

42 CFR 418.108 - Condition of participation: Short-term inpatient care.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Condition of participation: Short-term inpatient care. 418.108 Section 418.108 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of...

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)

Dire deadlines: coping with dysfunctional family dynamics in an end-of-life care setting.

PubMed

Holst, Lone; Lundgren, Maren; Olsen, Lutte; Ishøy, Torben

2009-01-01

Working in a hospice and being able to focus on individualized, specialized end-of-life care is a privilege for the hospice staff member. However, it also presents the hospice staff with unique challenges. This descriptive study is based upon two cases from an end-of-life care setting in Denmark, where dysfunctional family dynamics presented added challenges to the staff members in their efforts to provide optimal palliative care. The hospice triad--the patient, the staff member and the family member--forms the basis for communication and intervention in a hospice. Higher expectations and demands of younger, more well-informed patients and family members challenge hospice staff in terms of information and communication when planning for care. The inherent risk factors of working with patients in the terminal phase of life become a focal point in the prevention of the development of compassion fatigue among staff members. A series of coping strategies to more optimally manage dysfunctional families in a setting where time is of the essence are then presented in an effort to empower the hospice team, to prevent splitting among staff members, and to improve quality of care.

Knowledge and perceptions of hospice care of Chinese older adults.

PubMed

Enguidanos, Susan; Yonashiro-Cho, Jeanine; Cote, Sarah

2013-06-01

Despite dramatic increases in hospice enrollment, ethnic disparities persist. With rapidly growing populations of Asian Americans, research is needed to elucidate factors that contribute to hospice underenrollment in subgroups of Asian populations. The purpose of this study was to explore older Chinese Americans' knowledge, understanding, and perceptions of hospice care. Three focus groups were conducted, one each in English, Mandarin, and Cantonese, all recruited from a Chinese social service agency. Focus groups were audiotaped and transcribed and then coded for themes. Thirty-four Chinese Americans participated in the groups, all but one reporting primary language other than English. Themes included lack of knowledge, death timing, burden (financial, emotional, physical toward family or government), peaceful death (relief of suffering), and quality of care (and its influence on perception of best care location). Findings indicate the need for hospice education and outreach to Chinese Americans. Additionally, to address concerns about burden and death in the home, efforts to improve access to hospice facilities are needed. Findings from this study provide direction for healthcare providers to address potential barriers to increasing access to hospice of Chinese Americans. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

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.

Hospice decision making: diagnosis makes a difference.

PubMed

Waldrop, Deborah P; Meeker, Mary Ann

2012-10-01

This study explored the process of decision making about hospice enrollment and identified factors that influence the timing of that decision. 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 hospice patients and 55 caregivers after 2 weeks of hospice care. The study was guided by Janis and Mann's conflict theory model (CTM) of decision making. Qualitative data analysis involved a directed content analysis using concepts from the CTM. A model of hospice enrollment decision making is presented. Concepts from the CTM (appraisal, surveying and weighing the alternatives, deliberations, adherence) were used as an organizing framework to illustrate the dynamics. Distinct differences were found by diagnosis (cancer vs. other chronic illness, e.g., heart and lung diseases) during the pre-encounter phase or before the hospice referral but no differences emerged during the post-encounter phase. Differences in decision making by diagnosis suggest the need for research about effective means for tailored communication in end-of-life decision making by type of illness. Recognition that decision making about hospice admission varies is important for clinicians who aim to provide person-centered and family-focused care.

Social Work Involvement in Advance Care Planning: Findings from a Large Survey of Social Workers in Hospice and Palliative Care Settings.

PubMed

Stein, Gary L; Cagle, John G; Christ, Grace H

2017-03-01

Few data are available describing the involvement and activities of social workers in advance care planning (ACP). We sought to provide data about (1) social worker involvement and leadership in ACP conversations with patients and families; and (2) the extent of functions and activities when these discussions occur. We conducted a large web-based survey of social workers employed in hospice, palliative care, and related settings to explore their role, participation, and self-rated competency in facilitating ACP discussions. Respondents were recruited through the Social Work Hospice and Palliative Care Network and the National Hospice and Palliative Care Organization. Descriptive analyses were conducted on the full sample of respondents (N = 641) and a subsample of clinical social workers (N = 456). Responses were analyzed to explore differences in ACP involvement by practice setting. Most clinical social workers (96%) reported that social workers in their department are conducting ACP discussions with patients/families. Majorities also participate in, and lead, ACP discussions (69% and 60%, respectively). Most respondents report that social workers are responsible for educating patients/families about ACP options (80%) and are the team members responsible for documenting ACP (68%). Compared with other settings, oncology and inpatient palliative care social workers were less likely to be responsible for ensuring that patients/families are informed of ACP options and documenting ACP preferences. Social workers are prominently involved in facilitating, leading, and documenting ACP discussions. Policy-makers, administrators, and providers should incorporate the vital contributions of social work professionals in policies and programs supporting ACP.

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

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.

Best Practice for After-Hours Hospice Symptom Management: A Literature Review.

PubMed

Slack, Cheryl

2015-10-01

Medicare-certified hospice home care agencies must provide a 24/7 on-call system to respond to patient and caregiver concerns. How these calls are handled impacts patient and family outcomes and satisfaction. Ideally, hospice nurses provide adequate caregiver education during routine visits to minimize the need for after-hours calls. A literature review provided evidence that hospice nurse education and appropriate telephone support improves symptom management, enhances family support, provides a sense of security, reduces anxiety, and promotes comfort.

The Impact of Faith Beliefs on Perceptions of End-of-Life Care and Decision Making among African American Church Members.

PubMed

Johnson, Jerry; Hayden, Tara; True, Jennifer; Simkin, Daren; Colbert, Louis; Thompson, Beverly; Stewart, Denise; Martin, Latoya

2016-02-01

African Americans underuse palliative care and hospice services because of a combination of factors including faith beliefs. As the spiritual family for many African Americans, the church presents an opportunity to improve communication about palliative care and hospice and end-of-life (EOL) decision making. We conducted a focus group study to understand the cultural and spiritual perspectives that influence decisions about palliative care and hospice among African American church members who visit and support persons with life-limiting illnesses. Our specific aims were to elicit their perceptions, beliefs, and attitudes about: (1) the relation between faith beliefs and EOL care; (2) emotional and family influences on EOL decision making; (3) palliative care and hospice resources; and (4) opportunities to improve communication among lay persons and health professionals and within families. Seven focus groups using purposeful sampling. We partnered with two African American churches. Of 51 persons, 27 were deacons or deaconesses, 17 were members of health or bereavement ministries, and 7 were other members of the congregations. We found that faith beliefs of African Americans can support discussions about palliative care and hospice. Participants perceived that many of their congregants harbor beliefs, perceptions, and feelings about death and dying that were often not communicated to family members or to health providers. Among African Americans, faith beliefs, emotional issues, family dynamics, and insufficient knowledge of palliative care and hospice are intertwined and influence decision making about palliative care and hospice. Our findings confirm the influence of faith beliefs of African Americans on decisions about palliative care and hospice and demonstrate the opportunity to improve communication about palliative care and hospice and EOL through collaborations with the African American church.

Hospice or community network? Choices in end-of-life care in Jamaica.

PubMed

Mendoza, Roger Lee

2017-09-01

Now considered a subspecialty of medicine and nursing, palliative care is a critical aspect of healthcare at the end of life. National and international healthcare agencies typically attribute its slow or haphazard growth in developing countries to various resource constraints. However, this study provides evidence of the substantial and widening gap between policy advocacy and patient choices in end-of-life care. It does so by establishing the incentives and risks that underlie decision-making by patients and providers against the relative scarcity of palliative care and hospices in these countries. Jamaica offers an illustrative case. It shares the socioeconomic conditions and isolated provision of hospice and palliative care that remain prevalent in many developing countries. Empirical information was collected from all Jamaican hospices, along with agency and media reports, for comparative institutional analysis. Financial and infrastructural challenges hamper hospice expansion and integration into formal healthcare systems in developing countries. Yet, other equally vital considerations are too often neglected. These include the high transaction costs of decision-making, which account for limited hospice accessibility, affordability, and efficiency, particularly to underserved populations. Risk and payoff calculations by patients and their families as well as hospices and their providers lead to two strategic options in maximizing hospice value and/or minimizing transaction costs in end-of-life care. Policy formulation and advocacy for hospice and palliative care should match aggregate demand. The socio-cultural milieu of care is critical and should be equally considered. Otherwise, providing and expanding free or subsidized palliative care at the end-of-life stage can become cost-inefficient relative to robust family and grassroots community networks.

What are Hospice Providers in the Carolinas Doing to Reach African Americans in Their Service Area?

PubMed Central

Payne, Richard; Kuchibhatla, Maragatha N.

2016-01-01

Abstract Background: Experts and national organizations recommend that hospices work to increase service to African Americans, a group historically underrepresented in hospice. Objective: The study objective was to describe strategies among hospices in North and South Carolina to increase service to African Americans and identify hospice characteristics associated with these efforts. Methods: The study was a cross-sectional survey using investigator-developed scales to measure frequency of community education/outreach, directed marketing, efforts to recruit African American staff, cultural sensitivity training, and goals to increase service to African Americans. We used nonparametric Wilcoxon tests to compare mean scale scores by sample characteristics. Results: Of 118 eligible hospices, 79 (67%) completed the survey. Over 80% were at least somewhat concerned about the low proportion of African Americans they served, and 78.5% had set goals to increase service to African Americans. Most were engaged in community education/outreach, with 92.4% reporting outreach to churches, 76.0% to social services organizations, 40.5% to businesses, 35.4% to civic groups, and over half to health care providers; 48.0% reported directed marketing via newspaper and 40.5% via radio. The vast majority reported efforts to recruit African American staff, most often registered nurses (63.75%). Nearly 90% offered cultural sensitivity training to staff. The frequency of strategies to increase service to African Americans did not vary by hospice characteristics, such as profit status, size, or vertical integration, but was greater among hospices that had set goals to increase service to African Americans. Conclusions: Many hospices are engaged in efforts to increase service to African Americans. Future research should determine which strategies are most effective. PMID:26840854

Paying the Price at the End of Life: A Consideration of Factors that Affect the Profitability of Hospice

PubMed Central

Ettner, Susan L.; Lorenz, Karl A.

2008-01-01

Abstract Objective To evaluate factors that affect the financial performance of hospice. Methods Using the California Office of Statewide Health Planning and Development 2003 survey, we evaluated the organizational attributes, clinical care, and financial performance of 185 operational hospices. As outcomes, we evaluated revenues, costs, and profits per patient and per patient–day, the intensity and skill mix of care, and the provision of charitable and special palliative services. We evaluated regression-adjusted differences by profit status controlling for other organizational features and aggregate patient characteristics. Results Hospices reported median revenue of $6865 per patient and $138 per patient–day (for-profit-not-for profit [FP-NFP] difference −$20, p = 0.045), median cost of $6737 per patient, and $135 per patient–day (FP-NFP difference −$55, p = 0.002), and median pretax profit of $334 per patient and $6 per patient–day (FP-NFP difference $34, p = 0.026). Patients received a median of 29.9 total visits by all providers per patient (FP-NFP difference 8.8 visits, p = 0.010), but there was no difference in total visits per patient–day. A median of 50.8% of all nursing visits were registered nurse (RN) visits (FP-NFP difference −14.1%, p < 0.001). Few hospices provided charity care, and only 4% of hospices reported expenditures on chemotherapy and only 9% on radiation therapy. Conclusions Overall hospice profitability is low. Length of stay is strongly associated with financial performance, and greater FP profitability is related to lower costs. FP hospices also provide less RN care as a proportion of nursing care. Few hospices provide charitable care or special costly services. The relationship of service patterns to patient quality needs to be examined. PMID:18788962

Paying the price at the end of life: a consideration of factors that affect the profitability of hospice.

PubMed

O'Neill, Sean M; Ettner, Susan L; Lorenz, Karl A

2008-09-01

To evaluate factors that affect the financial performance of hospice. Using the California Office of Statewide Health Planning and Development 2003 survey, we evaluated the organizational attributes, clinical care, and financial performance of 185 operational hospices. As outcomes, we evaluated revenues, costs, and profits per patient and per patient-day, the intensity and skill mix of care, and the provision of charitable and special palliative services. We evaluated regression-adjusted differences by profit status controlling for other organizational features and aggregate patient characteristics. Hospices reported median revenue of $6865 per patient and $138 per patient-day (for-profit-not-for profit [FP-NFP] difference -$20, p = 0.045), median cost of $6737 per patient, and $135 per patient-day (FP-NFP difference -$55, p = 0.002), and median pretax profit of $334 per patient and $6 per patient-day (FP-NFP difference $34, p = 0.026). Patients received a median of 29.9 total visits by all providers per patient (FP-NFP difference 8.8 visits, p = 0.010), but there was no difference in total visits per patient-day. A median of 50.8% of all nursing visits were registered nurse (RN) visits (FP-NFP difference -14.1%, p < 0.001). Few hospices provided charity care, and only 4% of hospices reported expenditures on chemotherapy and only 9% on radiation therapy. Overall hospice profitability is low. Length of stay is strongly associated with financial performance, and greater FP profitability is related to lower costs. FP hospices also provide less RN care as a proportion of nursing care. Few hospices provide charitable care or special costly services. The relationship of service patterns to patient quality needs to be examined.

Branding Palliative Care Units by Avoiding the Terms "Palliative" and "Hospice".

PubMed

Dai, Ying-Xiu; Chen, Tzeng-Ji; Lin, Ming-Hwai

2017-01-01

The term "palliative care" has a negative connotation and may act as a barrier to early patient referrals. Rebranding has thus been proposed as a strategy to reduce the negative perceptions associated with palliative care. For example, using the term "supportive care" instead of "palliative care" in naming palliative care units has been proposed in several studies. In Taiwan, terms other than "palliative" and "hospice" are already widely used in the names of palliative care units. With this in mind, this study investigated the characteristics of palliative care unit names in order to better understand the role of naming in palliative care. Relevant data were collected from the Taiwan Academy of Hospice Palliative Medicine, the National Health Insurance Administration of the Ministry of Health and Welfare, and the open database maintained by the government of Taiwan. We found a clear phenomenon of avoiding use of the terms "palliative" and "hospice" in the naming of palliative care units, a phenomenon that reflects the stigma attached to the terms "palliative" and "hospice" in Taiwan. At the time of the study (September, 2016), there were 55 palliative care units in Taiwan. Only 20.0% (n = 11) of the palliative care unit names included the term "palliative," while 25.2% (n = 14) included the term "hospice." Religiously affiliated hospitals were less likely to use the terms "palliative" and "hospice" (χ 2 = 11.461, P = .001). There was also a lower prevalence of use of the terms "palliative" and "hospice" for naming palliative care units in private hospitals than in public hospitals (χ 2 = 4.61, P = .032). This finding highlights the strong stigma attached to the terms "palliative" and "hospice" in Taiwan. It is hypothesized that sociocultural and religious factors may partially account for this phenomenon.

What are Hospice Providers in the Carolinas Doing to Reach African Americans in Their Service Area?

PubMed

Johnson, Kimberly S; Payne, Richard; Kuchibhatla, Maragatha N

2016-02-01

Experts and national organizations recommend that hospices work to increase service to African Americans, a group historically underrepresented in hospice. The study objective was to describe strategies among hospices in North and South Carolina to increase service to African Americans and identify hospice characteristics associated with these efforts. The study was a cross-sectional survey using investigator-developed scales to measure frequency of community education/outreach, directed marketing, efforts to recruit African American staff, cultural sensitivity training, and goals to increase service to African Americans. We used nonparametric Wilcoxon tests to compare mean scale scores by sample characteristics. Of 118 eligible hospices, 79 (67%) completed the survey. Over 80% were at least somewhat concerned about the low proportion of African Americans they served, and 78.5% had set goals to increase service to African Americans. Most were engaged in community education/outreach, with 92.4% reporting outreach to churches, 76.0% to social services organizations, 40.5% to businesses, 35.4% to civic groups, and over half to health care providers; 48.0% reported directed marketing via newspaper and 40.5% via radio. The vast majority reported efforts to recruit African American staff, most often registered nurses (63.75%). Nearly 90% offered cultural sensitivity training to staff. The frequency of strategies to increase service to African Americans did not vary by hospice characteristics, such as profit status, size, or vertical integration, but was greater among hospices that had set goals to increase service to African Americans. Many hospices are engaged in efforts to increase service to African Americans. Future research should determine which strategies are most effective.

