Hospice And Palliative Care

In Stephen R Connor’s article “Development of Hospice ad Palliative Care in the United States,” Connor reviews the history and growth of hospice and palliative care in the U.S., the Medicare benefit’s relation to hospice, challenges that these end-of-life care services are facing, and strategies to improve the quality of hospice and palliative care. In 1963, Dr. Cicely Saunders from the United Kingdom introduced hospice and the concept of treating terminally ill patients in a holistic manner to the United States. In both countries, the goal was to provide support and comfort for those near death, but in the U.S. there was a greater emphasis on at-home care while the U.K focused on inpatient settings. Like we discussed in class, Americans

The MHB also set certain regulations for hospices: (1) patients are eligible only if they have a prognosis of six months or less to live and choose to stop curative treatment, (2) hospices need a governing body, plan for each patient, quality assurance, and use of volunteers, (3) and must provide fundamental services by hospice employees (Connor 91). The integration of hospice and the U.S. government has improved fiscal details, but the regulations and requirements also create logistic

These challenges are due to the Medicare benefit, workforce issues, and access and quality of the services. Medicare’s regulations state that hospice is only offered to those near death (six months or less to live) and that the admitted patients stop the treatments with the purpose of curing the illness. The purpose of these restrictions is to keep costs low, but there is also the ethical responsibility of hospice to provide the best end-of-life care possible for patients and their families. Another issue with hospice and palliative care is the lack of workforce while this field is growing. Currently, social workers provide the majority of psychological services, but psychologists and psychiatrists are also needed for effective psychosocial care. Since hospice and palliative care is now recognized as a sub-specialty, there is hope that this will increase physicians entering this medical field. Spiritual and religious services are other areas within hospice and palliative care that needs expansion. “If current projections are correct, then more than twice as many hospice professionals and volunteers will be needed in the next 20 years to meet the unmet need for palliative care and the growing numbers of older people in our society” (Connor 98). The last problem with end-of-life care programs is the access and quality. For example, African Americans are 7% less likely to receive hospice