...Hospice Care in the United States Catherine Harmer HCS.212 Feb.23, 2013 Prof. Mark Miller Hospice Care in the United States Hospice care is one of the best services the health care industry has to offer, and is available to all walks of life. When the patient has reached end of life, hospice provides support to the loved ones as well. “Hospice focuses on caring, not curing and, in most cases; care is provided in the patient’s home. Hospice care also is provided in freestanding hospice centers, hospitals, and nursing homes and other long-term care facilities. Hospice services are available to patients of any age, religion, race, or illness. Hospice care is covered under Medicare, Medicaid, most private insurance plans, HMOs, and other managed care organizations” (NHPCO, 2011, par.2). Hospice care has evolved over many years and has a lot to offer: Patients are kept as comfortable as humanly possible. For loved ones, finding peace or comfort is likely more achievable when helping their loved ones let go, making the course of grieving and acceptance much less difficult. Caregivers, employees, and volunteers are faced day-to-day with the reality that life as we know it does expire; it is only fitting then, that greater patience and appreciation of self, family, and life in general become more characteristic of the providers than might be otherwise. This facet of health care, one might fear, would require tremendous resilience. On the other hand however, facilitating a...
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... Serenity and the Importance to Nursing Practice THE CONCEPT OF SERENITY 6 References Beckstead, J.P., Conley, C.E., Kruse, B.G. (2005). Psychometric Properties of the Serenity Scale: Journal of Hospice and Palliative Nursing, November/December Volume 7, 337-344. Chinn, P.L., Kramer, M.K., (2004). Empiric Knowledge Development: Explaining and Structuring. Yvonne Alexopoulos. Melissa Boyle , Kristin Hebberd (6th Edition), Integrated Knowledge Development in Nursing (pp.54-90). St. Louis, Missouri. Dictionary.com, (2010). An Ask.com Service. Retrieved on January 25th, 2010 from http://dictionary.reference.com Get Palliative Care, (2010). What is Palliative Care. Retrieved on January 25th, 2010 from http://www.getpalliativecare.org/home/ . THE CONCEPT OF SERENITY 2 Incorporating the concept of serenity within nursing practice has been proven to be very beneficial when applied to patient care. The concept of serenity can have different meanings to different people. How one goes about obtaining serenity may vary greatly with each individual. The idea of serenity, of inner peace is desired by many. Nurses can assist patients with obtaining and maintaining this important concept. This paper will identify the concept of serenity...
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...Moore-Ramos 15 July 2013 Hospices Under Federal Scrutiny Investigations by federal agents have found that many hospices, especially in Florida, have systematically billed Medicare for patients not eligible for care or over-billed for “crisis care” that patients did not need. A huge false-billing lawsuit has been launched against Miami-based Vitas Healthcare, one of the nation’s largest hospice providers, accusing the organization of collecting tens of millions of dollars through unjustified and inflated bills (Lamendola). The suit came after four years of investigation in which the government found that eleven smaller hospices had been over-billing. Those hospices had to pay $88 million in settlements. And in January the government joined a lawsuit accusing Hospice of the Comforter near Orlando in phony billings at an estimated $11 million. The federal Inspector General’s office overseeing Medicare has placed hospice overcharges among one of its investigative projects for the year. They have also proposed tightening billing codes that hospices have used to increase Medicare payments six-fold since 1998 (Lamendola). Paul Ledford, executive director of the Florida Hospice & Palliative Care Association says that although hospice has escaped scrutiny over the years, they are getting more attention now. He does not think that hospices in Florida are committing fraud but that instead they are big targets for the government due to the fact that hospices are huge in Florida due...
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...The Effects of Palliative Care on Other Family Members Tonya Kerney McKendree University The Effects of Palliative Care on Other Family Members Family members of patients who are in palliative care experience emotions including hopelessness, guilt, and sadness. They are often physically exhausted and may become ill themselves. Many experience depression. Family Caregiver Alliance (as cited in McMillan et al., 2006) has estimated that over fifty million Americans assist a family member with a disability or illness on a regular basis. Of these ill patients, many require extensive care from family members. Caregivers of cancer patients especially experience very high stress levels. They are often burdened with physical exhaustion, emotional distress, and financial worries from loss of time at work to care for their loved one (Emanuel & Emanuel, as cited in McMillan et al., 2006). The purpose of the study I reviewed was “to determine whether hospice plus a coping skill training intervention improved family caregivers’ quality of life, burden, coping, and mastery, compared with hospice plus emotional support and usual hospice care (McMillan et al., 2006, p. 214)”. To participate in the study, caregivers had to be caring for adult cancer patients, both had to give consent, both had to be able to read and comprehend English, both had to have achieved at least a sixth grade education, and both had to achieve a minimun score of seven on the Short Portable Mental Status Questionnaire...