Employment Gains and Wage Declines: The Erosion of Black Women’s Relative Wages Since 1980

PubMed Central

PETTIT, BECKY; EWERT, STEPHANIE

2009-01-01

Public policy initiatives in the 1950s and 1960s, including Affirmative Action and Equal Employment Opportunity law, helped mitigate explicit discrimination in pay, and the expansion of higher education and training programs have advanced the employment fortunes of many American women. By the early 1980s, some scholars proclaimed near equity in pay between black and white women, particularly among young and highly skilled workers. More recent policy initiatives and labor market conditions have been arguably less progressive for black women’s employment and earnings: through the 1980s, 1990s, and the first half of the 2000s, the wage gap between black and white women widened considerably. Using data from the Current Population Survey Merged Outgoing Rotation Group (CPS-MORG), this article documents the racial wage gap among women in the United States from 1979 to 2005. We investigate how demographic and labor market conditions influence employment and wage inequality among black and white women over the period. Although shifts in labor supply influence the magnitude of the black-white wage gap among women, structural disadvantages faced by black women help explain the growth in the racial wage gap. PMID:19771940

Employment gains and wage declines: the erosion of black women's relative wages since 1980.

PubMed

Pettit, Becky; Ewert, Stephanie

2009-08-01

Public policy initiatives in the 1950s and 1960s, including Affirmative Action and Equal Employment Opportunity law, helped mitigate explicit discrimination in pay, and the expansion of higher education and training programs have advanced the employment fortunes of many American women. By the early 1980s, some scholars proclaimed near equity in pay between black and white women, particularly among young and highly skilled workers. More recent policy initiatives and labor market conditions have been arguably less progressive for black women's employment and earnings: through the 1980s, 1990s, and the first half of the 2000s, the wage gap between black and white women widened considerably. Using data from the Current Population Survey Merged Outgoing Rotation Group (CPS-MORG), this article documents the racial wage gap among women in the United States from 1979 to 2005. We investigate how demographic and labor market conditions influence employment and wage inequality among black and white women over the period. Although shifts in labor supply influence the magnitude of the black-white wage gap among women, structural disadvantages faced by black women help explain the growth in the racial wage gap.

Essentials of hospice: what every Oklahoma physician needs to know, Part I.

PubMed

Winn, Peter; Salinas, Robert

2004-12-01

Every physician, regardless of specialty, must advocate and facilitate patient access to comprehensive palliative and hospice care as their patients enter the last phase of life due to advanced disease or a terminal condition. Accordingly, physicians must become familiar with both the general and the disease-specific eligibility guidelines for hospice, the different levels of hospice care, physician re-imbursement for hospice patient care, and become knowledgeable in advance healthcare planning. The latter includes an understanding of Oklahoma's DNR law and the Advance Directive for Health Care (Living Will) law. Physician proficiency in the palliation of pain and non-pain symptoms that occur in patients at end-of-life is critical to alleviate patient suffering and to ensure the patient's peaceful dying.

Essentials of hospice: what every Oklahoma physician needs to know, Part II.

PubMed

Winn, Peter; Salinas, Robert

2005-01-01

Every physician, regardless of specialty, must advocate and facilitate patient access to comprehensive palliative and hospice care as their patients enter the last phase of life due to advanced disease or a terminal condition. Accordingly, physicians must become familiar with both the general and the disease-specific eligibility guidelines for hospice, the different levels of hospice care, physician re-imbursement for hospice patient care, and become knowledgeable in advance health care planning. The latter includes an understanding of Oklahoma's DNR law and the Advance Directive for Health Care (Living Will) law. Physician proficiency in the palliation of pain and non-pain symptoms that occur in patients at end-of-life is critical to alleviate patient suffering and to ensure the patient's peaceful dying.

42 CFR 418.54 - Condition of participation: Initial and comprehensive assessment of the patient.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Condition of participation: Initial and comprehensive assessment of the patient. 418.54 Section 418.54 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE...

42 CFR 418.54 - Condition of participation: Initial and comprehensive assessment of the patient.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Condition of participation: Initial and comprehensive assessment of the patient. 418.54 Section 418.54 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE...

42 CFR 418.54 - Condition of participation: Initial and comprehensive assessment of the patient.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Condition of participation: Initial and comprehensive assessment of the patient. 418.54 Section 418.54 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE...

Volunteer Motivations and Rewards: Shaping Future Programs.

ERIC Educational Resources Information Center

McClam, Tricia

Volunteerism is increasing today and helps to fill in the gaps created by funding and staff cutbacks in service-oriented agencies. It is critical not only to recruit new volunteers but to retain volunteers. This study examines hospice volunteers for motivation and rewards. Previous studies have found motivations to include altruism and…

42 CFR 406.2 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., home health services, and hospice care. [48 FR 56026, Dec. 16, 1983, as amended at 50 FR 33033, Aug. 16... 42 Public Health 2 2010-10-01 2010-10-01 false Scope. 406.2 Section 406.2 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL...

42 CFR 418.100 - Condition of Participation: Organization and administration of services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Condition of Participation: Organization and administration of services. 418.100 Section 418.100 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of...

42 CFR 418.100 - Condition of Participation: Organization and administration of services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Condition of Participation: Organization and administration of services. 418.100 Section 418.100 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of...

42 CFR 418.100 - Condition of Participation: Organization and administration of services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Condition of Participation: Organization and administration of services. 418.100 Section 418.100 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of...

Personality characteristics of hospice palliative care volunteers: the ''big five'' and empathy.

PubMed

Claxton-Oldfield, Stephen; Banzen, Yana

2010-09-01

The goal of this study was to examine the personality characteristics of hospice palliative care volunteers by measuring the so-called big five personality traits and 4 separate aspects of empathy. A total of 99 hospice palliative care volunteers completed the NEO Five-Factor Inventory (NEO-FFI) of Costa Jr and McCrae and the Interpersonal Reactivity Index (IRI) of Davis. The vast majority (84%) of the volunteers were females. Compared to the norms for adult females on the NEO-FFI, female hospice palliative care volunteers scored significantly higher on the traits of agreeableness, extraversion, and openness and significantly lower on the trait of neuroticism. On the empathy measure, female hospice palliative care volunteers scored significantly higher on the empathic concern and perspective taking subscales compared to the female norms, and significantly lower on the personal distress and fantasy subscales. The results of this study may have implications for the recruitment and retention of hospice palliative care volunteers.

Question asking by family caregivers in hospice interdisciplinary team meetings

PubMed Central

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

2009-01-01

This paper 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 as Yes/No questions (45.5%) mainly used to seek clarification (19.7%). Hospice staff asked 396 questions, with the majority of questions consisting of Yes/No questions (66.6%) mainly used to ask about the overall condition of the patient (17.2%). Data from this study suggest that when given the opportunity to participate in hospice team meetings caregivers will ask questions of hospice staff. Additionally, in light of prior research, this study’s findings suggest that caregivers may have questions that go unaddressed, specifically in regards to pain and medication. PMID:20415357

Pain assessment and management in end of life care: a survey of assessment and treatment practices of hospice music therapy and nursing professionals.

PubMed

Groen, Kara Mills

2007-01-01

The primary focus of this paper is to describe current trends in pain assessment in end of life care with a secondary focus on music therapy techniques commonly used to address pain for hospice patients. These trends were determined through a survey of 72 board certified music therapists and 92 hospice and palliative nurses. Survey results indicate that most music therapists in the hospice setting incorporate formal pain assessment into their practice; both nursing professionals and music therapists surveyed utilize multiple assessment tools to assess patient pain. Although there are currently a variety of pain assessment tools used, this study indicates that nursing professionals most frequently use the Numerical Rating Scale (NRS) and FACES scales, and identified them as appropriate for use by nonnursing members of the interdisciplinary hospice team. This paper also describes music therapy techniques most often utilized by music therapists with hospice patients to address acute and chronic pain symptoms.

The hospice movement: institutionalizing innovation.

PubMed

Abel, E K

1986-01-01

The early leaders of the hospice movement shared a number of attitudes with the founders of the alternative institutions of the 1960s and early 1970s: nostalgia for simple, old fashioned ways, dissatisfaction with bureaucratic and authoritarian institutions, faith in the power of nature, a determination to avoid domination by experts, and a desire to improve the quality of personal relationships. However, as hospices have become better established, they gradually have been incorporated into the dominant health care system and have lost their uniqueness. Some have affiliated with hospitals or home health agencies. Even autonomous organizations are subject to pressures for accommodation because they rely on the established order for resources, personnel, and political acceptance. Organizations receiving payment under the new Medicare benefit must adhere to a set of regulations that may distort the movement. Though creation of this benefit may have been facilitated by increased support for hospice ideals, the government views hospices primarily as a way to save money. Paradoxically, as hospices have grown in popularity, the critical force of the movement has been blunted.

75 FR 67662 - Wage Methodology for the Temporary Non-Agricultural Employment H-2B Program; Extension of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-03

... DEPARTMENT OF LABOR Employment and Training Administration 20 CFR Part 655 RIN 1205-AB61 Wage... AGENCIES: Employment and Training Administration. ACTION: Proposed rule; extension of comment period. SUMMARY: On October 5, 2010, the Employment and Training Administration (ETA) issued a Notice of Proposed...

24 CFR 70.5 - Procedure for obtaining HUD waiver of prevailing wage rates for volunteers.

Code of Federal Regulations, 2014 CFR

2014-04-01

... of prevailing wage rates for volunteers. 70.5 Section 70.5 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development USE OF VOLUNTEERS ON PROJECTS SUBJECT TO... rates for volunteers. (a) This section applies to those HUD programs under which HUD is statutorily...

24 CFR 70.5 - Procedure for obtaining HUD waiver of prevailing wage rates for volunteers.

Code of Federal Regulations, 2011 CFR

2011-04-01

... of prevailing wage rates for volunteers. 70.5 Section 70.5 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development USE OF VOLUNTEERS ON PROJECTS SUBJECT TO... rates for volunteers. (a) This section applies to those HUD programs under which HUD is statutorily...

24 CFR 70.5 - Procedure for obtaining HUD waiver of prevailing wage rates for volunteers.

Code of Federal Regulations, 2013 CFR

2013-04-01

... of prevailing wage rates for volunteers. 70.5 Section 70.5 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development USE OF VOLUNTEERS ON PROJECTS SUBJECT TO... rates for volunteers. (a) This section applies to those HUD programs under which HUD is statutorily...

24 CFR 70.4 - Procedure for implementing prevailing wage exemptions for volunteers.

Code of Federal Regulations, 2011 CFR

2011-04-01

... prevailing wage exemptions for volunteers. 70.4 Section 70.4 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development USE OF VOLUNTEERS ON PROJECTS SUBJECT TO DAVIS-BACON... volunteers. (a) This section applies to those HUD programs for which there is a statutory exemption for...

24 CFR 70.4 - Procedure for implementing prevailing wage exemptions for volunteers.

Code of Federal Regulations, 2013 CFR

2013-04-01

... prevailing wage exemptions for volunteers. 70.4 Section 70.4 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development USE OF VOLUNTEERS ON PROJECTS SUBJECT TO DAVIS-BACON... volunteers. (a) This section applies to those HUD programs for which there is a statutory exemption for...

24 CFR 70.5 - Procedure for obtaining HUD waiver of prevailing wage rates for volunteers.

Code of Federal Regulations, 2012 CFR

2012-04-01

... of prevailing wage rates for volunteers. 70.5 Section 70.5 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development USE OF VOLUNTEERS ON PROJECTS SUBJECT TO... rates for volunteers. (a) This section applies to those HUD programs under which HUD is statutorily...

24 CFR 70.4 - Procedure for implementing prevailing wage exemptions for volunteers.

Code of Federal Regulations, 2014 CFR

2014-04-01

... prevailing wage exemptions for volunteers. 70.4 Section 70.4 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development USE OF VOLUNTEERS ON PROJECTS SUBJECT TO DAVIS-BACON... volunteers. (a) This section applies to those HUD programs for which there is a statutory exemption for...

24 CFR 70.4 - Procedure for implementing prevailing wage exemptions for volunteers.

Code of Federal Regulations, 2012 CFR

2012-04-01

... prevailing wage exemptions for volunteers. 70.4 Section 70.4 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development USE OF VOLUNTEERS ON PROJECTS SUBJECT TO DAVIS-BACON... volunteers. (a) This section applies to those HUD programs for which there is a statutory exemption for...

Postgraduate Wage Premiums and the Gender Wage Gap in Canada

ERIC Educational Resources Information Center

Waite, Sean

2017-01-01

Since the 1990s, enrolment in postgraduate programs has increased significantly in Canada. In more recent years, this has led to concerns regarding overproduction and the labour market outcomes of those with postgraduate education. Women have played an important role in this growth, but questions remain as to whether women's progress into the…

24 CFR 574.655 - Wage rates.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 3 2014-04-01 2013-04-01 true Wage rates. 574.655 Section 574.655 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF... rates. The provisions of the Davis-Bacon Act (40 U.S.C. 276a-276a-5) do not apply to this program...

24 CFR 574.655 - Wage rates.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 3 2012-04-01 2012-04-01 false Wage rates. 574.655 Section 574.655 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF... rates. The provisions of the Davis-Bacon Act (40 U.S.C. 276a-276a-5) do not apply to this program...

24 CFR 574.655 - Wage rates.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 3 2013-04-01 2013-04-01 false Wage rates. 574.655 Section 574.655 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF... rates. The provisions of the Davis-Bacon Act (40 U.S.C. 276a-276a-5) do not apply to this program...

24 CFR 574.655 - Wage rates.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 3 2011-04-01 2010-04-01 true Wage rates. 574.655 Section 574.655 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF... rates. The provisions of the Davis-Bacon Act (40 U.S.C. 276a-276a-5) do not apply to this program...

WAGES (Women and Girls Employment Enabling Service): Final Report.

ERIC Educational Resources Information Center

Thomas, Leathia S.; Dickey, Sandy

The two-year report of the WAGES project (Women and Girls Employment Enabling Service) documents the growth, problems, and success experienced through efforts to open nontraditional fields of employment to women by way of a community-based program in Memphis, Tennessee. Staff and volunteers provided counseling and referrals to applicants. Personal…

76 FR 60134 - Proposed Information Collection (Monthly Statement of Wages Paid to Trainee) Activity; Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-28

... on-the-job training or apprenticeship program. DATES: Written comments and recommendations on the...: Extension of a currently approved collection. Abstract: Employers providing on-job or apprenticeship training to veterans complete VA Form 28-1917 to report each veteran's wages during the preceding month. VA...

77 FR 67737 - Proposed Information Collection (Monthly Record of Training and Wages) Activity: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-13

.... ADDRESSES: Submit written comments on the collection of information through the Federal Docket Management...-3521), Federal agencies must obtain approval from the Office of Management and Budget (OMB) for each... beginning of the program and at any time the trainee's wage rate changes. Following a trainee's completion...

Utilization of surgery, chemotherapy, radiation therapy, and hospice at the end of life for patients diagnosed with metastatic melanoma.

PubMed

Huo, Jinhai; Du, Xianglin L; Lairson, David R; Chan, Wenyaw; Jiang, Jing; Buchholz, Thomas A; Guadagnolo, B Ashleigh

2015-06-01

To examine the patterns of utilization of radiation therapy, chemotherapy, surgery, and hospice at the end-of-life care for patients diagnosed with metastatic melanoma. We identified 816 Medicare beneficiaries toward who were 65 years of age or older, with pathologically confirmed metastatic malignant melanoma between January 1, 2000, and December 31, 2007. We evaluated trends and associations between sociodemographic and health service characteristics and the use of hospice care, chemotherapy, surgery, and radiation therapy. We found increasing use of surgery for patients with metastatic melanoma from 13% in 2000 to 30% in 2007 (P=0.03 for trend), and no significant fluctuation in the use of chemotherapy (P=0.43) or radiation therapy (P=0.46). Older patients were less likely to receive radiation therapy or chemotherapy. The use of hospice care increased from 61% in 2000 to 79% in 2007 (P=0.07 for trend). Enrollment in short-term (1 to 3 d) hospice care use increased, whereas long-term hospice care (≥4 d) remained stable. Patients living in the SEER (Surveillance, Epidemiology and End Results) northeast and south regions were less likely to undergo surgery. Patients enrolled in long-term hospice care used significantly less chemotherapy, surgery, and radiation therapy. Surgery and hospice care use increased over the years of this study, whereas the use of chemotherapy and radiation therapy remained consistent for patients diagnosed with metastatic melanoma.

Hospice inpatients' views on physical examination by medical students: is it acceptable?

PubMed

Hayes, Jennifer

2012-12-01

Hospices are increasingly involved in medical student teaching, which the patients generally enjoy. No studies have specifically investigated how hospice patients view the prospect of physical examination by students. Previous evidence involves patients who have already seen students, while the views of other patients are unknown. This study aimed to provide an initial understanding of the views of a diverse group of hospice inpatients on the acceptability and perceived importance of students physically examining them. 42 hospice inpatients completed a short questionnaire focusing on their views of medical students examining them. Patients chose to do this alone or via a short interview. All inpatients at Exeter Hospice were considered eligible, including patients who were asked and those who may not have been asked to see students; all 42 patients completed the study. In accordance with existing evidence, patients generally held positive views about seeing students. However, many patients expressed concerns about being physically examined by students, specifically including that it might be painful, tiring or embarrassing. Most importantly, several patients who did not wish to be examined by medical students said they would feel obliged to accept it, or would find it difficult to decline. Hospice inpatients generally wish to be involved in medical student teaching, but many are concerned about being physically examined, and some feel a sense of obligation to participate. There are implications for hospices that teach students. Further research is necessary to investigate the frequency and severity of these concerns.

Hospice palliative care volunteers: the benefits for patients, family caregivers, and the volunteers.

PubMed

Claxton-Oldfield, Stephen

2015-06-01

Terminally ill patients and family caregivers can benefit greatly from the support and care provided by trained hospice palliative care volunteers. The benefits of doing this kind of volunteer work also extend to the volunteers themselves, who often say they receive more than they give from the patients/families they are "privileged" to be with. The purpose of this article is to demonstrate how hospice palliative care volunteerism benefits both the patients and families who utilize this service as well as the volunteers. A review of studies demonstrating how terminally ill patients, and especially family caregivers, can benefit from the use of hospice palliative care volunteers and how the volunteers themselves benefit from their experiences. Terminally ill patients and families receive many benefits from using the services of hospice palliative care volunteers, including emotional support, companionship, and practical assistance (e.g., respite or breaks from caregiving). Volunteering in hospice palliative care also provides many benefits for the volunteers, including being able to make a difference in the lives of others, personal growth, and greater appreciation of what is really important in life. More needs to be done to promote the value of hospice palliative care volunteers to those who can really benefit from their support and care (i.e., patients and their families) as well as to help people recognize the potential rewards of being a hospice palliative care volunteer. It is a win-win situation.

Changes in the quantity and level of evidence of palliative and hospice care literature: the last century.

PubMed

Tieman, Jennifer; Sladek, Ruth; Currow, David

2008-12-10

To objectively quantify the literature and the clinical trial basis for palliative and hospice practice given a perception that its evidence base is not well developed. Using Ovid Medline, the study looked at cumulative and absolute numbers of articles in the general medical literature and the palliative and hospice care literature. The same comparisons were made exploring clinical trials from 1902 to 2005. Data were collated in five year groups from 1970 onward using a highly specific search phrase. The proportion of all Ovid Medline publications relating to palliative and hospice care rose from 0.08% in 1970 to 0.38% of the literature in 2005. In the same time, clinical trials increased from 0.96% to 7.22% of the palliative care literature published. By 2005, one in every 122 clinical trials published in the literature as a whole was in palliative or hospice care. The rate of growth in palliative care clinical trials as a proportion of all palliative and hospice publications was on average 1.4 times greater than in the corresponding general literature. More than one half of these studies were reported in just 43 journals, most of which were not specialist palliative and hospice care journals. Given the diversity of journals in which clinical studies related to hospice and palliative care appear, there is a key challenge for clinicians in finding ways that will allow currency of practice in a broad and rapidly changing field.

Personally Meaningful Rituals: A Way to Increase Compassion and Decrease Burnout among Hospice Staff and Volunteers.

PubMed

Montross-Thomas, Lori P; Scheiber, Caroline; Meier, Emily A; Irwin, Scott A

2016-10-01

Rituals can increase a sense of connectedness, meaning, and support, especially after the death of those for whom we care. Hospice staff may benefit from the use of personal rituals as they cope with the frequent deaths of their patients, ultimately aiming to provide compassionate care while minimizing burnout. This study investigated the role of personally meaningful rituals in increasing compassion and decreasing burnout among hospice staff and volunteers. An online survey was completed by members of the National Hospice and Palliative Care Organization (NHPCO) which inquired about personal ritual practices, and included the Professional Quality of Life (ProQOL) scale to measure current levels of Compassion Satisfaction, Burnout, and Secondary Traumatic Stress. Three hundred ninety hospice staff and volunteers from across 38 states completed the online survey. The majority of participants were Caucasian and female, with an average of nine years of experience in hospice and palliative care. The majority of hospice staff and volunteers used personally meaningful rituals after the death of their patients to help them cope (71%). Those who used rituals demonstrated significantly higher Compassion Satisfaction and significantly lower Burnout as measured by the ProQOL, with professional support, social support, and age playing significant roles as well. Rituals may be an important way to increase compassion and decrease burnout among hospice staff and volunteers. Organizations may benefit from providing training and support for personalized rituals among team members, especially new staff who may be at greater risk for burnout.

An 11-Year Study of Home Hospice Service Trends in Singapore from 2000 to 2010.

PubMed

Ho, Benedict John; Akhileswaran, Ramaswamy; Pang, Grace Su Yin; Koh, Gerald Choon Huat

2017-05-01

Hospice care is most appropriate when a patient no longer benefits from curative treatment and has limited life expectancy. These patients may suffer from any type of life-limiting illness, including end-stage cancer, end-stage heart disease, end-stage renal failure, AIDS, and Alzheimer's disease, among other illnesses. Patients are managed on their pain and symptoms and home hospice care manages these patients in the comfort of their own home, enabling patients to spend their last days with dignity and have a good quality of life. To describe the home hospice patients at HCA Hospice Care (HHC) Singapore from 2000 to 2010. Description of home care patients in terms of their sociodemographic profile and diagnosis at admission. We reviewed the Electronic Medical Records of patients admitted into HHC from 2000 to 2010. Patients had multiple admissions into HHC home hospice as identified in the Electronic Medical Records (EMR) between January 1, 2000, and December 31, 2010, but we only selected patient's first admission into HHC home hospice for this analysis. Of the 25,065 patients in the entire samples, 47.3% were males, 65.2% were married, and 84.3% were Chinese. 50.9% of the patients died at home, 75.5% were referred from public hospitals, 53.9% of primary caregivers were children, and the mean age of the patients was 68.0 years. Among all cancer patients admitted into HHC home hospice, lung cancer (23.6%) was the most common principal diagnosis for admission, followed by colorectal (10.5%) and liver cancers (7.7%). Among noncancer patients, renal failure (7.0%) was the most common diagnosis. Among male patients admitted into HHC home hospice, lung cancer (29.6%) was the most common diagnosis, followed by liver cancer (10.8%), colorectal cancer (10.0%), and end-stage renal failure (5.5%). For female patients, lung cancer (16.9%) was the most common diagnosis, followed by breast cancer (15.9%), colorectal cancer (11.0%), and end-stage renal failure (8.7%). Ten-year trends of the sociodemographic profile and diagnosis at admission were further analyzed to determine home hospice services utilization and the needs of the home care patients. With an increasing emphasis to encourage aging and dying in the community and more attention given to building up the home hospice industry's capacity and capability, it is important to understand the profile of the patients who have been utilizing home hospice services. This also helps to plan and develop similar services in other parts of the world.

Palliative Care Training in Cardiology Fellowship: A National Survey of the Fellows.

PubMed

Dabbouseh, Noura M; Kaushal, Shivtej; Peltier, Wendy; Johnston, Fabian M

2018-02-01

To address perspectives of cardiology fellows on the current state of palliative education and palliative and hospice resource utilization within their fellowship experiences. We conducted an online national survey of cardiology fellows during the 2015 to 2016 academic year. Survey questions aimed to assess perceived importance of palliative care education, level of palliative care education during fellowship, and the structure of palliative care support at respondent institutions. Responses were collected anonymously. A total of 519 programs, including subspecialty programs, were contacted. We received 365 responses, a number that represents roughly 14% of all cardiology fellows nationwide during the 2015 to 2016 academic year. Fellows reported discordance in the quality of education between general cardiology and palliative care principles as it relates to care of the patient approaching the end of life. Fellows infrequently received explicit training nor were observed or mentored in delivering end-of-life discussions. Respondents reported an underutilization of palliative care and hospice resources during fellowship training and also a perception that attending faculty were not routinely addressing goals of care. Our survey results highlight a need for enhanced palliative care and end-of-life training experiences for cardiology fellows and also suggest underutilization of hospice and palliative care resources for patients with advanced cardiac diseases. These findings create a platform for future work that might: (1) confirm this training deficit, (2) lead to exploration of educational models that could reconcile this deficit, and (3) potentially help improve palliative care support for patients and families facing advanced heart disease.

New beginnings in hospice.

PubMed

Ryndes, T

1995-01-01

Healthcare decisionmakers in acute settings might well benefit from lessons learned over two decades of hospice experience providing community-based, cost-effective care. Now the hospice concepts of interdisciplinary symptom management and transition counseling are being made available to patients and families long before they reach the traditional six-month prognosis entry point.

A Military Hospice Model

DTIC Science & Technology

1983-05-06

that apply) A. A hospice inpatient facility; B. An inpatient unit in a a. Hospital; b. Intermediate Care Facility ; c. Skilled Nursing facility; C. A...Care Hospital Intermediate Care Facility SNF Hospice Other No License Page 3 V. "WEIGHTED" STANDARDS Please feel free to indicate with a "W" in the

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

Code of Federal Regulations, 2014 CFR

2014-10-01

... throughout the night; and (iii) Physical space for family privacy after a patient's death. (2) The hospice..., training, and experience in techniques used to address patients' behaviors. (4) Training documentation. The... were successfully completed. (o) Standard: Death reporting requirements. Hospices must report deaths...

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

Code of Federal Regulations, 2013 CFR

2013-10-01

... throughout the night; and (iii) Physical space for family privacy after a patient's death. (2) The hospice..., training, and experience in techniques used to address patients' behaviors. (4) Training documentation. The... were successfully completed. (o) Standard: Death reporting requirements. Hospices must report deaths...

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

Code of Federal Regulations, 2011 CFR

2011-10-01

... throughout the night; and (iii) Physical space for family privacy after a patient's death. (2) The hospice..., training, and experience in techniques used to address patients' behaviors. (4) Training documentation. The... were successfully completed. (o) Standard: Death reporting requirements. Hospices must report deaths...

Health benefits for the terminally ill: reality and perception.

PubMed

Gabel, J R; Hurst, K M; Hunt, K A

1998-01-01

This paper examines the availability and scope of hospice benefits as well as employers' attitudes and knowledge about care for the terminally ill. Data are drawn from a national random sample of 1,502 employers with 200 or more workers and from focus groups with employee benefits managers and their insurance advisers, brokers, and consultants. Major findings are that 83 percent of employers offer explicit hospice benefits, with most other firms covering hospice through high-cost case management. Most employers support the concept of hospice care because they believe that it reduces medical expenses.

Hospice and nursing homes.

PubMed

Castle, N G

1999-01-01

In this article a descriptive analysis of nursing homes with special care hospice units is provided. These are compared to nursing homes with other special care units and to nursing homes without any special care units. An analysis of the determinants of nursing homes with special care hospice units is also provided. Factors such as ownership, staffing levels, having other special care units, case-mix intensity, competitiveness of the nursing home market, and the state Medicaid reimbursement rate structure are examined. Finally, the influence of policies on hospice care in nursing homes is discussed.

Exploring professional boundaries in end-of-life care: considerations for hospice social workers and other members of the team.

PubMed

Sanders, Sara; Bullock, Karen; Broussard, Crystal

2012-01-01

Hospice social workers and members of the interdisciplinary team develop close therapeutic relationships with patients and families as they journey toward death. During this process, situations can develop that challenge professional boundaries and blur the line between a professional and personal relationship. This article will examine professional boundaries within the context of hospice care through case studies identifying challenges that hospice social workers and members of the interdisciplinary team may encounter with recommendations for how to manage boundary concerns.

Interactional communication challenges in end-of-life care: dialectical tensions and management strategies experienced by home hospice nurses.

PubMed

Gilstrap, Cristina M; White, Zachary M

2015-01-01

This study examines the dialectical tensions experienced by home hospice nurses in interactions with patients, families, and health care providers. In-depth, semistructured interviews were conducted with 24 home hospice nurses from a mid-size for-profit hospice organization serving approximately 230 patients on an annual basis. Interviews revealed hospice nurses experience both interpersonal and organizational dialectics during hospice interactions: authoritative-nonauthoritative, revelation-concealment, independence-collaboration, and quality of care-business of care. Dialectics often resulted as a by-product of (a) responding to expectations and care choices of patients and families particular to the emotionally charged home context, (b) obtaining authorization from health care providers who are not members of the interdisciplinary team, and (c) pressures associated with providing quality patient care while fulfilling organizational role requirements. The praxis strategies used to negotiate tensions included segmentation, balance, recalibration, and spiraling inversion. Specifically, nurses employed strategies such as ascertaining family/patient acceptance, using persuasive tactics when communicating with external health care providers, relying on effective time management, and working off the clock to provide more in-person care. Although functional for patients and hospice organizations, nurses who continually rely on these strategies may experience job stress when their interpersonal commitments repeatedly conflict with organizational role demands.

A Qualitative Analysis of Information Sharing in Hospice Interdisciplinary Group Meetings.

PubMed

Washington, Karla T; Demiris, George; Parker Oliver, Debra; Swarz, Jeffrey A; Lewis, Alexandria M; Backonja, Uba

2017-12-01

In the United States, hospice agencies are required to convene interdisciplinary group (IDG) meetings no less frequently than every 15 days to review patients' care plans. Challenges associated with information sharing during these meetings can impede efficiency and frustrate attendees. We sought to examine information sharing in the context of hospice IDG meetings as a first step toward developing an informatics tool to support interdisciplinary collaboration in this setting. Specifically, we wanted to better understand the purpose of information sharing in IDG meetings and determine the type(s) of information required to fulfill that purpose. Methods, Setting, and Participants: In this qualitative descriptive study, we analyzed video recordings of care plan discussions (n = 57) in hospice IDG meetings and individual interviews of hospice providers (n = 24). Data indicated that sharing physical, psychosocial, and spiritual information is intended to optimize hospice teams' ability to deliver whole-person care that is aligned with patient and family goals and that satisfies regulatory requirements. Information sharing is a key function of hospice teams in IDG meetings. Informatics tools may optimize IDG meeting efficiency by succinctly presenting well-organized and required information that is relevant to all team members. Such tools should highlight patient and family goals and ensure that teams are able to satisfy regulatory requirements.

An analysis of knowledge and attitudes of hospice staff towards organ and tissue donation.