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...palliative care patients?” Regina Nelson Governors State University Abstract Palliative Care Nurses are at risk of experiencing stressful situations related to symptom management and death. The aim of this paper is to critically examine the current stress nurses face caring for Palliative Care patients. Four Nursing Journals and one Psycho-Oncology were reviewed. There was strong evidence to support that nurse’s experience stress caring for Palliative care patients. Common concerns in the first study were caring for a dying patient; personal level, comfort of the patient, and mediating between patient and family. The second study reported physical and emotional health consequences for nurses who provide hospice and palliative care over extended periods of time. The third study of nursesreported job satisfaction, stressors, coping strategies, and support. The fourth study nurses had 10 themes that conceptualize their work that may enable palliative care workers to remain resilient and effectively buffer or moderate stressful effects. The fifth study reported routinization of care, lack of nursing staff’s availability for emotional engagement, frequent interruptions, quiet afternoons, upbeat and positive culture, and a matter of fact attitude surrounding death and dying ,were all the behaviors that “being with” could not create. Although the report showed nurses able to cope by not “being with” the overall impact is stress related to caring for Palliative care patients. Although...
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...Despite high levels of satisfaction expressed by hospice employees when compared to employees in other sectors of health care, hospice social workers have the lowest job satisfaction compared to other professionals on the hospice interdisciplinary team (Casarret, Spencer, Haskins, & Teno, 2011; Monroe & DeLoach, 2004). Job satisfaction amongst health care employees contributes to the retention or tenure of qualified and experienced employees (Fritzsche & Parrish, 2005; Head, Washington & Myers, 2013; Kobayshi & McCallister, 2013; Miller, 2008). High turnover has been shown to be associated with decreased job satisfaction among direct care hospice workers and has also been shown to compromise quality of care for hospice patients (Dill & Kagle,...
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...With most policies there are some limitations. The biggest limitation that is observed through the research is the negative social stigma of hospice. With Medicare having the hospice benefit avaible, but if people have this preconceived idea that hospice will kill you, and then there is no one to use the benefit. There are many people who could benefit from the use of hospice care, but wont because they think it means they are going to assists with your death. When hospice is exactly the opposite, the goals of a better quality of life and to die with dignity (Centers for Medicare and Medicaid Services, 2016). Another limitation, is hospice is being offered as a last resort type of care. This prevents family members and patients from fully...
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...Hospice Creation of Hospice Hospice care is designed to give supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life rather than cure. The goal is to enable patients to be comfortable and free of pain, so that they live each day as fully as possible. The term “hospice” ( from the same linguistic root as “hospitality”) can be traced back to medieval times when it referred to a place of shelter and rest for the weary or terminally ill on a long journey in 1948 (History of Hospice Care, 2012). The name of the physician was Dame Cicely Saunders who treated the terminally ill and eventually went on to create the first modern hospice, named St Christopher’s Hospice, in a residential suburb of London. (History of Hospice Care, 2012). Ms. Saunders introduced the idea of specialized care for the dying to the United States of America during a 1963 visit with Yale University. Her lecture, given to medical students, nurses, social workers, and chaplains, about the concept of holistic hospital care, included photos of terminally ill patients and their families, showing the dramatic differences before and after the symptom control care (History of Hospice Care, 2012). Ownership In 2010, there were over 5000 hospice programs nationwide (Facts and Figures: Hospice Care in America, 2012). The majority of these facilities are freestanding agencies constituting 58 percent of all hospice centers (Facts and Figures: Hospice Care in America...
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...of chronic disease patients that may benefit from Hospice for end of life care. In 2015, 1, 381, 182 Medicare beneficiaries were enrolled in hospice (National Hospice and Palliative Care Organization, 2016). Hospice was designed to improve the experience of dying for the patient with the help of interprofessional care. The design also included improving the healthcare costs associated with the end of life (Stevenson, 2012). Eligibility for hospice is based on a physician documented life expectancy of six months or less. There are four levels of care are covered under the Medicare benefit for hospice. These include in home care, general inpatient care which covers symptom management such as pain control, continuous care,...
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...with her husband Willie, in a rough part of town. Jane was admitted to hospice on December 23, 2017, for changes in the level of health-related illness. He had been living at home on hospice before going to the hospice facility. She had been living at home with her husband when he had hypertensive heart disease, acute or chronic systolic, unspecified atrial fibrilla, diabetes, major depressive disorder, cardiomyopathy, undefined, and angina pectoris, vague. There was some debate whether there had indeed been a change in the level of health-related issues. Jane, was currently not receiving the medication prescribed to her on a daily basis which caused some complication in...