PubMed

Wale, J; Arthur, A; Faull, C

2014-03-01

Only a minority of hospice patients eligible to donate tissue and organs choose to do so. Hospice care staff play a key role in discussions about donation, but their willingness to engage in these discussions and their understanding of issues around tissue and organ donation is poorly understood. To (i) identify factors associated with the wish of hospice doctors, nurses and healthcare assistants to donate their own organs after death; (ii) survey the experience of discussing the subject with patients; (iii) determine staff members' knowledge of organ and tissue donation and (iv) identify factors associated with knowledge of organ and tissue donation. Cross-sectional questionnaire survey of hospice care staff. 76 of the 94 care staff of one large UK hospice completed and returned the questionnaire. Staff wishing to donate their organs after death (43/76 56.6%) were more likely to be doctors or nurses than healthcare assistants (p=0.011) and more likely to have discussed organ or tissue donation with their family (p<0.001). Staff reporting ever having discussed donation with patients had more years' experience (p=0.045) and had similarly discussed donation with their own family (p=0.039). Those with greater knowledge were more likely to have discussed organ or tissue donation with a patient (p=0.042). A reluctance to instigate discussions about organ and tissue donation may prevent palliative patients and their families being allowed the opportunity to donate. Suboptimal knowledge among hospice staff suggests the need for greater liaison between hospice staff, and the organ and tissue donation teams.

The effects of the Balanced Budget Act of 1997 on home health and hospice in older adult cancer patients.

PubMed

Kilgore, Meredith L; Grabowski, David C; Morrisey, Michael A; Ritchie, Christine S; Yun, Huifeng; Locher, Julie L

2009-03-01

Home health and hospice services can constitute important elements in the continuum of care for older adults diagnosed with cancer. The Balanced Budget Act (BBA) of 1997 included provisions affecting those services. The first objective of this study is to assess the effect of the BBA of 1997 on home health and hospice service utilization in older cancer patients. The second objective is to estimate the effect of the BBA of 1997 on costs associated specifically with home health and hospice services and on total costs of care. The final objective is to evaluate the effect of the BBA of 1997 on mortality in these patients. Longitudinal analysis using the Surveillance, Epidemiology, and End Results-Medicare Database, covering a service area that includes 26% of the US population. Community-dwelling Medicare beneficiaries 65 years of age and older. Utilization rates of home health and hospice services; costs associated with those services, and total costs of care; and mortality. Home health utilization rates dropped substantially and hospice utilization rates increased after the BBA. Medicare costs for home health services declined as did total Medicare costs but hospice costs increased. There was no discernable effect on mortality rates. The BBA was successful in containing the costs of home health services and resulted in savings in overall costs of care for older cancer patients. Reduction in utilization of home health services did not seem to negatively affect outcomes. The BBA may have contributed to the trend of increasing use of hospice care.

Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer.

PubMed

De Vries, Kay; Plaskota, Marek

2017-04-01

Palliative sedation is a method of symptom management frequently used in hospices to treat uncontrolled symptoms at the end of life. There is a substantial body of literature on this subject; however, there has been little research into the experiences of hospice nurses when administering palliative sedation in an attempt to manage the terminal restlessness experienced by cancer patients. Semistructured interviews were conducted with a purposive sample of seven hospice nurses who had cared for at least one patient who had undergone palliative sedation within the past year in a hospice in the south of England in the United Kingdom. A phenomenological approach and Colaizzi's stages of analysis were employed to develop themes from the data. Facilitating a "peaceful death" was the primary goal of the nurses, where through the administration of palliative sedation they sought to enable and support patients to be "comfortable," "relaxed," and "calm" at the terminal stage of their illness. Ethical dilemmas related to decision making were a factor in achieving this. These were: medication decisions, "juggling the drugs," "causing the death," sedating young people, the family "requesting" sedation, and believing that hospice is a place where death is hastened. Hospice nurses in the U.K. frequently encounter ethical and emotional dilemmas when administering palliative sedation. Making such decisions about using palliative sedation causes general discomfort for them. Undertaking this aspect of care requires confidence and competence on the part of nurses, and working within a supportive hospice team is of fundamental importance in supporting this practice.

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.

76 FR 37686 - Wage Methodology for the Temporary Non-Agricultural Employment H-2B Program; Amendment of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-28

... electronic file on computer disk. The Department will consider providing the proposed rule in other formats... format, contact the Office of Policy Development and Research at (202) 693-3700 (VOICE) (this is not a... August 30, 2010 order,\\1\\ arguing that the Wage Rule violated the Administrative Procedure Act (APA...

Gender, Career and Technical Education (CTE) Nontraditional Coursetaking, and Wage Gap

ERIC Educational Resources Information Center

Fluhr, Stephanie A.; Choi, Namok; Herd, Ann; Woo, Hongryun; Alagaraja, Meera

2017-01-01

The two main objectives of this study were to examine the relationship between high school student (9th-12th) gender and nontraditional career and technical education (CTE) course taking, and the combined effects of gender and program area on estimated future wage earnings for male and female CTE completers. A Midwestern state CTE database…

Hospice Care in Nursing Homes: Does It Contribute to Higher Quality Pain Management?

ERIC Educational Resources Information Center

Kayser-Jones, Jeanie S.; Kris, Alison E.; Miaskowski, Christine A.; Lyons, William L.; Paul, Steven M.

2006-01-01

Purpose: The purpose of this study was to investigate pain management among 42 hospice and 65 non-hospice residents in two proprietary nursing homes. Design and Methods: In this prospective, anthropological, quantitative, and qualitative study, we used participant observation, event analysis, and chart review to obtain data. The Medication…

76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-21

... concerning the billing methodology for non-VA providers of home health services and hospice care. The proposed rulemaking would include home health services and hospice care under the VA regulation governing payment for other non-VA health care providers. Because the newly applicable methodology cannot supersede...

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

Code of Federal Regulations, 2013 CFR

2013-10-01

... evaluation and counseling services. 418.205 Section 418.205 Public Health CENTERS FOR MEDICARE & MEDICAID... Covered Services § 418.205 Special requirements for hospice pre-election evaluation and counseling... pre-election evaluation and counseling services as specified in § 418.304(d) may be made to a hospice...

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

Code of Federal Regulations, 2012 CFR

2012-10-01

... evaluation and counseling services. 418.205 Section 418.205 Public Health CENTERS FOR MEDICARE & MEDICAID... Covered Services § 418.205 Special requirements for hospice pre-election evaluation and counseling... pre-election evaluation and counseling services as specified in § 418.304(d) may be made to a hospice...

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

Code of Federal Regulations, 2014 CFR

2014-10-01

... evaluation and counseling services. 418.205 Section 418.205 Public Health CENTERS FOR MEDICARE & MEDICAID... Covered Services § 418.205 Special requirements for hospice pre-election evaluation and counseling... pre-election evaluation and counseling services as specified in § 418.304(d) may be made to a hospice...

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…

Development and Validation of the Hospice Professionals' Understanding of Preparatory Grief Scale

ERIC Educational Resources Information Center

Prost, Stephanie Grace

2017-01-01

Purpose: It is critical to assess hospice professionals' discrimination between adaptive and maladaptive reactions to terminal illness in persons at the end-of-life to assure targeted intervention aimed at maintaining quality of life. The proposed measure, the Hospice Professionals Understanding of Preparatory Grief scale (HPPG), contains…

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

... Hospice Care to Non-VA Providers AGENCY: Department of Veterans Affairs. ACTION: Final rule. SUMMARY: The Department of Veterans Affairs (VA) amends its regulations concerning the billing methodology for non-VA... billing methodology for non-VA providers of home health services and hospice care. The proposed rulemaking...

Update in Hospice and Palliative Care.

PubMed

Taylor, Richard A; Smith, Cardinale B; Coats, Heather; Gelfman, Laura P; Dionne-Odom, J Nicholas

2017-11-01

The objective of this update, presented at the 2017 Annual Assembly of the American Association of Palliative and Hospice Medicine (AAHPM) and the Hospice and Palliative Nurses Association (HPNA), is to identify, summarize, and critique a sampling of research from the prior year that has the potential for marked impact on hospice and palliative clinical practice. Eight reports of original research published between January 1, 2016 and December 31, 2016 were identified through a systematic PubMed search using the terms "hospice" and "palliative care," a hand search of 22 leading healthcare journals, and discussion with experts in the field. Candidate articles were ranked based on the study's methodological quality, appeal to a breadth of palliative care clinicians across different settings, and potential clinical practice impact. We summarize the eight articles with the highest ratings and give recommendations for clinical practice.

"Notice how you feel": an alternative to detached concern among hospice volunteers.

PubMed

Fox, John

2006-09-01

Medical schools teach physicians to practice "detached concern," a simultaneous emotional distance from and sensitivity toward their patients. Medical students learn detachment to protect themselves from emotion-laden experiences, including death and dying, by employing mechanisms of defense and adjustment, such as suppression and repression of emotions. In this study, the author inquires whether hospice volunteers are trained for and practice detached concern and finds that hospice volunteers are trained for concern. They are concerned for the well-being of patients and their families. The author argues that concern is a social product that can be trained; hospice volunteers are not trained to suppress and repress their emotions, and the hospice as an institution produces and transmits cultural norms, values, and practices surrounding death and dying, thus maintaining a pool of concerned volunteers.

42 CFR 419.21 - Hospital outpatient services subject to the outpatient prospective payment system.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... (c) Partial hospitalization services furnished by community mental health centers (CMHCs). (d) The following medical and other health services furnished by a home health agency (HHA) to patients who are not under an HHA plan or treatment or by a hospice program furnishing services to patients outside the...

78 FR 16632 - Medicare Program; Part B Inpatient Billing in Hospitals

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-18

...-hospital Skilled Nursing Facility (SNF) care, because section 1861(i) of the Act requires a prior 3-day... outpatients rather than inpatients or expanding the number of payable Part B inpatient services could impact... an inpatient in a hospital, SNF, hospice, or nursing home.'' Therefore, under our proposal these...

Extensions to regret-based decision curve analysis: an application to hospice referral for terminal patients.

PubMed

Tsalatsanis, Athanasios; Barnes, Laura E; Hozo, Iztok; Djulbegovic, Benjamin

2011-12-23

Despite the well documented advantages of hospice care, most terminally ill patients do not reap the maximum benefit from hospice services, with the majority of them receiving hospice care either prematurely or delayed. Decision systems to improve the hospice referral process are sorely needed. We present a novel theoretical framework that is based on well-established methodologies of prognostication and decision analysis to assist with the hospice referral process for terminally ill patients. We linked the SUPPORT statistical model, widely regarded as one of the most accurate models for prognostication of terminally ill patients, with the recently developed regret based decision curve analysis (regret DCA). We extend the regret DCA methodology to consider harms associated with the prognostication test as well as harms and effects of the management strategies. In order to enable patients and physicians in making these complex decisions in real-time, we developed an easily accessible web-based decision support system available at the point of care. The web-based decision support system facilitates the hospice referral process in three steps. First, the patient or surrogate is interviewed to elicit his/her personal preferences regarding the continuation of life-sustaining treatment vs. palliative care. Then, regret DCA is employed to identify the best strategy for the particular patient in terms of threshold probability at which he/she is indifferent between continuation of treatment and of hospice referral. Finally, if necessary, the probabilities of survival and death for the particular patient are computed based on the SUPPORT prognostication model and contrasted with the patient's threshold probability. The web-based design of the CDSS enables patients, physicians, and family members to participate in the decision process from anywhere internet access is available. We present a theoretical framework to facilitate the hospice referral process. Further rigorous clinical evaluation including testing in a prospective randomized controlled trial is required and planned.

Extensions to Regret-based Decision Curve Analysis: An application to hospice referral for terminal patients

PubMed Central

2011-01-01

Background Despite the well documented advantages of hospice care, most terminally ill patients do not reap the maximum benefit from hospice services, with the majority of them receiving hospice care either prematurely or delayed. Decision systems to improve the hospice referral process are sorely needed. Methods We present a novel theoretical framework that is based on well-established methodologies of prognostication and decision analysis to assist with the hospice referral process for terminally ill patients. We linked the SUPPORT statistical model, widely regarded as one of the most accurate models for prognostication of terminally ill patients, with the recently developed regret based decision curve analysis (regret DCA). We extend the regret DCA methodology to consider harms associated with the prognostication test as well as harms and effects of the management strategies. In order to enable patients and physicians in making these complex decisions in real-time, we developed an easily accessible web-based decision support system available at the point of care. Results The web-based decision support system facilitates the hospice referral process in three steps. First, the patient or surrogate is interviewed to elicit his/her personal preferences regarding the continuation of life-sustaining treatment vs. palliative care. Then, regret DCA is employed to identify the best strategy for the particular patient in terms of threshold probability at which he/she is indifferent between continuation of treatment and of hospice referral. Finally, if necessary, the probabilities of survival and death for the particular patient are computed based on the SUPPORT prognostication model and contrasted with the patient's threshold probability. The web-based design of the CDSS enables patients, physicians, and family members to participate in the decision process from anywhere internet access is available. Conclusions We present a theoretical framework to facilitate the hospice referral process. Further rigorous clinical evaluation including testing in a prospective randomized controlled trial is required and planned. PMID:22196308

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

PubMed Central

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

2014-01-01

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

Demographics, Resource Utilization, and Outcomes of Elderly Patients With Chronic Liver Disease Receiving Hospice Care in the United States.

PubMed

Fukui, Natsu; Golabi, Pegah; Otgonsuren, Munkhzul; Mishra, Alita; Venkatesan, Chapy; Younossi, Zobair M

2017-11-01

Hospice offers non-curative symptomatic management to improve patients' quality of life, satisfaction, and resource utilization. Hospice enrollment among patients with chronic liver disease (CLD) is not well studied. The aim of tis tudy is to examine the characteristics of Medicare enrollees with CLD, who were discharged to hospice. Medicare patients discharged to hospice between 2010 and 2014 were identified in Medicare Inpatient and Hospice Files. CLDs and other co-morbidities were identified by International Classification of Diseases-ninth revision codes. Generalized linear model was used to estimate regression coefficients with P-values. Logistic regression was used to calculate odds ratios and 95% confidence intervals. A total of 2,179 CLD patients and 34,986 controls without CLD met the inclusion criteria. Non-alcoholic fatty liver disease, alcoholic liver disease, and hepatitis C virus (HCV) were the most frequent cause of CLD. CLD patients were younger (70 vs. 83 years), more likely to be male (57.7 vs. 39.3%), had longer hospital stay (length of stay, LOS) (19.4 vs. 13.0 days), higher annual charges ($175,000 vs. $109,000), higher 30-day re-hospitalization rates (51.6 vs. 34.2%), and shorter hospice LOS (13.7 vs. 17.7 days) than controls (all P<0.001). Presence of HCV and congestive heart failure were the strongest contributors to increased total annual costs (34% and 31% higher, P<0.001), increased total annual LOS (26% and 43% higher, P<0.001), and increased 30-day readmission risk (2.20 and 2.19 times, respectively). Patients with CLD have longer and costly hospitalizations before hospice enrollment as compared with patients without CLD. It was highly likely that these patients were enrolled relatively late, which could potentially lead to less benefit from hospice.

The rise of concurrent care for veterans with advanced cancer at the end of life.

PubMed

Mor, Vincent; Joyce, Nina R; Coté, Danielle L; Gidwani, Risha A; Ersek, Mary; Levy, Cari R; Faricy-Anderson, Katherine E; Miller, Susan C; Wagner, Todd H; Kinosian, Bruce P; Lorenz, Karl A; Shreve, Scott T

2016-03-01

Unlike Medicare, the Veterans Health Administration (VA) health care system does not require veterans with cancer to make the "terrible choice" between receipt of hospice services or disease-modifying chemotherapy/radiation therapy. For this report, the authors characterized the VA's provision of concurrent care, defined as days in the last 6 months of life during which veterans simultaneously received hospice services and chemotherapy or radiation therapy. This retrospective cohort study included veteran decedents with cancer during 2006 through 2012 who were identified from claims with cancer diagnoses. Hospice and cancer treatment were identified using VA and Medicare administrative data. Descriptive statistics were used to characterize the changes in concurrent care, hospice, palliative care, and chemotherapy or radiation treatment. The proportion of veterans receiving chemotherapy or radiation therapy remained stable at approximately 45%, whereas the proportion of veterans who received hospice increased from 55% to 68%. The receipt of concurrent care also increased during this time from 16.2% to 24.5%. The median time between hospice initiation and death remained stable at around 21 days. Among veterans who received chemotherapy or radiation therapy in their last 6 months of life, the median time between treatment termination and death ranged from 35 to 40 days. There was considerable variation between VA medical centers in the use of concurrent care (interquartile range, 16%-34% in 2012). Concurrent receipt of hospice and chemotherapy or radiation therapy increased among veterans dying from cancer without reductions in the receipt of cancer therapy. This approach reflects the expansion of hospice services in the VA with VA policy allowing the concurrent receipt of hospice and antineoplastic therapies. Cancer 2016;122:782-790. © 2015 American Cancer Society. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Care planning for pressure ulcers in hospice: the team effect.

PubMed

Eisenberger, Andrew; Zeleznik, Jomarie

2004-09-01

The standards of care for patients at risk for or with a pressure ulcer in hospitals and nursing homes focus on prevention and ulcer healing using an interdisciplinary approach. Although not a primary hospice condition, pressure ulcers are not uncommon in dying patients. Their management in hospices, particularly the involvement of family caregivers, has not been studied. The objective of this study is to identify the factors that influence care planning for the prevention and treatment of pressure ulcers in hospice patients and develop a taxonomy to use for further study. A telephone survey was conducted with 18 hospice directors of clinical services and 10 direct-care nurses. Descriptive qualitative data analysis using grounded theory was utilized. The following three themes were identified: (1) the primary role of the hospice nurse is an educator rather than a wound care provider; (2) hospice providers perceive the barriers and burdens of family caregiver involvement in pressure ulcer care to be bodily location of the pressure ulcer, unpleasant wound characteristics, fear of causing pain, guilt, and having to acknowledge the dying process when a new pressure ulcer develops; and (3) the "team effect" describes the collaboration between family caregivers and the health care providers to establish individualized achievable goals of care ranging from pressure ulcer prevention to acceptance of a pressure ulcer and symptom palliation. Pressure ulcer care planning is a model of collaborative decision making between family caregivers and hospice providers for a condition that occurs as a secondary condition in hospice. A pressure ulcer places significant burdens on family caregivers distinct from common end-of-life symptoms whose treatment is directed at the patient. Because the goals of pressure ulcer care appear to be individualized for a dying patient and their caregivers, the basis of quality-of-care evaluations should be the process of care rather than the outcome of an incident pressure ulcer.

[Cancer Disease Trajectory and the Contribution of Artistic Outreach Activity to Palliative Care].

PubMed

Oshiro, Hisako; Oshiro, Tatsuo; Tanimizu, Masahito

2018-03-01

The purpose of this article is to show some unintentional aspects of palliative supports offered by the community. The activities of the Opera Ehime, an amateur opera group, play an important role in palliative and grief care. This community is also committed to providing supportive care for home hospice cancer patients through an outreach music program that offers patients connection with others and reduces isolation. Assessment by the coordinator includes determiningthe patients' preferences and the relevance of music throughout their lives. Then, the coordinator predicts the cancer trajectory and invites patients to participate in the home hospice concert at any stage of their illness. These activities are an effective form of supportingcancer care for patients to promote wellness and improve physical and emotional well-being, as well as quality of life.

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

Code of Federal Regulations, 2011 CFR

2011-10-01

... evaluation and counseling services. 418.205 Section 418.205 Public Health CENTERS FOR MEDICARE & MEDICAID... Services § 418.205 Special requirements for hospice pre-election evaluation and counseling services. (a... evaluation and counseling services as specified in § 418.304(d) may be made to a hospice on behalf of a...

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

Code of Federal Regulations, 2010 CFR

2010-10-01

... evaluation and counseling services. 418.205 Section 418.205 Public Health CENTERS FOR MEDICARE & MEDICAID... Services § 418.205 Special requirements for hospice pre-election evaluation and counseling services. (a... evaluation and counseling services as specified in § 418.304(d) may be made to a hospice on behalf of a...

Hospice in Assisted Living: Promoting Good Quality Care at End of Life

ERIC Educational Resources Information Center

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

2009-01-01

Purpose: 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). Design and Methods: A qualitative descriptive design was used to obtain detailed descriptions of EOL care provided by ALF medication aides, caregivers, nurses, and hospice nurses in…

Knowledge About Hospice Care and Beliefs About Pain Management: Exploring Differences Between Hispanics and Non-Hispanics.

PubMed

Carrion, Iraida V; Cagle, John G; Van Dussen, Daniel J; Culler, Krystal L; Hong, Seokho

2015-09-01

Among Hispanics, incomplete knowledge about hospice care may explain low rates of utilization and culturally-specific beliefs about pain and pain treatments may contribute to disparities in pain management. To compare (1) knowledge and attitudes regarding hospice, (2) and beliefs about pain and pain medication between Hispanics and non-Hispanics. A cross-sectional phone-based survey of adults living in the contiguous United States was conducted using randomly selected phone numbers with over-sampling for diversity. Measures assessed knowledge (a 23-item test), attitudes (an 8-item scale), experiences, preferences related to hospice and beliefs regarding pain and pain management. 123 individuals participated in the survey, 13% of whom were Hispanic. Hispanics were less likely to have heard of hospice are (p <. 001) and, among those who had, more likely to have inaccurate information about it (p = .05). Specifically, Hispanics were more likely to report that only individuals over age 65 are eligible for hospice services, which is incorrect (44% vs. 93% of non-Hispanics; p=.001). Only 67% of Hispanics knew that hospice helps family members as well as the dying person. More Hispanics (43%) than non-Hispanics (9.3%) reported that admitting pain is a sign of weakness (p < .001). A greater proportion of Hispanic respondents agreed that a good patient does not talk about pain (p = .07): 38% vs. 18% from non-Hispanics. Despite the increasing knowledge of hospice care among Hispanics, specific information about the scope of services remains limited. Cultural beliefs about pain management, along with inadequate knowledge of the role of pain management at end of life, persist. © The Author(s) 2014.

Exploring the Association of Hospice Care on Patient Experience and Outcomes of Care

PubMed Central

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

2016-01-01

Objective 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 characterized. Methods 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 organizational characteristics for 236 US hospitals to examine the relationship between hospice utilization and a number of variables that represent care value including hospital care intensity index, hospital deaths, ICU deaths, patient satisfaction, and a number of patient quality indicators. Structural equation modeling was used to demonstrate the effect of hospice use on patient experience of care variables, clinical outcomes of care variables, and efficiency of care variables. Results 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 deaths in the hospital (r=−0.842, p=0.01), and fewer deaths occurring with an ICU admission during hospitalization (r=−0.358, p=0.01). The structural equation model identified use of hospice care was inversely related to both hospital mortality (−.885) and ICU mortality rate (−.457). Conclusions The results of this investigation demonstrate that greater utilization of hospice care during the last 6-months of life is associated with improved patient experience of care including satisfaction and pain control, as well as clinical outcomes of care including decreased ICU and hospital mortality. PMID:27531840

The Quality Improvement Environment: Results of the 2016 AAHPM/HPNA Membership Needs Assessment Survey.

PubMed

Lindley, Lisa C; Rotella, Joseph D; Ast, Katherine; Matzo, Marianne; Kamal, Arif H

2017-11-01

The American Academy of Hospice and Palliative Medicine (AAHPM) and Hospice and Palliative Nurses Association (HPNA) convened the Measuring What Matters (MWM) initiative in 2013, which recommended 10 quality performance measures; yet, little is known about the quality improvement (QI) environment and implementation of the MWM among hospices and palliative care services. The objective of this study was to describe the findings of the 2016 AAHPM/HPNA Needs Assessment survey exploring the QI environment among hospice and palliative care services. An online survey was distributed to approximately 16,500 AAHPM and HPNA members, and other hospice and palliative care organizations were invited to respond. Summary data and individual write-in responses were collated and analyzed. Data analysis included generating descriptive statistics and analyzing individual write-in responses for additional information and themes. More than 1000 responses were received. Most organizations had a designated QI leader and used an electronic medical record. Less than 50% of systems had fields for palliative care information. The top three MWM measures collected through an electronic medical record were pain treatment (66%), screening for physical symptoms (55%), and comprehensive assessment (54%). The most common barrier to implementing QI was time constraint. Most respondents had received no training and education in how to implement QI. The 2016 AAHPM/HPNA Needs Assessment Survey provided important information about the QI systems and measurement environment within hospice and palliative care services. Survey insights can aid AAHPM/HPNA in developing resources to empower hospice and palliative care clinicians to make QIs that matter for their patients and families. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Music Therapy Clinical Practice in Hospice: Differences Between Home and Nursing Home Delivery.

PubMed

Liu, Xiaodi; Burns, Debra S; Hilliard, Russell E; Stump, Timothy E; Unroe, Kathleen T

2015-01-01

Hospice music therapy is delivered in both homes and nursing homes (NH). No studies to date have explored differences in music therapy delivery between home and NH hospice patients. To compare music therapy referral reasons and delivery for hospice patients living in NH versus home. A retrospective, electronic medical record review was conducted from a large U.S. hospice of patients receiving music therapy between January 1, 2006, and December 31, 2010. Among the 4,804 patients, 2,930 lived in an NH and 1,847 patients lived at home. Compared to home, NH hospice patients were more likely to be female, older, unmarried, and Caucasian. For home hospice patients, the top referral reasons were patient/family emotional and spiritual support, quality of life, and isolation. The most frequent referral reasons for NH hospice patients were isolation, quality of life, and patient/family emotional and spiritual support. Differences in music therapy delivery depended mainly on patients' primary diagnosis and location of care. Results suggest differences in referral reasons and delivery based on an interaction between location of care and patient characteristics. Delivery differences are likely a result of individualized assessment and care plans developed by the music therapist and other interdisciplinary team members to address the unique needs of the patient. Thus, it is important to have professionally trained music therapists assess and provide tailored music-based interventions for patients with different referral reasons and personal characteristics. This study also supports staffing decisions based on patient need rather than average daily census. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

University-Community-Hospice Partnership to Address Organizational Barriers to Cultural Competence.

PubMed

Reese, Dona J; Buila, Sarah; Cox, Sarah; Davis, Jessica; Olsen, Meaghan; Jurkowski, Elaine

2017-02-01

Research documents a lack of access to, utilization of, and satisfaction with hospice care for African Americans. Models for culturally competent hospice services have been developed but are not in general use. Major organizational barriers include (1) lack of funding/budgeting for additional staff for community outreach, (2) lack of applications from culturally diverse professionals, (3) lack of funding/budgeting for additional staff for development of culturally competent services, (4) lack of knowledge about diverse cultures, and (5) lack of awareness of which cultural groups are not being served. A participatory action research project addressed these organizational barriers through a multicultural social work student field placement in 1 rural hospice. The effectiveness of the student interventions was evaluated, including addressing organizational barriers, cultural competence training of staff, and community outreach. Results indicated that students can provide a valuable service in addressing organizational barriers through a hospice field placement.

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

Determinants of Oregon hospice chaplains' views on physician-assisted suicide.

PubMed

Goy, Elizabeth R; Carlson, Bryant; Simopoulos, Nicole; Jackson, Ann; Ganzini, Linda

2006-01-01

Although religiousness is a strong predictor of attitudes towards physician-assisted suicide (PAS), Oregon hospice chaplains express wide variation in their opposition to or support for legalized PAS. We explored factors associated with chaplains' views on PAS. A mailed survey to chaplains from 51 Oregon hospices. Fifty of 77 eligible hospice chaplains (65%) returned surveys. Views on PAS were associated with views on suicide in general. Moral and theological beliefs were the most important influences on views on PAS. Chaplains who were opposed to PAS believed that God alone may take life, that life is an absolute good, and that suffering has a divine purpose. Those who supported PAS placed emphasis on the importance of self-determination and sanctity of life as defined by quality of life. Oregon hospice chaplains' diverse views towards PAS are closely related to their views on suicide in general, and their personal and theological beliefs.

Use of Electronic Documentation for Quality Improvement in Hospice

PubMed Central

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

2015-01-01

Little evidence exists on the use of electronic documentation in hospice and its relationship to quality improvement practices. The purposes of this study were to: (1) estimate the prevalence of electronic documentation use in hospice; (2) identify organizational characteristics associated with use of electronic documentation; and (3) determine whether quality measurement practices differed based on documentation format (electronic vs. nonelectronic). Surveys concerning the use of electronic documentation for quality improvement practices and the monitoring of quality-related care and outcomes were collected from 653 hospices. Users of electronic documentation were able to monitor a wider range of quality-related data than users of nonelectronic documentation. 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 electronic documentation. Use of electronic documentation may help hospices to monitor quality and compliance. PMID:22267819

45 CFR 2553.44 - May cost reimbursements received by a RSVP volunteer be subject to any tax or charge, treated as...

Code of Federal Regulations, 2014 CFR

2014-10-01

... volunteer be subject to any tax or charge, treated as wages or compensation, or affect eligibility to... VOLUNTEER PROGRAM Eligibility, Cost Reimbursements and Volunteer Assignments § 2553.44 May cost reimbursements received by a RSVP volunteer be subject to any tax or charge, treated as wages or compensation, or...

45 CFR 2553.44 - May cost reimbursements received by a RSVP volunteer be subject to any tax or charge, treated as...

Code of Federal Regulations, 2013 CFR

2013-10-01

... volunteer be subject to any tax or charge, treated as wages or compensation, or affect eligibility to... VOLUNTEER PROGRAM Eligibility, Cost Reimbursements and Volunteer Assignments § 2553.44 May cost reimbursements received by a RSVP volunteer be subject to any tax or charge, treated as wages or compensation, or...

45 CFR 2553.44 - May cost reimbursements received by a RSVP volunteer be subject to any tax or charge, treated as...

Code of Federal Regulations, 2011 CFR

2011-10-01

... volunteer be subject to any tax or charge, treated as wages or compensation, or affect eligibility to... VOLUNTEER PROGRAM Eligibility, Cost Reimbursements and Volunteer Assignments § 2553.44 May cost reimbursements received by a RSVP volunteer be subject to any tax or charge, treated as wages or compensation, or...

45 CFR 2553.44 - May cost reimbursements received by a RSVP volunteer be subject to any tax or charge, treated as...

Code of Federal Regulations, 2012 CFR

2012-10-01

... volunteer be subject to any tax or charge, treated as wages or compensation, or affect eligibility to... VOLUNTEER PROGRAM Eligibility, Cost Reimbursements and Volunteer Assignments § 2553.44 May cost reimbursements received by a RSVP volunteer be subject to any tax or charge, treated as wages or compensation, or...

20 CFR 603.23 - What information must State UC agencies obtain from other agencies, and crossmatch with wage...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What information must State UC agencies obtain from other agencies, and crossmatch with wage information, for purposes of an IEVS? 603.23 Section 603.23 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR FEDERAL-STATE UNEMPLOYMENT COMPENSATION (UC) PROGRAM;...

The Youth Entitlement Demonstration: Subsidized Employment with a Schooling Requirement.

ERIC Educational Resources Information Center

Farkas, George; And Others

1983-01-01

Describes a program of the Youth Incentive Entitlement Pilot Projects (YIEPP) that offered a minimum wage job to 16 to 19 year olds who were from low-income households and who were still enrolled in high school. Provides strong evidence that the unemployment of these youths is largely involuntary, due to demand deficiency at the minimum wage. (NRJ)

The Vermont Survey of Employer Receptivity to Wage Subsidy Programs in the Private Sector.

ERIC Educational Resources Information Center

Cashman, John R.; Mattson, Robert E.

The Vermont study details employer responses to a two-phase survey designed to gauge employer receptivity to the use of wage subsidies in the private sector. The "mail survey" obtained from a sample of 1,084 employers (of whom 71% responded) elicited responses to a limited number of questions, while the "face-to-face survey"…

How do marital status, work effort, and wage rates interact?

PubMed

Ahituv, Avner; Lerman, Robert I

2007-08-01

How marital status interacts with men's earnings is an important analytic and policy issue, especially in the context of debates in the United States over programs that encourage healthy marriage. This paper generates new findings about the earnings-marriage relationship by estimating the linkages among flows into and out of marriage, work effort, and wage rates. The estimates are based on National Longitudinal Survey of Youth panel data, covering 23 years of marital and labor market outcomes, and control for unobserved heterogeneity. We estimate marriage effects on hours worked (our proxy for work effort) and on wage rates for all men and for black and low-skilled men separately. The estimates reveal that entering marriage raises hours worked quickly and substantially but that marriage's effect on wage rates takes place more slowly while men continue in marriage. Together; the stimulus to hours worked and wage rates generates an 18%-19% increase in earnings, with about one-third to one-half of the marriage earnings premium attributable to higher work effort. At the same time, higher wage rates and hours worked encourage men to marry and to stay married. Thus, being married and having high earnings reinforce each other over time.