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...Executive Summary When people think of Hospice, they think of someone who is dying within the next couple of days, but it isn’t what it seems. Hospice is not a place; it’s a philosophy of care that enhances life as it nears its end for the patients and their families and friends. (Odyssey Health Care, 2013). Some people may feel that it’s scary to have to see someone going through something that they cannot fix, but what people have to realize is that you are making a difference in their lives. Some of the patients don’t have any family, so for someone to just go and talk to them for less than 30 minutes can really make a difference. The patients that are in Hospice sometimes don’t even show symptoms and act completely normal. Most patients accept that they are going to pass, so they usually do whatever they can before that happens. As soon as the physician let’s the patients know that hospice care is appropriate, they call Odyssey Hospice nurses. Within three hours, 24 hours a day, seven days out of the week, the patient is admitted into the program. At the end of life, what often matters most to a person who is dying is simply taking the time to hold a hand, give support and just be there. We as Odyssey Hospice volunteers would like to improve the quality of life of all individuals who see Hospice as something different then what it actually is. Mission Statement To provide compassionate care to those we serve during the end of life’s journey through our commitment to...
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...Personal Perceptions As a Registered Nurse for thirteen years in an acute care hospital setting, I have tended to many dying patients. It is my personal belief that quality of life and health promotion are imperative to the care of the terminally ill patient. Personally, I am a big fan of palliative care nursing. The World Health Organization (WHO) defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.” B. Strategies Improving Mrs. Thomas’ quality of life would comprise of assisting her with her increased level of pain, limited amount of emotional support, and financial concerns. Firstly, Mrs. Thomas’ physical comfort needs addressed immediately. As evidenced by the patient spending large amounts of her day crying in bed, her pain is not under control. As her nurse, I would listen to her fears about addiction, but discuss quality of life versus drug addiction. I would explain how once her pain is tolerable, she will be able to assume a more productive, engaged role in her own life. Secondly, addressing Mr. and Mrs. Thomas’ financial concerns would be my next order of business. Insufficient health care insurance or financial resources can cause excessive worry and concern for...
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...giving to the fact that African Americans are less likely to pursue hospice care at the end of their lives. This paper will first examine the case for hospice and why it is a valuable resource and one that is consistent with Christian values. Then, I will survey the data regarding African Americans and hospice, particularly looking at considering what the main factors are for the racial disparity of hospice users. I conclude the main factor is distrust for the healthcare system as a result of centuries of medical abuse, experimentation and neglect. In light of this racist healthcare history, I will consider theologically what a Christian response to the racial disparity in hospice care is by using...
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...The Death Knell for Debility and Adult Failure to Thrive as Terminal Diagnoses in Hospice May 24, 2013 Terri Maxwell On May 10, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a Proposed Rule entitled FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting Requirements; and Updates on Payment Reform [CMS-1449-P]. This rule contains important information, including proposed hospice rates for 2014 (no good news here, rates are going down), changes to the hospice quality reporting program, alterations to the cost report, and an update to hospice payment reform options. In addition to these proposed changes, CMS “clarified” a number of coding requirements that has had the industry buzzing. Included in these clarifications is a directive to hospices that non-specific diagnoses such as Debility or Adult Failure to Thrive (AFTT) may no longer be listed as a principle terminal diagnosis on the hospice claim. Claims submitted with these diagnoses would be returned to the provider (RTPd) for a more definitive hospice diagnosis. However, Debility and AFTT can and should be listed on the claim as secondary (related) conditions to support prognosis if indicated. CMS states that disallowing these diagnoses is not a new position, which comes as a surprise to most of us in the industry (otherwise why does CMS’ Medicare Administrative Contractor (MAC), Palmetto GBA, have an LCD guideline for AFTT?). Why is CMS making this clarification now...
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...Hospice care The term was from the medieval times when it referred to a place of shelter and rest for weary or ill travelers on a long journey. The name was first applied to specialized care for dying patients by physician Dame Cicely Saunders, who began her work with the terminally ill in 1948 and eventually went on to create the first modern hospice—St. Christopher’s Hospice—in a residential suburb of London. Sanders idea of specialized care for the dying to the United States during a 1963 visit with Yale University brought on the thought of helping the ones that couldn’t help them self and more and day were limited. To help them go in peace. It been an ongoing thing since the 1963 and still used to day Hospice is a type of care and a philosophy of care that focuses on the palliation of a terminally ill or seriously ill patient's symptoms. These symptoms can be physical, emotional, or psychosocial in nature. Hospice care focuses on bringing comfort, self-respect, and tranquility to people in the final years of life. Patients’ symptoms and pain are controlled, goals of care are discussed and emotional needs are supported. Hospice believes that the end of life is not a medical experience, it is a human experience that benefits from expert medical and holistic support that hospice offers. The concept of hospice has been evolving since the 11th century. Then, and for centuries thereafter, hospices were places of hospitality for the sick, wounded, or dying, as well as those...
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