Medicare and Medicaid programs; fire safety requirements for certain health care facilities. Final rule.

PubMed

2003-01-10

This final rule amends the fire safety standards for hospitals, long-term care facilities, intermediate care facilities for the mentally retarded, ambulatory surgery centers, hospices that provide inpatient services, religious nonmedical health care institutions, critical access hospitals, and Programs of All-Inclusive Care for the Elderly facilities. Further, this final rule adopts the 2000 edition of the Life Safety Code and eliminates references in our regulations to all earlier editions.

Portraits of Caregivers of End-Stage Dementia Patients Receiving Hospice Care

ERIC Educational Resources Information Center

Sanders, Sara; Butcher, Howard K.; Swails, Peggy; Power, James

2009-01-01

The purpose of this study was to investigate how caregivers respond to the end stages of dementia with the assistance from hospice. Data were collected from 27 family caregivers over the course of 10 months, with each caregiver being interviewed up to 4 times during the time that the patient received hospice care. Chart review data were also…

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.

Developing a nurse led hospice outpatient clinic to improve palliative care services.

PubMed

Lawton, Catherine

A team of palliative care clinical nurse specialists at the Phyllis Tuckwell Hospice in Farnham, Surrey, set up a hospice based outpatient clinic to improve services for patients with cancer. This article examines how the team used clinical audit, a staff questionnaire and patient feedback to evaluate the service and make recommendations for the future development of the clinic.

42 CFR 418.116 - Condition of participation: Compliance with Federal, State, and local laws and regulations...

Code of Federal Regulations, 2012 CFR

2012-10-01

..., State, and local laws and regulations related to the health and safety of patients. 418.116 Section 418... related to the health and safety of patients. The hospice and its staff must operate and furnish services... health and safety of patients. If State or local law provides for licensing of hospices, the hospice must...

42 CFR 418.116 - Condition of participation: Compliance with Federal, State, and local laws and regulations...

Code of Federal Regulations, 2014 CFR

2014-10-01

..., State, and local laws and regulations related to the health and safety of patients. 418.116 Section 418... related to the health and safety of patients. The hospice and its staff must operate and furnish services... health and safety of patients. If State or local law provides for licensing of hospices, the hospice must...

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

...; counseling (including spiritual, dietary and bereavement); social work; provision of medical supplies... hospice must: (1) Designate a member of each interdisciplinary group that is responsible for a patient who is a resident of a SNF/NF or ICF/MR. The designated interdisciplinary group member is responsible for...

78 FR 68364 - Payment for Home Health Services and Hospice Care to Non-VA Providers; Delay of Effective Date

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-14

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and... providers of home health services and hospice care. The preamble of that final rule stated the effective... 17.56, applicable to non-VA home health services and hospice care. Section 17.56 provides, among...

Hospice Use among Urban Black and White U.S. Nursing Home Decedents in 2006

ERIC Educational Resources Information Center

Lepore, Michael J.; Miller, Susan C.; Gozalo, Pedro

2011-01-01

Purpose: Medicare hospice is a valuable source of quality care at the end of life, but its lower use by racial minority groups is of concern. This study identifies factors associated with hospice use among urban Black and White nursing home (NH) decedents in the United States. Design and Methods: Multiple data sources are combined and multilevel…

Referral and Timing of Referral to Hospice Care in Nursing Homes: The Significant Role of Staff Members

ERIC Educational Resources Information Center

Welch, Lisa C.; Miller, Susan C.; Martin, Edward W.; Nanda, Aman

2008-01-01

Purpose: Given concerns about end-of-life care for many nursing home (NH) residents, this study sought to understand factors influencing hospice referral or nonreferral as well as timing of referral. Design and Methods: We conducted semistructured interviews with personnel from seven participating NHs and two hospices. We interviewed NH directors…

Team functioning in hospice interprofessional meetings: An exploratory study of providers' perspectives.

PubMed

Washington, Karla T; Guo, Yuqi; Albright, David L; Lewis, Alexandria; Parker Oliver, Debra; Demiris, George

2017-07-01

Interprofessional collaboration is the foundation of hospice service delivery. In the United States, hospice agencies are required to regularly convene interprofessional meetings during which teams review plans of care for the patients and families they serve. A small body of research suggests that team functioning could be significantly enhanced in hospice interprofessional meetings; however, systematic investigation of this possibility has been limited to date. The purpose of this qualitative study was to better understand the experiences and perspectives of hospice providers who regularly participate in interprofessional meetings as a first step toward improving teamwork in this setting. We interviewed 24 hospice providers and conducted a template analysis of qualitative data to identify barriers and facilitators to effective team functioning in interprofessional meetings. Participants recognised the ways meetings supported high-quality, holistic patient and family care but voiced frustrations over meeting inefficiencies, particularly in light of caseloads they perceived as overly demanding. Time constraints were often viewed as prohibiting the inclusion of interprofessional content and full participation of all team members. Findings suggest that modifications to interprofessional meetings such as standardising processes may enhance meeting efficiency and team functioning.

'A bridge to the hospice': the impact of a Community Volunteer Programme in Uganda.

PubMed

Jack, Barbara A; Kirton, J; Birakurataki, J; Merriman, A

2011-10-01

In Africa, the need for palliative care provision is escalating with an increasing number of people living with HIV/AIDS, coupled with rising cancer and AIDS-related cancer diagnoses. In Uganda there is a shortage of doctors, particularly in rural areas. To address this Hospice Africa Uganda developed a Community Volunteer Programme to train volunteers to help by providing support to patients in their own homes. The aim of this qualitative study was to evaluate the impact of the Community Volunteer Programme. Sixty-four interviews, with patients (21), community volunteer workers (CVWs) (32), and the hospice clinical teams (11) were conducted, using semi-structured digitally recorded individual, group and focus group interviews, at the Hospice Africa Uganda sites. The results reported the value of the Community Volunteer Programme, including the impact on patients and families, and how the CVWs acted as a 'bridge to the hospice' in identifying patients. Developing financial challenges that are emerging which could potentially impact on the programme were reported. The Community Volunteer Programme appears to be having a positive impact on patients, families and the hospice team, and is a model worthy of consideration by other developing countries to allow the expansion of palliative care.

Short break and emergency respite care: what options for young people with life-limiting conditions?

PubMed

Mitchell, Tracy K; Knighting, Katherine; O'Brien, Mary R; Jack, Barbara A

2016-02-01

Service providers face difficult decisions about how best to develop services for the increasing numbers of young people with life-limiting conditions who require palliative care. To explore alternative short break and emergency respite care options to children's hospice care. A two-phase evaluation with young people, families and professionals. Phase 1: qualitative semi-structured interviews and focus groups (n=53). Phase 2: mixed-method survey (n=82), qualitative findings only. There were few, or no, appropriate short break and emergency respite care alternatives when children's hospice care was not available that can meet the need of young people with life-limiting conditions, creating anxiety for children's hospice users and those leaving the service as a result of reaching transition age or through no longer meeting the children's hospice eligibility criteria. Access to appropriate short break and emergency respite care is required to prevent lifelong negative consequences for young people with life-limiting conditions, their family and society. Research is undoubtedly required to explore the impact and outcomes of children's hospice discharge for young people and their family. Particular attention should be paid to the lack of services for an increasing population making the transition from children's hospices.

The development of funding policies for hospices: is casemix-based funding an option?

PubMed

Carter, H; MacLeod, R; Hicks, E; Carter, J

1999-06-25

The 1993 health reforms, with their emphasis on the purchasing of defined amounts or units of service, have led to the implementation of casemix-based funding for the acute medical and surgical services of the public hospitals. Despite growing interest in New Zealand in casemix-based funding for non-acute services such as palliative care, the nature of this service and the characteristics of its patient population pose particular difficulties for the development and implementation of casemix. This paper examines the feasibility of implementing casemix-based funding for hospice/palliative care services and discusses the development of casemix classification systems for palliative care. Problems associated with implementing casemix-based funding are considered including: the dual funding of hospices, the multi-agency nature of palliative care service provision and the need for the Health Funding Authority to identify and specify the hospice services it is willing to fund. While it is concluded that these problems will impede the introduction of casemix-based funding of hospice care, they highlight important issues that the hospice movement must address if it is to ensure its future within the new health environment.

[The everyday life of survivors. The quality of life of hospice workers].

PubMed

Révay, Edit; Kegye, Adrienne; Zana, Ágnes; Hegedűs, Katalin

2016-06-19

Each year, the number of hospice services and terminally ill patients increase while the number of hospice workers is falling. The intensification of the physical and mental burdens of the latter can lead to burnout and the fluctuation of the workers. The aim of the authors was to survey the physical and mental state of hospice workers, as well as the risk of burnout and coping strategies. A questionnaire survey in hospice experts and volunteers (n ≈ 1500) based on the Hungarostudy survey was performed. Those who filled in the questionnaire (n = 195) had on average 1.86 workplaces and 45.8% of them reported working 12 or more hours a day. Most often, they suffered from lack of energy (65.1%), disturbing physical pain (46.9%), sleeping (56.9%) and digestion (35%), they considered themselves overweight (56.9%) and they were occupied with work problems even at bedtime (72.8%). Hospice workers are overloaded, they have physical and mental symptoms and they are characterized by compassion fatigue. At the same time, they are also characterized by compassion satisfaction as an ability to accept appreciation for the caretaking.

Discharge Outcomes and Survival of Patients with Advanced Cancer Admitted to an Acute Palliative Care Unit at a Comprehensive Cancer Center

PubMed Central

Hui, David; Elsayem, Ahmed; Palla, Shana; De La Cruz, Maxine; Li, Zhijun; Yennurajalingam, Sriram

2010-01-01

Abstract Background Acute palliative care units (APCUs) are new programs aimed at integrating palliative and oncology care. Few outcome studies from APCUs are available. Objectives We examined the frequency, survival, and predictors associated with home discharge and death in our APCU. Methods All patients discharged from the APCU between September 1, 2003 and August 31, 2008 were included. Demographics, cancer diagnosis, discharge outcomes, and overall survival from discharge were retrieved retrospectively. Results The 2568 patients admitted to APCU had the following characteristics: median age, 59 years (range, 18–101); male, 51%; median hospital stay, 11 days; median APCU stay, 7 days; and median survival 21 days (95% confidence interval [CI] 19–23 days). Five hundred ninety-two (20%), 89 (3%), and 1259 (43%) patients were discharged to home, health care facilities, and hospice, respectively, with a median survival of 60, 29, and 14 days, respectively (p < 0.001). Nine hundred fifty-eight (33%) patients died during admission (median stay, 11 days). Compared to hospice transfers, home discharge (hazard ratio = 0.35, 95% CI 0.30–0.41, p < 0.001) was associated with longer survival in multivariate analysis, with a 6-month survival of 22%. Multivariate logistic regression revealed that male gender, specific cancer primaries, and admissions from oncology units were associated with death in the APCU, while younger age and direct admissions to the APCU were associated with home discharge. Conclusions Our APCU serves patients with advanced cancer with diverse clinical characteristics and survival, and discharged home a significant proportion with survival greater than 6 months. Results from this simultaneous care program suggest a pattern of care different from that of traditional hospice and palliative care services. PMID:19824813

An end-of-life practice survey among clinical nephrologists associated with a single nephrology fellowship training program

PubMed Central

Ceckowski, Kevin A.; Little, Dustin J.; Merighi, Joseph R.; Browne, Teri

2017-01-01

Abstract Background Our nephrology fellowship requires specific training in recognition and referral of end-stage renal disease patients likely to benefit from palliative and hospice care. Methods To identify end-of-life (EOL) referral barriers that require greater training emphasis, we performed a cross-sectional, 17-item anonymous online survey (August–October 2015) of 93 nephrologists associated with the program since 1987. Results There was a 61% response rate (57/93 surveys). Ninety-five percent practiced clinical nephrology (54/57). Of these, 51 completed the survey (55% completion rate), and their responses were analyzed. Sixty-four percent were in practice >10 years; 65% resided in the Southern USA. Ninety-two percent felt comfortable discussing EOL care, with no significant difference between those with ≤10 versus  >10 years of practice experience (P = 0.28). Thirty-one percent reported referring patients to EOL care ‘somewhat’ or ‘much less often’ than indicated. The most frequent referral barriers were: time-consuming nature of EOL discussions (27%); difficulty in accurately determining prognosis for <6-month survival (35%); patient (63%) and family (71%) unwillingness; and patient (69%) and family (73%) misconceptions. Fifty-seven percent would refer more patients if dialysis or ultrafiltration could be performed in hospice. Some reported that local palliative care resources (12%) and hospice resources (6%) were insufficient. Conclusions The clinical nephrologists surveyed were comfortable with EOL care discussion and referral. Patient, family, prognostic and system barriers exist, and many reported lower than indicated referral rates. Additional efforts, including, but not limited to, EOL training during fellowship, are needed to overcome familial and structural barriers to facilitate nephrologist referral for EOL care. PMID:28852478

Workplace health promotion implementation, readiness, and capacity among midsize employers in low-wage industries: a national survey.

PubMed

Hannon, Peggy A; Garson, Gayle; Harris, Jeffrey R; Hammerback, Kristen; Sopher, Carrie J; Clegg-Thorp, Catherine

2012-11-01

To describe workplace health promotion (WHP) implementation, readiness, and capacity among midsize employers in low-wage industries in the United States. A cross-sectional survey of a national sample of midsize employers (100 to 4999 employees) representing five low-wage industries. Employers' WHP implementation for both employees and employees' spouses and partners was low. Readiness scales showed that employers believe WHP would benefit their employees and their companies, but they were less likely to believe that WHP was feasible for their companies. Employers' capacity to implement WHP was very low; nearly half the sample reported no capacity. Midsize employers in low-wage industries implement few WHP programs; their responses to readiness and capacity measures indicate that low capacity may be one of the principal barriers to WHP implementation.

Perceptions of the Pediatric Hospice Experience among English- and Spanish-Speaking Families

PubMed Central

Marks, Emily; Funes, Maria; Martinez-Puente, Louizza Maria; Winick, Naomi; Lee, Simon Craddock

2016-01-01

Abstract Objective: Many children who die are eligible for hospice enrollment but little is known about parental perceptions of the hospice experience, the benefits, and disappointments. The objective of this study was to explore parental perspectives of the hospice experience in children with cancer, and to explore how race/ethnicity impacts this experience. Study Design: We held 20 semistructured interviews with 34 caregivers of children who died of cancer and used hospice. Interviews were conducted in the caregivers' primary language: 12 in English and 8 in Spanish. Interviews were recorded, transcribed, and analyzed using accepted qualitative methods. Results: Both English and Spanish speakers described the importance of honest, direct communication by medical providers, and anxieties surrounding the expectation of the moment of death. Five English-speaking families returned to the hospital because of unsatisfactory symptom management and the need for additional supportive services. Alternatively, Spanish speakers commonly stressed the importance of being at home and did not focus on symptom management. Both groups invoked themes of caregiver appraisal, but English-speaking caregivers more commonly discussed themes of financial hardship and fear of insurance loss, while Spanish-speakers focused on difficulties of bedside caregiving and geographic separation from family. Conclusions: The intense grief associated with the loss of a child creates shared experiences, but Spanish- and English-speaking parents describe their hospice experiences in different ways. Additional studies in pediatric hospice care are warranted to improve the care we provide to children at the end of life. PMID:26618809

"Living in the Dragon's Shadow" Fathers' Experiences of a Child's Life-Limiting Illness

ERIC Educational Resources Information Center

Davies, Betty; Gudmundsdottir, Maria; Worden, Bill; Orloff, Stacy; Sumner, Liz; Brenner, Paul

2004-01-01

Grounded theory methods were used to study the experiences of 8 bereaved fathers whose children received care in a home-based hospice program. In-depth, unstructured interviews were audiotaped, transcribed, and coded for themes and categories. Every aspect of fathers' lives was affected by their experiences, which were described in metaphoric…

'Courage of conviction with compassion'.

PubMed

Haidrani, Layla

2017-08-30

What is your job? I am chief executive officer (CEO) of Woking and Sam Beare Hospices, Surrey. The charity delivers specialist palliative care services to more than 1,400 patients and their families across six boroughs, and has recently moved into a brand new state-of-the-art hospice. My role includes the financial and business running of the hospice, along with fundraising, retail, governance and clinical services.

Racial Differences in Hospice Use and In-Hospital Death among Medicare and Medicaid Dual-Eligible Nursing Home Residents

ERIC Educational Resources Information Center

Kwak, Jung; Haley, William E.; Chiriboga, David A.

2008-01-01

Purpose: We investigated the role of race in predicting the likelihood of using hospice and dying in a hospital among dual-eligible (Medicare and Medicaid) nursing home residents. Design and Methods: This follow-back cohort study examined factors associated with hospice use and in-hospital death among non-Hispanic Black and non-Hispanic White…

Feigning terminal illness to get narcotics: a cautionary tale for hospices.

PubMed

Gonzalez, Faustino; Galante, Mirta

2012-08-01

We present the case of a woman who enrolled in the hospice benefit in order to obtain narcotics. We believe this is a cautionary tale for hospices because of our propensity to enroll patients with minimal corroborating information, in order not to delay symptom management. Also we are philosophically predisposed to believe a patient's self-report of pain and other distressing symptoms.

A Study of Low-Wage Workers and Their Response to High Intensity Training. Volume I: Final Report.

ERIC Educational Resources Information Center

Davis, Earl E.

The intent of this study was to describe low-wage, low-skill workers within the context of their work environment and to develop techniques to measure the effects of Skill Advancement's skill training program on the participants. Due to the lack of research findings in this area, these research efforts were somewhat exploratory in nature,…

Costs and benefits of employment transportation for low-wage workers: an assessment of job access public transportation services.

PubMed

Thakuriah Vonu, Piyushimita; Persky, Joseph; Soot, Siim; Sriraj, P S

2013-04-01

This paper focuses on an evaluation of public transportation-based employment transportation (ET) services to transport low-wage workers to jobs in the US. We make an attempt to capture a more comprehensive range of intended and unintended outcomes of ET services than those traditionally considered in the case of public transportation services. Using primary data from 23 locations across the country, we present a framework to evaluate how transportation improvements, in interaction with labor markets, can affect users' short-run economic welfare, users' long-run human capital accumulation and non-users' short-run economic welfare. These services were partially funded by a specialized program - the Job Access and Reverse Commute (JARC) program - which was consolidated into larger transit funding programs by recent legislation. In the sites examined, we found that low wage users benefited from self-reported increased access to jobs, improvements in earnings potential, as well as from savings in transport cost and time. Simulations show the potential of users to accrue long-term worklife benefits. At the same time, users may have accrued changes in leisure time as a result of transitioning from unemployment to employment, and generated a range of societal impacts on three classes of non-users: the general tax-paying public, the general commuting public in the service operating area and other low-wage workers in local labor markets. Copyright © 2012 Elsevier Ltd. All rights reserved.

Access to pain relief: an essential human right. A report for World Hospice and Palliative Care Day 2007. Help the hospices for the Worldwide Palliative Care Alliance.

PubMed

Adams, Vanessa

2008-01-01

In observance of World Hospice and Palliative Care Day, October 6, 2007, the Worldwide Palliative Care Alliance developed a comprehensive publication advocating access to pain relief as a basic human right. The British Charity help the Hospices distributed this publication, which describes the current state of pain relief in advanced disease throughout the world, availability and lack of access to opioid analgesics, clinical case examples of how pain can be managed, governmental and private initiatives and barriers to pain relief, and statistics to support the position that pain relief is a basic human right.

Hospice benefits and phase I cancer trials.

PubMed

Byock, Ira; Miles, Steven H

2003-02-18

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

Ethical issues for hospice volunteers.

PubMed

Berry, Patricia; Planalp, Sally

Health care professionals usually receive professional education in ethics, but the half million hospice volunteers in the United States may receive only brief training that is limited to confidentiality and the volunteer role. The purpose of this study was to explore ethical issues hospice volunteers confront in their work. Interviews with 39 hospice volunteers were conducted, audio recorded, transcribed, and analyzed using qualitative methods. Prominent themes were dilemmas about gifts, patient care and family concerns, issues related to volunteer roles and boundaries, and issues surrounding suicide and hastening death. Suggestions for training include discussions of ethics after initial training once volunteers had confronted ethical issues, with special emphasis on strategies for negotiating their uneasy role positioned between health care professional and friend.

Motivations of hospice volunteers.

PubMed

Planalp, Sally; Trost, Melanie

2009-01-01

To recruit and retain volunteers, coordinators need to understand volunteers' motivations. In this study, 351 volunteers from 32 hospices in the western United States answered questions on a mailed survey about their motivations. The motivations reported were, in order of overall importance: to help others and learn, foster social relationships, feel better, and pursue career goals. Younger volunteers reported stronger career motivations, and retired and unemployed volunteers reported stronger social motivations. Volunteer coordinators should consider these motivations in communicating with potential and current volunteers, with special emphasis on compassion for those in need and the importance of helping, on fostering hospice volunteering as a learning experience, and in accessing and building social networks around hospice volunteering.

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.

What their terms of living and dying might be: hospice social workers discuss Oregon's Death with Dignity Act.

PubMed

Norton, Elizabeth M; Miller, Pamela J

2012-01-01

This article presents data from a qualitative study of nine social work hospice practitioners and experts as they discuss Oregon's Death with Dignity Act. Three themes emerged from the analysis: (a) values regarding physician-assisted death; (b) agency policies about the option; and (c) the role of hospice social workers with physician-assisted death. Three states now allow terminally ill persons to obtain a lethal prescription if criteria are met. Two other states are actively considering and may pass similar legislation over time. Hospice social work practitioners work with patients and families as they consider this option and their voices reflect the complexities and nuances of these interactions.

Seeing is believing - reducing misconceptions about children's hospice care through effective teaching with undergraduate nursing students.

PubMed

Price, Jayne; Dornan, Jean; Quail, Lorraine

2013-09-01

Children's palliative care has evolved in recent years and is now recognised as a distinct area of health and social care practice. Whilst children's hospices are viewed as central to quality care for these children and families, lack of knowledge regarding the exact nature of care they provide exists. Education can go part way to changing attitudes and knowledge about the key contribution of hospices, thus improving future care. Alternative and innovative strategies to stimulate meaningful learning are pivotal to children's nurse education and this paper examines one such innovation adopted with 2nd year children's nursing students. Aiming to help students explore the ethos of children's hospice an educational visit was arranged, followed by an on line discussion. Although some practical challenges were encountered, the visit heightened student awareness moving them from the readily held perception that children's hospices were exclusively for dying children and was viewed by students as more effective than a traditional classroom session. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

Transcultural comparison of hospital and hospice as caring environments for dying patients.

PubMed

Gates, M F

1991-01-01

Leininger's nursing Theory of Cultural Care Diversity and Universality provided the framework for this comparative study of two environments for persons who are dying; namely a hospital oncology unit and a free-standing hospice unit. Analysis of data from ethnographic and ethnonursing research methods including unstructured interviews, observation-participation, and field journal materials yielded contrasts with two settings. The presence of a caring atmosphere/ambience was apparent in both the hospital and hospice. Universal patterns common to both were: caring beliefs and practices of staff; identification of each setting as "community" or "home"; and multiple symbolic uses of humor and food. Diversities included hierarchical organizational structure and cure orientation in the hospital; interdisciplinary collaboration and care orientation in hospice; more pronounced use of touch as a caring modality; and greater evidence of symbolism and ritual related to death and dying in hospice. Adoption of the cultural care modes of accommodation, repatterning, and maintenance are suggested in promoting a caring atmosphere wherever dying patients are served.

Love, money, or flexibility: what motivates people to work in consumer-directed home care?

PubMed

Howes, Candace

2008-07-01

The purpose of this study was to investigate the impact of wages and benefits (relative to other jobs available to workers), controlling for personal characteristics, on the recruitment and retention of providers working in a consumer-directed home care program. I used the results of focus groups to design a survey that was administered to 2,260 workers stratified by ethnicity and working in eight California counties that represented the range of wage and benefit packages available. I used logistic regression to measure the effect of wage and benefit levels, controlling for covariates, on home care workers' stated reason for entering and remaining in the job. Two thirds of respondents reported that commitment to their consumer was the most important reason why they took the job and flexibility was the second most important reason, regardless of wages and benefits and personal characteristics. However, in the county in which very part-time workers were eligible, health insurance was the most important reason for retention. Wage levels above $9 an hour mattered somewhat, especially where the increase was recent. Family providers responded to wage and benefit incentives similarly to non-family providers. To improve recruitment and retention of consumer-directed home care workers, jobs should be flexible and provide affordable health insurance for part-time workers. The effect of wages suggests that recruitment might be improved with higher wages, but only when they reach the $9 to $10 range (in 2004 dollars). Finally, policy must recognize that family caregivers have financial needs similar to non-family caregivers.

Workplace Health Promotion Implementation, Readiness, and Capacity Among Mid-Sized Employers in Low-Wage Industries: A National Survey

PubMed Central

Hannon, Peggy A.; Garson, Gayle; Harris, Jeffrey R.; Hammerback, Kristen; Sopher, Carrie J.; Clegg-Thorp, Catherine

2012-01-01

Objective To describe workplace health promotion (WHP) implementation, readiness, and capacity among mid-sized employers in low-wage industries in the United States. Methods A cross-sectional survey of a national sample of mid-sized employers (100–4,999 employees) representing five low-wage industries. Results Employers’ WHP implementation for both employees and employees’ spouses and partners was low. Readiness scales showed that employers believe WHP would benefit their employees and their companies, but they were less likely to believe that WHP was feasible for their companies. Employers’ capacity to implement WHP was very low; nearly half the sample reported no capacity. Conclusion Mid-sized employers in low-wage industries implement few WHP programs; their responses to readiness and capacity measures indicate that low capacity may be one of the principal barriers to WHP implementation. PMID:23090160

Hospice use among African Americans, Asians, Hispanics, and Whites: implications for practice.

PubMed

Carrion, Iraida V; Park, Nan Sook; Lee, Beom S

2012-03-01

This study examined the characteristics of individuals in hospice care by racial/ethnic groups. A total of 22,936 patients served by a hospice in Central Florida during a four-year period, from 2002 to 2006, were included. Of these, 80.6% were White, 9.6% were Black/African-American, 9.3% were Hispanic and 0.5% were Asian American/Pacific Islander. We examined the associations between the characteristics of hospice users and race/ethnicity, and change of hospice user characteristics over time using chi-square and ANOVA tests. More females than males were represented. Spouse caregivers were most common for Whites (35%) and Asian/Pacific Islanders (36%). However, "other" (41%) caregivers were most frequent for African Americans and daughters (33%) were most often caregivers for Hispanics. Cancer was the primary diagnosis across the four groups. Racial/ethnic minorities were more likely to rely on Medicaid than Whites (10-70% vs. 4%) and African Americans were most likely to be transferred from hospital (57%), whereas Whites were referred from assisted living/nursing homes more frequently than others(16% vs. 7-10%). As the hospice settings become more racially/ethnically diverse, it is essential to attend to the different circumstances and needs of the various groups in providing optimal care.

[Effects of aroma hand massage on pain, state anxiety and depression in hospice patients with terminal cancer].

PubMed

Chang, So Young

2008-08-01

The purpose of this study was to examine the effects of aroma hand massage on pain, state anxiety and depression in hospice patients with terminal cancer. This study was a nonequivalent control group pretest-posttest design. The subjects were 58 hospice patients with terminal cancer who were hospitalized. Twenty eight hospice patients with terminal cancer were assigned to the experimental group (aroma hand massage), and 30 hospice patients with terminal cancer were assigned to the control group (general oil hand massage). As for the experimental treatment, the experimental group went through aroma hand massage on each hand for 5 min for 7 days with blended oil-a mixture of Bergamot, Lavender, and Frankincense in the ratio of 1:1:1, which was diluted 1.5% with sweet almond carrier oil 50 ml. The control group went through general oil hand massage by only sweet almond carrier oil-on each hand for 5 min for 7 days. The aroma hand massage experimental group showed more significant differences in the changes of pain score (t=-3.52, p=.001) and depression (t=-8.99, p=.000) than the control group. Aroma hand massage had a positive effect on pain and depression in hospice patients with terminal cancer.

Hospice and palliative social workers' experiences with clients at risk of suicide.

PubMed

Washington, Karla T; Albright, David L; Parker Oliver, Debra; Gage, L Ashley; Lewis, Alexandria; Mooney, Megan J

2016-12-01

We sought to determine the frequency with which hospice and palliative social workers encounter patients, family caregivers, and other clients at risk of suicide, and to discover the extent to which hospice and palliative social workers feel prepared to address issues related to suicide in their professional practice. We conducted a cross-sectional survey of hospice and palliative social workers, recruiting a convenience sample of volunteer respondents through advertisements at professional conferences and listservs, and via social media accounts associated with national organizations, state hospice and palliative care associations, and individual healthcare professionals. Most respondents reported having worked with patients, family caregivers, or other clients who had exhibited warning signs of suicide during the previous year. Fewer respondents indicated that they had worked with patients and family members who had attempted or died by suicide. While the majority of respondents believed they possessed sufficient knowledge and skills to intervene effectively with individuals at risk of suicide, they indicated that additional education on this topic would be valuable for their professional practice. These study results suggest that suicide-related competencies are important in the practice of hospice and palliative social work. Future education and training efforts should include skill development in addition to knowledge building.

Understanding the association between employee satisfaction and family perceptions of the quality of care in hospice service delivery.

PubMed

York, Grady S; Jones, Janet L; Churchman, Richard

2009-11-01

Families often draw their conclusions about the quality of care received by a family member during the last months of life from their interactions with professional caregivers. A more comprehensive understanding of how these relationships influence the care experience should include an investigation of the association between employee job satisfaction and family perception of the quality of care. This cross-sectional study investigated the association at a regional hospice. Using the Kendall's tau correlation, employee satisfaction scores for care teams trended toward a positive correlation with family overall satisfaction scores from the Family Evaluation of Hospice Care (tau=0.47, P=0.10). A trend for differences in employee satisfaction between the care teams to associate with differences in overall family perceptions of the quality of care also was found using the Kruskal-Wallis analysis of variance (chi(2)(K-W)=9.236, P=0.075). Post hoc tests indicated that overall family perceptions of quality of care differed between the hospice's Residence Team and Non-Hospice Facilities Team. Finally, positive associations between employee satisfaction and the families' Intent to recommend hospice (tau=0.55, P=0.059) and Inform and communicate about patient (tau=0.55, P=0.059) were noted. Selected employee and family comments provide complementarity to further clarify or explain the respondent data. These results suggest that employee satisfaction is associated with family perceptions of the quality of hospice care. Opportunities for improving both employee job satisfaction and family perceptions of the quality of care are discussed.

The Impact of Hospice Patient Disease Type and Length of Stay on Caregiver Utilization of Grief Counseling: A 10-Year Retrospective Study.

PubMed

Palmer, William W; Yuen, Francis K

2017-11-01

This investigation explored the relationship between hospice patient disease type, length of stay (LOS) in hospice, and caregiver utilization of grief counseling in bereavement. A 10-year retrospective study was conducted utilizing data from caregivers associated with hospice patients who died between 2004 and 2014. A threshold of inclusion for disease type (≥1.00% of hospice admissions) resulted in a sample size of 3704 patients, comprising 19 different disease types and 348 associated caregivers who received counseling. Replicating a previous study, brain cancer, lung cancer, and renal failure were among the top 4 disease types associated with higher-than-average utilization of bereavement services among caregivers, regardless of the patient's LOS. This finding may be related to factors such as the duration of the disease, the deterioration of the patient, the absence of symptom control, and secondary losses. LOS as a predictor of whether counseling will be utilized by hospice caregivers was unsupported by this study, as the percentage of caregivers receiving counseling closely paralleled the patient's LOS across 4 cohorts (1-30 days, 31-60 days, 61-90 days, and 91+ days). However, among the caregivers who utilized counseling, the LOS was a statistically significant predictor of the number of counseling sessions utilized. For caregivers who utilized only 1 counseling session, the associated patient median LOS was 21.5 days. For caregivers who utilized 5 or more counseling sessions, the associated patient median LOS dropped to 12 days, suggesting an inverted relationship between hospice patient LOS and the duration of counseling in bereavement.

The role of hospice in the transition from hospital to home for technology-dependent children-A qualitative study.

PubMed

Price, Jayne; McCloskey, Sharon; Brazil, Kevin

2018-01-01

To report parent and professional perspectives of step-down care in assisting the transition from hospital to home, within one children's hospice in a constituent country of the United Kingdom. In recent years, increasing numbers of children-dependent on long term assisted ventilation have been noted. Meeting the complex physical, emotional and social needs of the child and family is challenging. Many of these children spend extended periods in hospital even when medically stable. This was a qualitative study using an inductive, semantic analytic approach within a realist epistemology. Data collection was carried out in 2013. Interviews took place with parents (n = 5) and focus groups with professionals (n = 26) who had experience of step-down care. Multiple benefits of step-down in the hospice were clear. Both sets of accounts suggested that for children and families life was "on hold" in hospital. Hospice was considered a home-like environment where the child and family could "live again". Parents reflected that, in hospice they were "living, not existing" while professionals highlighted hospice as nurturing and empowering the whole family, promoting the child's development while safely meeting their clinical needs. The study highlights a number of crucial benefits to the child and family both in the immediate and longer terms. The collective perspectives therefore endorse hospice as a potential viable choice for these children and their families during the always difficult, usually protracted transition from hospital to home. © 2017 John Wiley & Sons Ltd.

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.

The spiritual struggle of anger toward God: a study with family members of hospice patients.

PubMed

Exline, Julie J; Prince-Paul, Maryjo; Root, Briana L; Peereboom, Karen S

2013-04-01

Anger toward God is a common form of spiritual struggle, one that people often experience when they see God as responsible for severe harm or suffering. The aim of this study was to assess the prevalence, correlates, and preferred coping strategies associated with anger toward God among family members of hospice patients. Teams from a large hospice in the midwestern United States distributed surveys, one per household, to family members of home-care patients. The survey assessed feelings toward God (anger/disappointment and positive feelings), depressive symptoms, religiosity, and perceived meaning. Participants also rated their interest in various strategies for coping with conflicts with God. Surveys (n=134) indicated that 43% of participants reported anger/disappointment toward God, albeit usually at low levels of intensity. Anger toward God was associated with more depressive symptoms, lower religiosity, more difficulty finding meaning, and belief that the patient was experiencing greater pain. Prayer was the most highly endorsed strategy for managing conflicts with God. Other commonly endorsed strategies included reading sacred texts; handling the feelings on one's own; and conversations with friends, family, clergy, or hospice staff. Self-help resources and therapy were less popular options. Anger toward God is an important spiritual issue among family members of hospice patients, one that is commonly experienced and linked with depressive symptoms. It is valuable for hospice staff to be informed about the issue of anger toward God, especially because many family members reported interest in talking with hospice team members about such conflicts.

Duration and determinants of hospice-based specialist palliative care: A national retrospective cohort study.

PubMed

Allsop, Matthew J; Ziegler, Lucy E; Mulvey, Matthew R; Russell, Sarah; Taylor, Ros; Bennett, Michael I

2018-06-01

Understanding service provision for patients with advanced disease is a research priority, with a need to identify barriers that limit widespread integration of palliative care. To identify patient and organisational factors that influence the duration of hospice-based palliative care in the United Kingdom prior to death. This is a retrospective cohort study. A total of 64 UK hospices providing specialist palliative care inpatient beds and community services extracted data for all adult decedents (aged over 17 years) with progressive, advanced disease, with a prior referral (e.g. inpatient, community teams, and outpatient) who died between 1 January 2015 and 31 December 2015. Data were requested for factors relating to both the patient and hospice site. Across 42,758 decedents, the median time from referral to death was 48 days. Significant differences in referral to death days were found for those with cancer (53 days) and non-cancer (27 days) ( p < 0.0001). As age increases, the median days from referral to death decreases: for those under 50 years (78 days), 50-74 years (59 days), and 75 years and over (39 days) ( p = 0.0001). An adjusted multivariable negative binomial model demonstrated increasing age persisting as a significant predictor of fewer days of hospice care, as did being male, having a missing ethnicity classification and having a non-cancer diagnosis ( p < 0.001). Despite increasing rhetoric around early referral, patients with advanced disease are receiving referrals to hospice specialist palliative care very late in their illness trajectory. Age and diagnosis persist as determinants of duration of hospice specialist palliative care before death.

Nursing Unit Environment Associated with Provision of Language Services in Pediatric Hospices.

PubMed

Lindley, Lisa C; Held, Mary L; Henley, Kristen M; Miller, Kathryn A; Pedziwol, Katherine E; Rumley, Laurie E

2017-04-01

Provision of language services in pediatric hospice enables nurses to communicate effectively with patients who have limited English proficiency. Language barriers contribute to ethnic disparities in health care. While language service use corresponds with improved patient comprehension of illness and care options, we lack an understanding of how the nurse work environment affects the provision of these services. Data were obtained from the 2007 National Home and Hospice Care Survey and included a study sample of 1251 pediatric hospice agencies. Variable selection was guided by structural contingency theory, which posits that organizational effectiveness is dependent upon how well an organization's structure relates to its context. Using multivariate logistic regression, we analyzed the extent to which nursing unit environment predicted provision of translation services and interpreter services. The majority of hospices provided translation services (74.9 %) and interpreter services (87.1 %). Four variables predicted translation services: registered nurse (RN) unit size, RN leadership, RN medical expertise, and for-profit status. RN medical expertise and having a safety climate within the hospice corresponded with provision of interpreter services. Findings indicate that nursing unit environment predicts provision of language services. Hospices with more specialized RNs and a stronger safety climate might include staffs who are dedicated to best care provision, including language services. This study provides valuable data on the nurse work environment as a predictor of language services provision, which can better serve patients with limited English proficiency and ultimately reduce ethnic disparities in end-of-life care for children and their families.

Nursing unit environment associated with provision of language services in pediatric hospices

PubMed Central

Lindley, Lisa C.; Held, Mary L.; Henley, Kristen M.; Miller, Kathryn A.; Pedziwol, Katherine E.; Rumley, Laurie E.

2016-01-01

Background Provision of language services in pediatric hospice enables nurses to communicate effectively with patients who have limited English proficiency. Language barriers contribute to ethnic disparities in health care. While language service use corresponds with improved patient comprehension of illness and care options, we lack an understanding of how the nurse work environment affects the provision of these services. Methods Data were obtained from the 2007 National Home and Hospice Care Survey and included a study sample of 1,251 pediatric hospice agencies. Variable selection was guided by Structural Contingency Theory, which posits that organizational effectiveness is dependent upon how well an organization’s structure relates to its context. Using multivariate logistic regression, we analyzed the extent to which nursing unit environment predicted provision of translation services and interpreter services. Results The majority of hospices provided translation services (74.9%) and interpreter services (87.1%). Four variables predicted translation services: registered nurse (RN) unit size, RN leadership, RN medical expertise, and for-profit status. RN medical expertise and having a safety climate within the hospice corresponded with provision of interpreter services. Conclusions Findings indicate that nursing unit environment predict provision of language services. Hospices with more specialized RNs and a stronger safety climate might include staff who are dedicated to best care provision, including language services. This study provides valuable data on the nurse work environment as a predictor of language services provision, which can better serve patients with limited English proficiency, and ultimately reduce ethnic disparities in end-of-life care for children and their families. PMID:27059050

Worksite Influences on Obesogenic Behaviors in Low-Wage Workers in St Louis, Missouri, 2013–2014

PubMed Central

Pizzorno, Galen; Kinghorn, Anna M.; Evanoff, Bradley A.

2015-01-01

Introduction More than one-third of US adults are obese. Workplace programs to reduce obesity and improve overall health are not available or accessible to all workers, particularly low-wage workers among whom obesity is more prevalent. The goal of the study was to identify modifiable workplace factors and behaviors associated with diet and exercise to inform future workplace interventions to improve health. Methods We distributed paper and online surveys to 2 groups of low-wage workers, hospital workers and retail sales workers, at the worksites. The surveys assessed obesity, obesogenic behaviors, workplace factors, and worker participation in workplace health programs (WHPs). Descriptive and regression analyses were conducted to examine workplace factors associated with obesogenic behaviors. Results A total of 529 surveys were completed (219 hospital workers and 310 retail workers). More than 40% of workers were obese and 27% were overweight. In general, workers had poor diets (frequent consumption of sugary and high-fat foods) and engaged in little physical activity (only 30.9% met recommended physical activity guidelines). Access to and participation in workplace health programs varied greatly between hospital and retail sales workers. We identified several modifiable workplace factors, such as food source and work schedule, that were associated with diet, exercise, or participation in workplace health programs. Conclusion This study illustrates the high prevalence of obesity and obesogenic behaviors workers in 2 low-wage groups. The differences between work groups indicated that each group had unique facilitators and barriers to healthy eating and exercise. An understanding of how socioeconomic, demographic, and work-related factors influence health will help to identify high-risk populations for intervention and to design interventions tailored and relevant to the target audiences. PMID:25950573

Worksite influences on obesogenic behaviors in low-wage workers in St Louis, Missouri, 2013-2014.

PubMed

Strickland, Jaime R; Pizzorno, Galen; Kinghorn, Anna M; Evanoff, Bradley A

2015-05-07

More than one-third of US adults are obese. Workplace programs to reduce obesity and improve overall health are not available or accessible to all workers, particularly low-wage workers among whom obesity is more prevalent. The goal of the study was to identify modifiable workplace factors and behaviors associated with diet and exercise to inform future workplace interventions to improve health. We distributed paper and online surveys to 2 groups of low-wage workers, hospital workers and retail sales workers, at the worksites. The surveys assessed obesity, obesogenic behaviors, workplace factors, and worker participation in workplace health programs (WHPs). Descriptive and regression analyses were conducted to examine workplace factors associated with obesogenic behaviors. A total of 529 surveys were completed (219 hospital workers and 310 retail workers). More than 40% of workers were obese and 27% were overweight. In general, workers had poor diets (frequent consumption of sugary and high-fat foods) and engaged in little physical activity (only 30.9% met recommended physical activity guidelines). Access to and participation in workplace health programs varied greatly between hospital and retail sales workers. We identified several modifiable workplace factors, such as food source and work schedule, that were associated with diet, exercise, or participation in workplace health programs. This study illustrates the high prevalence of obesity and obesogenic behaviors workers in 2 low-wage groups. The differences between work groups indicated that each group had unique facilitators and barriers to healthy eating and exercise. An understanding of how socioeconomic, demographic, and work-related factors influence health will help to identify high-risk populations for intervention and to design interventions tailored and relevant to the target audiences.

Eliciting regret improves decision making at the end of life.

PubMed

Djulbegovic, Benjamin; Tsalatsanis, Athanasios; Mhaskar, Rahul; Hozo, Iztok; Miladinovic, Branko; Tuch, Howard

2016-11-01

Management choices at the end of life are high-stake decisions fraught with emotions, chief among is regret. Our objective in this paper is to test the utility of a regret-based model to facilitate referral to hospice care while helping patients clarify their preferences on how they wish to spend the remaining days of their lives. A prospective cohort study that enrolled consecutive adult patients (n = 178) aware of the terminal nature of their disease. The patients were at the point in care where they had to decide between continuing potentially 'curative/life-prolonging' treatment (Rx) versus hospice care. Preferences were elicited using a Dual Visual Analog Scale regarding the level of regret of omission versus commission (RgO/RgC) towards hospice care and Rx. Each patient's RgO/RgC was contrasted against the predictive probability of death to suggest a management plan, which was then compared with the patient's actual choice. The probability of death was estimated using validated Palliative Performance Scale predictive model. Eighty-five percent (151/178) of patients agreed with the model's recommendations (p < 0.000001). Model predicted the actual choices for 72% (128/178) of patients (p < 0.00001). Logistic regression analysis showed that people who were initially inclined to be referred to hospice and were predicted to choose hospice over disease-directed treatment by the regret model have close to 98% probability of choosing hospice care at the end of their lives. No other factors (age, gender, race, educational status and pain level) affected their choice. Using regret to elicit choices in the end-of-life setting is both descriptively and prescriptively valid. People with terminal disease who are initially inclined to choose hospice and do not regret such a choice will select hospice care with high level of certainty. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Hospice palliative care article publications: An analysis of the Web of Science database from 1993 to 2013.

PubMed

Chang, Hsiao-Ting; Lin, Ming-Hwai; Chen, Chun-Ku; Hwang, Shinn-Jang; Hwang, I-Hsuan; Chen, Yu-Chun

2016-01-01

Academic publications are important for developing a medical specialty or discipline and improvements of quality of care. As hospice palliative care medicine is a rapidly growing medical specialty in Taiwan, this study aimed to analyze the hospice palliative care-related publications from 1993 through 2013 both worldwide and in Taiwan, by using the Web of Science database. Academic articles published with topics including "hospice", "palliative care", "end of life care", and "terminal care" were retrieved and analyzed from the Web of Science database, which includes documents published in Science Citation Index-Expanded and Social Science Citation Indexed journals from 1993 to 2013. Compound annual growth rates (CAGRs) were calculated to evaluate the trends of publications. There were a total of 27,788 documents published worldwide during the years 1993 to 2013. The top five most prolific countries/areas with published documents were the United States (11,419 documents, 41.09%), England (3620 documents, 13.03%), Canada (2428 documents, 8.74%), Germany (1598 documents, 5.75%), and Australia (1580 documents, 5.69%). Three hundred and ten documents (1.12%) were published from Taiwan, which ranks second among Asian countries (after Japan, with 594 documents, 2.14%) and 16(th) in the world. During this 21-year period, the number of hospice palliative care-related article publications increased rapidly. The worldwide CAGR for hospice palliative care publications during 1993 through 2013 was 12.9%. As for Taiwan, the CAGR for publications during 1999 through 2013 was 19.4%. The majority of these documents were submitted from universities or hospitals affiliated to universities. The number of hospice palliative care-related publications increased rapidly from 1993 to 2013 in the world and in Taiwan; however, the number of publications from Taiwan is still far below those published in several other countries. Further research is needed to identify and try to reduce the barriers to hospice palliative care research and publication in Taiwan. Copyright © 2015. Published by Elsevier Taiwan LLC.

Stakeholder Perspectives on Workplace Health Promotion: A Qualitative Study of Midsized Employers in Low-Wage Industries

PubMed Central

Hannon, Peggy A.; Hammerback, Kristen; Garson, Gayle; Harris, Jeffrey R.; Sopher, Carrie J.

2014-01-01

Purpose Study goals were to (1) describe stakeholder perceptions of workplace health promotion (WHP) appropriateness, (2) describe barriers and facilitators to implementing WHP, (3) learn the extent to which WHP programs are offered to workers’ spouses and partners and assess attitudes toward including partners in WHP programs, and (4) describe willingness to collaborate with nonprofit agencies to offer WHP. Design Five 1.5-hour focus groups. Setting The focus groups were conducted with representatives of midsized (100–999 workers) workplaces in the Seattle metropolitan area, Washington state. Subjects Thirty-four human resources professionals in charge of WHP programs and policies from five low-wage industries: accommodation/food services, manufacturing, health care/social assistance, education, and retail trade. Measures A semistructured discussion guide. Analysis Qualitative analysis of focus group transcripts using grounded theory to identify themes. Results Most participants viewed WHP as appropriate, but many expressed reservations about intruding in workers’ personal lives. Barriers to implementing WHP included cost, time, logistical challenges, and unsupportive culture. Participants saw value in extending WHP programs to workers’ partners, but were unsure how to do so. Most were willing to work with nonprofit agencies to offer WHP. Conclusion Midsized, low-wage employers face significant barriers to implementing WHP; to reach these employers and their workers, nonprofit agencies and WHP vendors need to offer WHP programs that are inexpensive, turnkey, and easy to adapt. PMID:23113780